Professor Jim Egan:

I thank the committee for the opportunity to speak today on this important topic for many families in the country. I was appointed as the HSE's director of the national organ donation and transplantation office via the Royal College of Surgeons and Royal College of Physicians in April 2011. I am a fellow of the joint faculty of intensive care medicine. I am the Irish representative on the Council of Europe committee on organ transplantation. I am a former chairman of the European Respiratory Society transplantation group, and am the co-chair of the International Society of Heart and Lung Transplantation committee for the management of chronic rejection.

I am privileged to be involved in the care of patients and families who are awaiting organ transplantation. I have had the benefit and fortune to work with wonderful surgeons such as David Hickey, Oscar Traynor at St. Vincent's University Hospital and Jim McCarthy at the Mater hospital. These are highly skilled individuals who execute this form of treatment. I am continually humbled by the generosity of Irish society and the Irish families who donate in the most difficult of circumstances - truly Olympian events which affect other people's lives - and save lives on a regular basis.

The three distinct transplant programmes in this country are unique in that, although located in university teaching hospitals in Dublin, they must provide a service for the entire nation while competing for resources with other regional and acute local services in those hospitals. At present, 685 patients and their families are awaiting transplantation in Ireland. Organ donation in Ireland is based on an opt-in system, and thankfully it is rare for somebody to die in circumstances which allow organ donation. Of 3,000 deaths in intensive care units per annum, approximately 80 to 100 cases are patients in these circumstances. In 2010 only 58 donations were made. The procurement and co-ordination of organ donation is provided by the renal transplant service because of the absence of standard formal structures. This gap has been filled very successfully in a voluntary capacity based on historical needs over many years.

Internationally, many stakeholders emphasise the benefits of organ transplantation. The European Commission Action Plan on Organ Donation and Transplantation (2009-2015) emphasizes the substantial health care benefits of organ transplantation and states that all European states need to identify potential organ donors and support their conversion to actual organ donors. The goal of soft opt-out is to allow organ donation to be the society norm. It does not devalue organ donation as an extraordinary gift from one family to another. However, soft opt-out legislation alone does not enhance organ donation. It is part of a package that includes donation infrastructure. Donation infrastructure protects the interests of families and donors, ensuring a compassionate and professional approach at the time of donation.

Earlier, we heard subjective views on specific data, but there is specific data which supports presumed consent. A review of presumed consent published in BMJ, formerly known as the British Medical Journal, indicates that it is associated with a 25% increase in organ donation rates, or an additional two to six donors per million of population. This is further emphasised in the UK health technology assessment report mentioned by Dr. Plant earlier today. European league tables of organ donation rates are consistently dominated by those countries which have presumed consent in partnership with formal organ donation infrastructures, including Spain, Portugal and Croatia. Generally speaking, we quote the Spanish model as the international standard for organ donation and transplantation, but Norway is also an excellent role model.

To comply with society's expectations and national and international needs, three structures must be deployed in the Irish health service, and we are actively working on these. Intensive care key donation personnel would be assigned throughout the health service in line with international practice and the European Commission action plan. These medical and nursing personnel will underpin the organ donation process by protecting the interests and welfare of those families who choose to donate organs in the most difficult of circumstances. The second element of infrastructure development is the national organ procurement office, which would be developed to be independent of recipient co-ordination to comply with the standards required by the EU tissue directive and the EU organ directive. It would also be in keeping with the 2011 HSE-commissioned independent international review of transplant services we completed and the recommendations of the Irish Medicines Board, which regulates this area. The third element is the recently established HSE national organ donation and transplantation office, which would be positioned to establish a financial and governance framework to protect the interests of donors and recipients in the current challenging fiscal environment.

Deploying these three structures would will bring Ireland in line with international practice norms, mitigate the risks of a fall in organ donation rates in a changing society - a very significant risk based on the experience in 2010 - potentially remove up to 530 patients from dialysis over the next ten years, and save up to 750 additional lives of patients with advanced liver, lung and heart disease over the next ten years. These structures would also provide a platform for co-operation with services in Northern Ireland. In a very measured fashion, deploying these structures would save up to €60 million over the next ten years.

It is our goal to have one of the very best organ donation and transplantation systems in Europe and we are deeply committed to this. I thank committee members for their attention and I am happy to take any questions in due course.