Tom Fleming (Kerry South, Independent) | Oireachtas source

I move:

That Dáil Éireann:notes:

-- the life-saving and life altering gift that is organ donation;

-- the incredible generosity such gifts represent on the part of families of donors at times of great loss, and of those individuals who make their wish to be donors known during their lifetimes; and

-- the significant contribution made to the lives of organ recipients by those involved in operating, supporting and advocating for organ donation and transplantation services;

recognises that not only do organ donations offer life-changing outcomes for recipients but also represent the potential for significant savings to the State through reduced dependency on services such as dialysis and other acute supports, as proven in the Spanish and Croatian experiences; and

calls on the Government to immediately devise and implement a multi-pronged approach aimed at improving donation services through legislation that will:

-- institute a system where everybody is deemed to have opted-in for organ donation, and if any person opts not to be part of that system they sign themselves out of the automatic donor involvement scheme;

-- provide for sufficient numbers of specialised donor coordinators to be put in place in all major hospitals of Ireland to create a national network of expert personnel charged with operating this vital service;

-- establish a national donor registry that facilitates engagement among prospective donors and is accessible by all acute hospitals; and

-- initiate a nationwide and effective public information and education campaign that will promote the vital importance of organ donation, the very real and life-changing difference it can and does make for so many and, most vitally, the urgent need for an increase in donation levels in Ireland.

I wish to share time with Deputies Richard Boyd Barrett, Mattie McGrath, Catherine Murphy and Michael Healy Rae.

In 1999, on average 100 patients were on the waiting list for renal transplant and 145 transplants took place. Today more than 600 people are on the waiting list and at best it is expected that 180 renal transplants will be achieved by the end of 2013. This is the statistic on patient demand in one area of organ donation in Ireland. Numerous patients are awaiting suitable organs which can transform their lives. Transplantation has proven to be so successful on a worldwide basis and developments have occurred through research and various new techniques, which means more and more patients have a chance of benefiting from transplantation. Unfortunately there are not enough donors to match the number of patients awaiting transplants and the numbers have spiralled upwards over the past five to ten years in particular.

Ireland is lagging behind the rest of Europe with regard to proper infrastructure and a lack of public awareness regarding organ donation. I very much commend the Irish Donor Network and the Irish Kidney Association for their tremendous work and endeavours to get the message across to the general public. They have very restricted budgets and resources but they also have wonderful staff and personnel who are very proactive and perform excellent public relations work. Their efforts have been rewarded with almost 5,000 transplant operations since they were established. These include 3,800 kidney transplants, 280 heart transplants, 650 liver transplants, 120 pancreas transplants and 25 lung transplants.

Live organ donors make the ultimate gesture and are true examples of unselfishness and generosity towards their fellow man. They are an inspiration to all citizens to come forward and give their consent in the event of a fatality or a life-ending situation. They give their consent unconditionally and wholeheartedly which benefits the recipient who, in most cases, gains a completely new lease of life.

The Irish active transplant waiting list increases by approximately 10% each year, and the ageing population and increasing incidence of type 2 diabetes are both factors in exacerbating the shortage of available organs. Approximately one in ten people on the waiting list for transplantation will die. This is the stark reality. This figure does not include those who have become untransplantable because they have become too ill for transplant, perhaps because they have developed additional antibodies, and are removed from the waiting list.

In this country in 2011, 165 deceased kidney donor transplants were carried out. To service the needs of renal patients alone, at least 250 to 300 deceased organ donors are needed per annum. This statistic demonstrates very clearly the seriousness of the situation and the vast room there is for dramatic improvement. The annual cost of dialysis coupled with medication is almost €70,000. Over 15 years, which is the average lifespan of a deceased kidney donor transplantation, saves the Exchequer approximately €750,000. In addition, 80% of transplant patients returned to work. This is a very significant matter also which provides a huge boost to the Exchequer and the taxpayer.

There is a need to develop the required infrastructure in the Republic of Ireland. Intensive care donation personnel would be assigned across the health service in line with international practice and the EU Commission action plan. These medical and nursing personnel would underpin the organ donation process by protecting the interests and welfare of those families who chose to donate organs in very difficult circumstances. Historically Ireland has performed proficiently with regard to organ donation and transplantation. However the unmet need of patients requiring organ transplantation continues to grow. A fall in organ donation rates, as witnessed in 2010, would have a negative act on the lives of many of our citizens. The recently enacted EU 2010 directive on organ transplantation requires a strong national organ donation and transplantation system with documented protocols and clear standards of governance and accountability. Recognising the substantial health benefits of organ transplantation, the EU Commission Action Plan on Organ Donation and Transplantation 2009-2015 emphasises a requirement for all European states to identify potential organ donors and support their conversion to being actual organ donors. The programme for Government commits to complying with the EU directive. As a member of the EU we support the Commission's 16 point action plan on organ donation and transplantation.

The Republic of Ireland has three distinct transplant programme. These clinical units are unique in the Irish health service in that although located in three teaching hospitals in Dublin they deliver services for the entire nation. They are distinctive in being the only service providers with the critical mass and expertise to deliver organ transplantation. They are located in, and compete for, resources in acute hospitals which also deliver regional and local services. Most importantly, these programmes are underpinned by the death of an Irish citizen whose family chooses to donate organs in difficult circumstances. This highlights the unique position of these transplant units in the health care sector.

The national renal and pancreatic transplant programme is the longest established and largest transplant programme in Ireland. It is based in Beaumont Hospital. To date it has completed 3,866 renal transplants and 126 pancreas transplants. The Beaumont Hospital transplantation staff also provide paediatric transplantation in Temple Street University Hospital. The renal transplant co-ordination office in Beaumont Hospital serves a dual role, providing renal transplant co-ordination and a procurement service for liver, lung and heart transplantation. The increased number of patients undergoing dialysis has inevitably resulted in a dramatic rise in the number of patients actively awaiting renal transplantation. At present 1,768 patients are being treated by dialysis of which 1,557, which is 88%, are treated by centre-based haemodialysis. In 2000 the waiting list for kidney transplantation was 150, while in 2010, 620 people were awaiting kidney transplantation. By necessity, increasing demand for renal transplantation has seen the re-emergence of living kidney donation.

The live kidney donor programme is expanding and is planning to conduct up to 60 transplants per annum in five years time. If Ireland is to achieve the activity levels of the top European countries such as Norway, Austria, Croatia and the Netherlands, we would need to perform 220 to 250 transplants annually, including deceased and living donation transplants, or 50 to 60 renal transplants. Ireland is ranked eighth in Europe for deceased renal transplantation.

The national liver transplant programme is located in St. Vincent's University Hospital. Since 1993, some 800 liver transplants have been completed. There are currently 22 patients awaiting liver transplantation. Paediatric liver transplantation is managed via Our Lady's Children's Hospital in Crumlin and is conducted in various UK hospitals on their behalf. Ireland is ranked 12th in Europe for liver transplantation.

The national heart transplant programme is based in the Mater university hospital. Since 1985, 300 heart transplants have been performed. There are currently 15 patients awaiting heart transplants. Paediatric heart transplantation is managed via Our Lady's Children's Hospital, Crumlin, and is conducted in various UK hospitals on their behalf. Ireland is ranked 24th in Europe for heart transplantation.

The lung transplantation programme is also located in the Mater university hospital. Since its inception in 2005, some 57 lung transplants have been completed. There are currently 49 patients awaiting lung transplantation in Ireland. Historically, a "buddy" arrangement with the Freeman Hospital in Newcastle, UK, has existed for patients requiring lung transplantation. This is a costly arrangement and the full repatriation of this service should be completed. Ireland is ranked 15th in Europe for lung transplantation.

Organ donation in Ireland is based on a voluntary donation system and occurs in 22 intensive care units throughout the country. Developing a modern organ donation structure would be a significant positive advance in the Irish health service. Historically, there has been no specific investment in organ donation in Ireland. Currently, for instance, there are no key donation personnel deployed in Irish intensive care units. This is a major deficiency that will have to be corrected. There are voluntary link nurses in a proportion of intensive care units across the country who laudably try to foster organ donation.

The three transplant centres have developed independently of each other and have different requirements in regard to organ donation. Each transplant centre has its own organ retrieval team which provides a 24-7 service and travels nationwide to retrieve organs. No formal organ procurement service exists in Ireland. The renal transplant co-ordinators have historically provided procurement - that is donor - co-ordination services for liver and lung, and heart transplantation, as well as its original primary function of co-ordinating renal and pancreas transplantation. They deliver a 24-hour on-call service for the three transplant centres and deal with all organ donor referrals. The renal co-ordinators are responsible for registering each donor, the allocation of organs nationally and abroad and traceability of donated organs thereafter. The co-ordinating teams consist of five wholetime equivalent co-ordinators working a one-in-five on-call rota to provide this service. Therefore, the current transplant co-ordinators have a dual role and carry both donor and recipient co-ordination responsibilities. As well as all the donors, I wish to commend everyone else concerned in this professional service. I also compliment all those engaged in this demanding work on the wonderful medical service they provide across the board.

The European Union has given particular priority to transplantation because of its compelling health benefits and cost effectiveness. This culminated in the 2008 ten-point EU action plan. This action plan proposes that member states should appoint key donation personnel in all hospitals where there is potential for organ donation. Public health and safety concerning organ transplantation has been addressed by EU Directive 2010/53/EC, which was transposed into Irish law in August 2012 by the Minister for Health. That directive requires a strong national transplantation system with documented protocols and clear standards of governance and accountability. The system proposed will give assurance to the public that organ donation and transplantation are national priorities and should help to encourage a greater proportion of the population to be organ donors.

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