Seán Crowe (Dublin South West, Sinn Fein) | Oireachtas source

I have long been a firm believer in the need to reform and streamline the organ donation system. In particular the difficult and sensitive issue of consent from bereaved families needs to be addressed. Hopefully this legislation will go some way towards doing that.

It is a terrible time for a family which is still reeling from the loss of a loved one. To be asked to donate as you watch a loved one die in front of you is a difficult time. It can never be easy, not only for the family involved, but also for the staff asking that awful question. At least with this Bill, the intention of the deceased to donate or not will have been made clear to families and hopefully they will know more about their options. As with all matters in our health service, infrastructure will be key in deciding whether our reforms are worthwhile.

Ireland ranks well below the average for organ donation with some 700 people waiting on donations at the moment. In 2021, 31 people on the list died without receiving that all-important phone call that an organ had been found. Do we have the capacity to honour those who wish to donate organs by accepting them in our hospitals and getting them to where they need to be? That is the big question. Organ donation is an extremely time-sensitive matter. If an organ is donated in Sligo, could it be accepted, transported to Dublin or Cork, a recipient found and surgery performed in the time available? Time and infrastructure is key.

The scarcity of ICU beds was laid bare during Covid and without significant investment we risk failing to capitalise on the potential increase in organ donations this legislation could bring. The Bill is a step in the right direction but we cannot leave ourselves unable to facilitate organ donation and transplant because the theatre space is not there. Towards Excellence in Critical Care, submitted to the HSE in 2009, mandated the number of critical care beds should be increased from the then figure of 289 to 579 by 2020 to kept up with population growth. In 2021, we had 276 operational full-time ICU beds. We managed to lose 13 beds in the 12 years, despite huge population growth. Will the Minister confirm that critical care infrastructure will be radically expanded to provide for post-operative care? Without it, I fear we will not see the good of any of the changes we are discussing.

I have a number of questions about the practical application of changes to the donation system. Will the opt-out system be a blanket refusal only or will individuals be allowed to opt out of donating specific organs? There are sensitivities, with some people reluctant to donate eyes or something.

Maybe the Minister could clarify that in his response. Some people might have particular reasons for not donating certain organs, but they may want to donate others. Will that be provided for, or will it be a case that you opt out and that is it? Again, this is a matter of clarity. Will the Minister publish any of the reports on the investigations into the non-use of organ donation in the Mater hospital in November 2021 and what the learnings or actions have resulted to avoid a repeat in the future?

I cannot imagine the distress of being told a donation has been arranged for you, only to be told that the lack of a bed means that you cannot accept it. It is inhuman to put someone through that whiplash of emotions and every effort must be made to ensure that it never happens again. While I welcome the efforts to reform the system of organ donation, my big concern is the ability of our health service to accommodate it. We saw the havoc in our public hospitals during the winter months and how a predictable wave of respiratory infections brought the entire system to a standstill.

Organ transplants are not like an elective surgery where you can bump someone off a list and tell them to come back in two months. It is a matter of priority. If we are to make these changes and introduce the soft opt-out system, then we need to make the necessary investments to ensure that those who stand to benefit see the benefit.

Lastly, I want to use this opportunity to thank those who are involved in blood banks. It is a voluntary service. They move organs. They move blood. They do an essential service within our health service. They do it all on a voluntary basis. I want to congratulate them on the work they do.

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