Dáil debates

Friday, 21 February 2014

12:30 pm

Photo of Niall CollinsNiall Collins (Limerick, Fianna Fail) | Oireachtas source

Fianna Fáil welcomes this debate and believes that we need to greatly increase the volume of organ donations in the country. As outlined previously by Deputy Billy Kelleher in this House, we favour the soft opt-out position, which assumes that people are willing to participate in organ donation, but medical staff must seek permission from the family. However, we believe that there should be training of medical personnel on how they approach families.

The presentations made by various witnesses to the Joint Committee on Health and Children were enlightening in the sense that while there was no unanimous position on all issues, there was unanimity on the need to increase the number of people who are willing to donate organs and carry donor cards. If all this debate achieves is to highlight awareness of the issue, then that is something to be welcomed.

Interesting points were made at the committee hearings and varying views were expressed on the soft and hard opt-outs and whether it should be left to people to acquire donor cards. I understand that one point made by all groups that presented was that the family should always be consulted and that, irrespective of whether a soft or hard opt-out approach was taken, the family should be the decision maker. However, if an individual makes an explicit determination to donate organs then, surely, consultation should not be required and his or her last wishes should be respected. The Irish Donor Network pointed out that in Ireland consent is never presumed, even if a donor card has been signed. While the wishes of the family should be ascertained, surely the individual's autonomy is critical too. It is not an issue that should be approached in adversarial manner. If we are to raise awareness and encourage as many people as possible to donate their organs, everyone with an interest should be involved in this discussion.

Taking into account Ireland's ranking in terms of organ donation, we are reasonably positioned, but we could be much better. Notable progress has been made at St. Vincent's and Beaumont hospitals in terms of capacity to transplant. According to Mr. Jim Egan, a consultant in respiratory medicine writing in The Irish Times last year, Ireland has historically performed proficiently in regard to organ donation and transplantation. However, Mr. Egan went on to point out that the unmet need of patients requiring organ transplantation continues to grow, and a fall in the organ donation rate, as witnessed in 2010, would have a negative impact on the lives of many Irish families. The committee heard evidence that in 1999 there were an average of 100 patients on the waiting list for renal transplant, and 145 transplants took place. In 2013, there were 600 people on the waiting list and we could at best expect to achieve 180 renal transplants.

The Croatian experience is worth noting. That is a country that has positively improved its outcomes in organ donation and transplantation. Donation rates in Croatia have risen to 30 per million of the population, compared with 18 per million in the Republic. It seems that Croatia has a strong network of hospital physicians responsible for organ donation within intensive care units. The legislation in Croatia was also adjusted to include an opt-out system, in keeping with those of Spain, Belgium, Austria and Portugal.

Countries that have made determined efforts in organ transplantation have seen substantial medical and financial benefits. It would not be to our advantage if, having made significant technological and medical strides in saving people's lives, we find there is an insufficient supply of organs available to meet demand. Variations and fluctuations in the rate of organ donation rates and donor numbers in recent years are interesting. This may stem from the small number of people involved.

It is important to acknowledge the role of live donors and to recognise their significant contribution. As Deputy Kelleher stated in a previous debate on this, it is magnificent and exhilarating that a human being is willing to donate, in life, his or her kidney to save someone else.

A key point often made is that, irrespective of the recommendation that results from the consultation process, the key issue is the provision of resources. Provision must be made to the centres for organ harvesting, and it is also necessary to work with the families. The resources must be there to enable the provision of co-ordinators who can take a compassionate approach to the families of donors and potential donors. Many people might simply not have been fully aware of the significance of organ donation, or many have passed on whose organs could have been used but were not used because we do not have the essential infrastructure in terms of trauma centres, cardiac units and intensive care units to approach families in a planned way to discuss the issue with them.

Consultants in various hospitals do their best to save their patients and when it becomes obvious that there is no hope, they approach families to discuss the possibility of organ donation. Consultants are exceptionally busy people who work at the coalface and are under constant pressure. Further supports are required for medical professionals. For example, bereavement counsellors should be available to talk to families as well as co-ordinators trained in the area. It is too much to expect that the doctor or surgeon dealing with the patient must also deal with the family. It is important to provide supports to facilitate organ donation and to liaise with families in a meaningful way.

The Government has undertaken a consultation and, again, it appears there is significant support for the soft opt-out. There are currently in the region of 650 patients awaiting organ transplantation in Ireland. One donor can potentially help nine other persons. In recent years there were on average 80 donations in Ireland a year, resulting in approximately 250 transplants.

In Ireland, 2011 was a ground-breaking year for organ donation. There were 93 deceased organ donors, which allowed 248 organ transplants to be carried out. This surpassed the previous record of 91 deceased donors, which was set in 1998. In comparison, there were 58 deceased donors in 2010, which saw the worst decline in organ donation in Ireland on record. In that year, there were also 23 living kidney donors.

Aside from dealing with the appropriate legislation, we should advocate strongly and give people a platform to express ways to develop organ donation. We are talking about life and death here, but organ donation needs proper administration. There have been advances in technology, medical technologies and immunosuppressants. We should also examine North-South relations and the possibility of a strong island-based transplant system, just as we are doing for rare communicable diseases. We should work closely with the United Kingdom in that context. In the UK, there is strong co-operation between various hospitals. We should also set up an infrastructure that will allow us to improve our ranking in the league of organ donation. We need a strong international co-ordinating body, and the EU is working on this.

There are two forms of presumed consent - hard and soft. In the case of hard presumed consent citizens must clearly express their wish not to participate in organ donation. Where there is soft opt-out, it is assumed that citizens will participate in organ donation but medical staff must seek the consent of the family. Northern Ireland and Wales have indicated their intention to deploy this system. Dr. Jim Egan, consultant respiratory physician at the Mater Hospital in Dublin, states:

The soft approach protects the autonomy and dignity of the deceased by placing the stewardship of the decision with the family. Therefore the goal of “soft opt out” is to encourage organ donation to be the society norm.
As Deputy Jerry Buttimer points out in his introduction to the report, the current practice of using the opt-in system, or expressed consent, is used in a small minority of countries in the European Union. Countries that have changed to opt-out systems have seen significant increases in rates of organ donation. It is extraordinary that, following a transition to an opt-out system, Belgium’s rate of organ donation doubled in a three year period. Potential savings of almost €700,000 per kidney transplant over a 15 year period is a further incentive. "Win-win" is an overused phrase, but any situation where we can prolong lives and make savings is one that must be welcomed and an outcome pursued.

During the Oireachtas committee discussion there was a warning that the service was reaching a crisis that could result in facilities such as kidney dialysis being rationed or denied to the old and infirm. Dr. David Hickey, director of the national kidney and pancreas transplant programme, said renal failure management could potentially bankrupt health services in the western world in the next 20 years and that if the issue was not dealt with, “we are going to be talking about rationing dialysis in the not too distant future.” He went on to say the best possible outcome was for more donors to become available as those who received a kidney from a living donor could expect to live twice as long as those on dialysis.

It is notable that the number of people donating their organs upon death in Northern Ireland has almost doubled in recent years, a point underlined by Mr. Joe Brolly at the committee. An 82% increase in deceased organ donors in the region was announced as the NHS revealed it had achieved a target to increase the number by 50% across the United Kingdom as a whole. In 2008 there were 22 donors in Northern Ireland, while in the year to April last there were 40. In the same period the number of donors in the United Kingdom rose by 50% to 1,212. The upsurge has been linked with developments in 2008 when the four UK administrations accepted recommendations made by an expert task force.

We have a way to travel, but the Oireachtas Joint Committee on Health and Children did a valuable job in hosting the debate last year. I congratulate all those involved and express the hope it will serve to greatly increase the volume of organ donations. I return to Mr. Joe Brolly’s contribution at the committee which is worth quoting in full:

If one thinks of it logically for a moment, the question at present is, "Should I decide to become a donor?" Apathy is a big problem in that regard - we only have 27% or 28% of the people involved. Under the new system, the question will be, "Is there a reason that I should not be a donor?" That will more properly accord with the overwhelming view in society that organ donation is good. Who does not want to save seven lives after he or she is dead?

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