Dáil debates

Friday, 21 February 2014

12:00 pm

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I move:

That Dáil Éireann shall consider the Report of the Joint Committee on Health and Children, entitled ‘Report on Organ Donation’, copies of which were laid before Dáil Éireann on 1st October, 2013.
I welcome the Minister for Health, Deputy James Reilly, to the House, and I welcome the fact that we are having this debate on the report of the Oireachtas Joint Committee on Health and Children on organ donation. I pay tribute to the members of the committee who participated in the hearings, particularly Deputy Kelleher, who is absent today, and Deputy Ó Caoláin, the main Opposition spokespeople, for their cooperation and participation.

Early last year many of us in the House were contacted by people about organ donation. Those affected, either undergoing dialysis, awaiting transplant, who have received transplants or made donations left a lasting impression. One of the meetings that stands out in my memory was the one in which I had the pleasure of meeting Shane Finnegan and Joe Brolly, and people from Cork, to hear their stories directly. I was struck by their positive and uplifting stories. It was clear to me and to other members of the committee that we needed to reflect upon and change our policy on, and approach to, organ donation.

It is only when one sits down with people directly affected that one realises the severe impact transplants have on the lives of so many people, the waiting, the anticipation, the phone call, the ambulance, the journey to the hospital, followed by false dawns or success and new life, a second chance. The courage and bravery of all those I met was impressive. Their honesty in relaying their stories, in reliving what they went through, or what they were going through, was personal and touching. It was a privilege to listen to them. These meetings also highlighted many of the structural challenges which face organ donation in Ireland. Thankfully, the Department of Health under the Minister, Deputy Reilly, had also commenced a process of consultation on our policy. Everyone in this House, or in the Seanad, who meets many groups and vested interests on a range of issues knows that they all have a story. What struck me on this issue was the near uniformity of opinion on the same problems and difficulties across the country.

Our current system of organ donation is an opt-in one, which requires an explicit decision to donate to be made, either by the person prior to their death or by family members after death. Even though we have a generous culture of organ donation in Ireland, we consistently rank low, at just 23 in European league tables, behind all other countries that have a soft opt-out system. In June 2012, more than 1,700 Irish adults were receiving haemodialysis, yet, throughout all of 2012 just 163 renal transplants were carried out in the Republic of Ireland. To meet the needs of those receiving haemodialysis our health system should be performing in the region of 300 kidney transplants each year.

Our opt-in system, or expressed consent, is used by only a small minority of countries in the EU. Countries that have changed to the opt-out system have seen significant increases in their rates of organ donation. Over a three year period, after making the change to opt-out systems, Belgium saw its rate of organ donation increase by 100%, while over the same period, Singapore saw an increase of a massive 700%. Over recent years there have been suggestions that we should change to a soft opt-out system, with a presumption of consent to donate upon death, unless specifically stated otherwise. It is important to state that even if this change were made, we must ensure that in all instances a person's family has the final say. This maintains the principle that donation is a gift and would help to change public attitudes so that donation becomes the norm, not the exception.

This morning I heard Liam Neeson speak eloquently about his late wife's gift of organs, which has given three people a new opportunity to live a normal life. We have a chronic shortage of deceased organs available for donation. In 2011, when an estimated 250 to 300 kidneys were required, only 164 deceased kidney donor transplants were carried out. This suggests that our current system is not working and that a review is required so that the many people who are in need of an organ transplant can be helped.

The committee was of the view that as this issue is being, or has been, debated throughout the world, and it was about time we as a country started to consider seriously the changes we need to make so that our rate of organ donation can be increased. Countries that have changed to opt-out systems have seen significant increases in organ donation rates. Any similar increase here could have a very positive impact on those who require a transplant and ultimately would help save lives.

Last April the joint committee held two public hearings examining organ donation in Ireland. During those hearings we heard the views of a wide range of stakeholders, including organ donors, organ recipients, practising clinicians and surgeons, support organisations, the National Organ Procurement Service, the Irish Medicines Board and the Department of Health.

These hearings greatly enhanced the joint committee's understanding of the position pertaining to organ donation and reaffirmed our view that the transition to a soft opt-out system is a necessary one.

Over the course of our hearings, the sessions were held in a way to allow us hear from different advocates, those with direct experience, medical professionals and those involved in policy development and the various legal aspects. I will not name all the people from whom we heard but the testimonies of the people who received and gave organs were powerful. People such as Christine Quinn, Noreen O'Halloran, Michael Kiely, Annette Betson, Shane Finnegan and Joe Brolly, to name a few, struck a pertinent message with every member of the committee and those who were involved. Equally, we heard from a wide range of people on the medical and legal perspective including Professor David Hickey, Professor Peter Conlan, Dr. James O'Rourke, Dr. Colman O'Loughlin, Dr. Ruairí Dwyer, Dr. Liam Plant and Dr. Brian O'Brien, all people of experience with involvement in the medical field.

I thank all the witnesses who attended our hearings and who made submissions. They were informative and impressive contributions to the committee, which helped us in our work, and they gave us an insight we would never have got, and which we were required to get, to allow us prepare a report and make recommendations.

The Joint Committee on Health and Children warmly welcomes the Government's consultative process regarding its proposal to change the current practice of expressed consent or opt-in consent to one of opt-out consent in regard to organ donation in Ireland. Changing to a soft opt-out system has the potential to change public attitudes toward organ donation, and more importantly, to increase vastly our rate of organ donation. It is important that in such a new system, the family of the next of kin would always be consulted. This will ensure that the principle that donation is a gift is maintained.

The joint committee is strongly of the view that any transition to a soft opt-out system must be supported by increased investment in essential infrastructure, transplant surgeons and trained support staff. Each kidney transplant has the potential to save €680,000 over a 15 year period. A short-term investment in our organ donation infrastructure has the potential to deliver real long-term savings for our health system, not to mention the long-term benefits to the lives of organ recipients, which must be of paramount importance.

The joint committee welcomes the current public consultation on the proposals to change how Ireland operates its systems of organ donation. This underpins the ethos that everyone should have the right to participate in decisions affecting their health and to have their concerns heard. Individuals should be empowered to exercise control over their own health and to participate in the decision-making process around health law and policy. Any transition to a new soft opt-out system should be accompanied by a significant public awareness campaign prior to such changes taking effect.

The joint committee recommends that any transition to a soft opt-out system will only apply to organs available for donation to other patients and not to reproductive organs or other organs and tissues for research purposes.

All persons over the age of 16 with legally recognised mental capacity should have the ability to dissent from their presumed consent. For children under the age of 16 and those lacking the legal capacity to consent, the next of kin should retain full control over consent, and the opt-in requirement should remain in these cases.

The joint committee recommends the establishment of a national register on withholding consent to organ donation. This should be automatically accessible to organ procurement services and managed by the health departments.

Since we have published our report there have been significant developments in the area of organ donation. As part of budget 2014, the Minister prioritised the development of a robust organ donation and transplantation infrastructure. An allocation of an extra €2.92 million for organ donation and transplantation services in 2014 was made available. This extra funding is to be used to facilitate the employment of 19 whole-time equivalent positions including consultants, network link nurses, organ procurement co-ordinators, which are vital to the system, and quality officers. These additional resources will be a great help in increasing the levels of organ donation and transplantation and will be of benefit to patients and their families.

I hope this additional funding, along with the committee's recommendations, reassures those who have been sceptical about what the committee was trying to achieve. As a committee we recognise that changing our system of consent will only be of limited benefit without the necessary infrastructure to support the intended change. Our recommendations have clearly set out the need for a co-ordinated procurement and transplantation service across the country.

The Minister's decision to allocate additional resources indicates that he, too, is aware of the need to fund additional posts so that the overall system can be changed.

Over the course of the year I hope that every person in the Minister's office, the Department, the Health Service Executive and Members of this House will work to raise awareness of the importance of organ donation and also to ensure that the €2.9 million is used for the intended purpose. At the end of the year, I hope the committee will revisit this issue to allow us monitor the progress in delivering an improved environment for organ donation and transplantation in Ireland.

I want to thank all the members of the joint committee for their contributions and co-operation on this very important body of work. In particular, I thank Deputies Ó Caoláin, Kelleher and Healy, who is not present, and Senator van Turnhout on behalf of the Technical Group in the Seanad, along with the members of my party and the Labour Party, for their co-operation and diligence in this particular matter.

I also thank the Oireachtas Library & Research Service, the Clerk to the Committee and the secretariat for their assistance in the production of our report and in organising the hearings last April. Each week their work enables the committee members to carry out our parliamentary duties and without the dedication of our committee secretariat, our work would not be possible. Sometimes that goes unnoticed but it should be acknowledged today.

As a committee we all work together. We put aside our partisan rivalry and advocate on behalf of the people. We have political differences but for the most part we put them aside and work as a committee dealing with important and sensitive issues that transcend party politics. All members on the committee were united in endorsing this report. We want to work to see an all-Ireland system, North and South, in terms of an improved health system that delivers for people, in this case regarding organ donation. I hope this report can provide a template for a way forward in the area of organ donation and transplantation. I welcome the publishing of this report and that we are debating it in the Chamber of Dáil Éireann.

12:10 pm

Photo of Terence FlanaganTerence Flanagan (Dublin North East, Independent)
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Under Standing Orders I am now obliged to call the Minister, Deputy James Reilly, to provide the Government's response to the report. The Minister has up to 15 minutes to reply.

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I hope that even if there were no Standing Orders the Acting Chairman would still call upon me.

I am delighted to have the opportunity to address the House regarding the Report of the Joint Committee on Health and Children on Organ Donation. Increasing the number of organ donors and organ transplants is one of my stated priorities and the joint committee is to be congratulated on the production of this report. The report arose from committee hearings last April, which discussed consent for organ donation and other issues pertaining to organ donation and transplantation. I echo the Chairman's thanks to members of the Opposition, Deputy Ó Caoláin, Deputy Kelleher and others on the committee who were very supportive during the course of these discussions regarding this initiative.

I noted with interest the contributions made by a broad range of people who were given the opportunity to address the hearings of the joint committee. Their submissions, which are included in the report of the committee, do not just make for interesting reading but for compelling reading and are of particular benefit to my Department in the work to frame legislation for the introduction of an opt-out system of organ donation.

All of us here are well aware of the enormous difference an organ transplant can make to the life of a recipient and to the lives of their families and loved ones. Organ donation truly represents a gift of life, and I note the emphasis the committee put on ensuring that the principle that donation is a gift is retained. I welcome that. Also, as some of the contributors to the committee emphasised, it can bring much consolation to the families of the donors and support them in the grieving process.

There is a global shortage of organs for transplantation. This applies to kidneys in particular, with renal failure increasing significantly. This situation is mirrored in Ireland where we do not have enough organs available to meet the increasing needs. All of us must work together to ensure that more organs are donated. In this context, the programme for Government commits to the introduction of an opt-out system of consent for organ donation with the aim of improving the availability of organs for patients in need.

The service plan for the HSE specifically allocated money to make organ transplantation more available and, in particular, to support live donors.

I firmly believe that the introduction of an opt-out system of consent is an integral element in changing our cultural attitude towards organ donation. We need to make organ donation the norm in Irish society so that it is the default position when people pass away in circumstances in which donation is a possibility. In the recent past we have proved as a nation that we can change our cultural attitudes and adapt to new ways of thinking on health issues in a short space of time. Examples include the introduction of the smoking ban in the workplace and substantially changed attitudes towards drink driving. I am not suggesting these achievements were easily attained, because significant change in attitude or policy is never easy to bring about. However, the effort required was worthwhile in helping to bring about a healthier and safer society. The introduction of opt-out consent for organ donation is another step along the road of providing the best quality health care to people in need of transplants, thereby improving the quality of their lives and the quality of life for those closest to them. These words sometimes come out too easily, but I ask Deputies to reflect on what they mean for somebody who has to attend dialysis treatment on a daily basis. The gift of a kidney means they can get back the freedom of living. It is an extraordinary gift. Heart and lung transplants are similarly life-altering events.

The introduction of an opt-out system of consent will mean that the consent of individuals to organ donation is deemed to have been given unless they have specifically opted out during their lifetime. That said, however, I am aware of the importance of respecting the feelings of the families involved, and to this end I am proposing a soft opt-out system. Such a system will allow the deceased's next-of-kin to retain an important role in the process of organ donation. I want to ensure that the system of consent we put in place will operate effectively in hospitals throughout the country in a manner that is sensitive to families who are bereaved. It would be a churlish system if it ignored the feelings of a family that has just lost a loved one. That certainly is not my intention.

I recognise that many issues need to be addressed in introducing this new system of consent. In light of this, my Department undertook a public consultation between July and September last year to seek the views of the public on the practical aspects of introducing an opt-out system of consent for organ donation. A total of 57 submissions were received, including that of the Joint Committee on Health and Children. A document summarising the views received is available on my Department's website. Many important issues were raised in the submissions. These issues formed the basis of a consultation event which I opened in Dublin Castle last November. The consultation event was organised by my Department in conjunction with the HSE's national organ donation and transplantation office, and approximately 80 key stakeholders attended. It provided an opportunity to explore more deeply the important issues that were raised in the public consultation and to consider how best to implement an opt-out system that will be most beneficial to recipients, while being mindful of the feelings of the families of donors. The event was structured in such a way as to give every opportunity to those involved to share their views and to consider how best to implement the opt-out system of organ donation in a way that addresses any concerns raised. The outcome of the public consultation process, bolstered by the outcome of the consultation event, is informing the work of my Department in drawing up legislative proposals to give effect to the introduction of an opt-out system of consent.

Changing the system of consent is only one aspect in a package of measures that are needed to increase organ donation and transplantation rates. Experience in other countries has shown that the development of an appropriate organ donation and transplantation infrastructure is necessary to have a positive effect on organ donation and transplantation rates. This is why, in the face of very difficult economic circumstances and despite reductions in staffing and financial resources, I arranged for the HSE to allocate an additional €2.9 million to organ donation and transplantation in 2014. This additional investment is all the more significant when one considers the continuing demographic and service pressures that the HSE faces this year. It is a clear demonstration of my commitment to improving organ donation and transplantation rates in Ireland. The extra investment will facilitate an increase in the levels of organ donation and transplantation, to the benefit of patients and their families. It will allow for the appointment of 19 whole-time-equivalent staff dedicated to organ donation and transplantation, including consultants, network link nurses, organ procurement officers and quality officers. The appointments will include six half-time consultant intensive care physicians and six network link nurses, who will comprise a key element of the organ donation effort in each of the hospital groups. They will work to foster a strong culture of organ donation, optimise conversion rates and champion educational strategies and training programmes that promote organ donation to health care professionals across each hospital group. These key donation personnel will have a particular focus on protecting the interests of donating families throughout the process. I am aware that reservations have been expressed about this initiative. It was never the case that it would be an either-or situation. We have to do everything in our power to improve organ donation rates and to comfort, console and counsel families who find themselves in the most difficult of circumstances, having lost a loved one, while encouraging them to allow their loved one to live on through the gift of life to another person. That is a truly consoling part of the worst life experience that most families endure.

The additional investment in 2014 will also facilitate the employment of five organ procurement co-ordinators. Currently the renal transplant co-ordinators employed at Beaumont Hospital also undertake the co-ordination of organ procurement supplementary to their core work. Apart from the fact that best practice dictates that the same people should not be involved in both donor and recipient co-ordination, this situation is not sustainable if we are to achieve the increase in donation and transplantation rates envisaged. The additional organ procurement co-ordinators will be on call on a 24-7 basis and their responsibilities will include travelling to any hospital where a potential organ donor is identified; obtaining consent from bereaved families; obtaining comprehensive donor medical and social history; supporting the donor family throughout the donation process; organising retrieval teams; and co-ordinating theatre time for organ retrieval. It must be a priority to ensure that every link in the chain from donation to transplantation adheres to the highest possible standards of quality, safety and compassion. In respect of organ donation and transplantation, this involves ensuring that those who donate organs, as well as those who receive organs, can be fully confident that the system meets the highest standards of international practice. The extra investment in 2014 will also facilitate the employment of four quality officers. It is a legislative requirement under the European Union (Quality and Safety of Human Organs Intended for Transplantation) Regulations 2012 that an effective framework for quality and safety must be established. This framework for quality and safety will ensure that the risks of transplantation are minimised and the benefits are maximised. Patient safety and quality are at the core of our health reform programme and I am on record as constantly striving for better standards in this key area. A dedicated quality manager will be appointed in each of the three transplant hospitals - the Mater, Beaumont and St Vincent's - as well as in the national organ procurement service. The appointees will establish relevant standard operating procedures, forms and reports and co-ordinate the development of quality systems for transplant services.

In the context of the introduction of an opt-out system of consent for organ donation, funding has also been provided for the establishment of a secure register of persons who do not wish to become organ donors after death. This will be provided for in the human tissue Bill, the heads of which are being drafted by my Department. In addition to the area of organ donation and transplantation, the human tissue Bill will cover a range of other issues, most likely including post-mortems, research and anatomical examination.

I am currently considering the possibility of some level of reimbursement of living donor expenses. This could have the potential to increase the number of living donors while avoiding a situation where there could be any financial incentives or benefits for potential donors.

I believe the strong tradition that exists in the blood transfusion service is one that we would like to emulate in organ donation, but there are real expenses for those involved, such as lost time from work, that we must make good.

I am committed to making every effort to increase the level of organ donation and transplantation. In 2013 a record total of 294 organ transplantations were performed in Ireland. This figure includes 38 transplants involving living kidney donors, itself a record number. I am confident that the additional resources provided in 2014, along with the envisaged legislation and the additional staff that have already been assigned to the HSE's National Organ Donation and Transplantation Office, will facilitate further significant increases in Ireland's organ donation and transplantation rates over the coming years.

I look forward to hearing the contributions from Deputies and I envisage that these will further inform the optimum way forward as we work to enhance donation and transplantation rates to the benefit of patients and their families.

I will finish by thanking the Chairman of the Oireachtas committee and the committee itself for their good work on this issue, but I cannot sit down without first thanking all those families who have allowed their loved ones' organs be donated and those brave Irish people who have given a living donation.

12:30 pm

Photo of Niall CollinsNiall Collins (Limerick, Fianna Fail)
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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?

12:40 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is undeniable that the work of Oireachtas committees in the current Oireachtas has surpassed that in all previous sessions of the Dáil and the Seanad prior to 2011. That is my clear perception and understanding. In terms of quality and quantity, the work and product have improved, which is a tribute to the members of the committees, their respective chairpersons and secretariats, including Mr. Paul Kelly. There is more engagement than ever with citizens and groups representing citizens across many sectors and interests on many issues. On no committee is this more marked than the Joint Committee on Health and Children and I make no apology for saying this. I acknowledge and commend the role of the Chairman, Deputy Jerry Buttimer, and the secretariat.

Lest anyone think this is a back-slapping exercise - God forbid that I would be involved in such - the hard work of the committees is not always matched by the response from the Government to the many constructive and viable proposals that emerge from committees. There is a temptation on the part of the Government to see committees as useful devices to produce copious reports that can easily be shelved and, worse again, to keep Opposition Members busy. God forbid that that would be the subtext. I trust that will not be the case with our committee's report on organ donation because, as the Chairman acknowledges in the foreword, it is part of the Government's consultative process on its proposal to change the current practice of expressed, or opt-in, consent to one of opt-out consent to organ donation. I commend the report of the committee to the Minister and appeal to him to progress it. We have common cause and will all benefit.

Sinn Féin made a submission to the committee which I will briefly summarise. We need to address the question of organ donation and transplants in its entirety. There is a severe shortage of organs for transplant. There is also a severe deficit in the infrastructure for delivering transplants in terms of personnel, physical structures and funding. All of these shortfalls need to be addressed in a comprehensive manner. Speaking at the Oireachtas Joint Committee on Health and Children in April 2013, Dr. David Hickey, director of the national kidney and pancreas transplant programme, identified the three big gaps in the current system. They are a lack of organ donors, poor infrastructure in which transplant patients are housed and a shortage of transplant surgeons. He said these gaps must be filled by means of increased organ donation, investment and legislation.

Current Sinn Féin policy supports the presumed consent, or opt-out, rather than opt-in, system of organ donation. This reflects our desire to meet the need for greatly increased donations and transplants. That desire is shared by all, whatever a person's views on the best model of consent for organ donation. Having said that, debate on organ donation, including at the Joint Committee on Health and Children and in the Dáil, has increased knowledge of the issue and there is a new general awareness of the complexity of the opt-in and opt-out scenarios. It is far from being a black and white choice between opt-in and opt-out consent.

Underlying our position are a number of key principles that we believe should underpin the delivery of health services. We believe everyone has the right to enjoy the benefits of scientific progress and its application without discrimination. We believe it is necessary to use regulatory policy to protect the public good, including the safeguarding of public health and safety. Everyone has the right to participate in decisions affecting his or her health and to have his or her concerns heard. This means that individuals must be empowered to exercise control over their own health and participate in the decision-making process around health, law and policy. Importantly, people should not be subjected to medical or scientific intervention without their informed consent.

We recall the pain inflicted and injustice done to families in cases in which the organs of children were removed without parental knowledge, much less consent. On this basis, we believe a complete and comprehensive public consultation process should take place on the issue of organ donation.

We have called on the Irish Government, the British Government and the Northern Ireland Assembly to ensure that the principle of presumed consent, if adopted, would operate only with regard to organs available for donation to other patients and would not extend to reproductive organs, other tissues and organs for research. We have also argued that presumed consent would operate based on the idea that everybody carries a donor card and all persons who have the ability under the current "opt-in" policy to provide consent shall have the ability to dissent from presumed consent - that is, those who are over 16 and with legally recognised mental capacity. For children under 16 and those adults lacking legal capacity to consent, the next-of-kin should retain full control over consent, and the "opt-in" requirement should remain in place.

It should be the responsibility of the relevant health bodies to comprehensively inform the public of a presumed consent policy, if adopted, and an information booklet fully outlining the rights of potential donors and their families should be sent to every household and educational institution. This should include the ability to consent or dissent; how to officially register for and opt out of donating; the legal position regarding children; how organ donation works; how the new process will work in practice; and safeguards that will be put in place to protect the public. An all-lreland national register on withholding consent to organ donation should be established. I emphasise that this should be all-Ireland, as this is a practical area for real co-operation. This would be automatically accessible to the organ procurement services and managed by respective health departments.

We must address all aspects of this issue, most especially the need for greater resources to be devoted to organ transplantation by the Government. Even in these straitened economic times, I hope that will be an integral part of what the Government will do in moving this new approach forward. This would result in significant long-term savings for the State but, far more importantly, it would save and enhance more lives, which is the real objective we all share.

The position I have just outlined was reaffirmed by a resolution passed unanimously at the recent Sinn Féin Ard-Fheis in Wexford, which states:

In light of the continuing acute need for organ transplants and the unacceptably long waiting lists, the increased debate and public knowledge on this issue in the past year, and the wider recognition that changing to a soft opt-out system in relation to organ donation in Ireland has the potential to greatly increase our rate of organ donation, this Ard-Fheis reaffirms our call on the Irish Government to:Conduct an extensive consultation with stakeholders and the general public,

Publish legislation to introduce a soft opt-out system of organ donation,

Put the necessary resources and infrastructure in place to support the new system.
I have emphasised the point a couple of times already, and I strongly believe it is essential. It was very clear to us as members of the committee when those at the coalface dealing with transplants came before us and explained the reality of what they face and what they would face if we had a greater stream of willing donors but did not have the resources to cope with the increased opportunities this would present.

I acknowledge also the call from Cystic Fibrosis Ireland for early progress with speedy enactment of the human tissue Bill, a national online system to facilitate the change to an opt-out system, and the filling of the long-vacant cardio-thoracic transplant post in the Mater Hospital. I ask the Minister's colleague to note these points, as they are very significant. The post in the Mater Hospital in particular needs to be filled with urgency. Progress is being made and although it is not often that I have the basis to say the following sincerely, I acknowledge the Minister's proactiveness in this regard. The committee's report points the way forward and I commend my fellow members of the Oireachtas Joint Committee on Health and Children. I urge the Minister to endorse the report and move forward for the sake of the many whose lives can be saved and the many whose lives can be enhanced by organ transplantation.

12:50 pm

Photo of Mary Mitchell O'ConnorMary Mitchell O'Connor (Dún Laoghaire, Fine Gael)
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This is a very comprehensive report on organ donation. As a member of the Oireachtas Joint Committee on Health and Children, I thank those who presented or gave written submissions on this topic. I pay tribute to the patients who gave a real insight into the effects of debilitating illness before organ donation and their feelings of well-being after transplant operations. Many of them described the transformation of their lives after the operation, and these were real and compelling accounts. For some, organ donations provide a platform for a "Yes" or "No" debate based on theory, supposition and a question of morality. What should not be forgotten is that real people are suffering, hoping and praying for the call that will offer an organ with the potential to transform their lives. In many cases, lives are saved with this call. We have a duty to make it easier for these people to access organs.

Contributions from associations such as the Irish Kidney Association and Irish Heart and Lung Transplant Association have ensured that this report is fully representative and understanding of the position pertaining to organ donation. I also pay tribute to the very able Deputy Buttimer, Chairman of the committee, who ensured this report was comprehensive and well-informed. He was aided by the committee clerk, who is present today.

In Ireland there are currently an average of 80 organ donations per annum, but in 2010 the number was as low as 58. There are fewer than 3,000 people in Ireland enjoying extended life because of organ donation and there are as many as 650 people waiting for heart, liver, lung, kidney and pancreas transplants. Are these numbers acceptable, and can we do something about that? Spain has the highest donation rate in the world, with 35 donors per million of population. Opt-out legislation was introduced in Spain in 1979 and permits organs to be taken for transplant with the consent of family or in the absence of any known objection by the deceased.

I firmly believe the report's recommendation of transitioning to a soft opt-out system will greatly improve the system of organ donation and ultimately save lives. Study after study has concluded that countries with opt-out legislation have higher organ donation rates than most countries with opt-in legislation. The soft opt-out 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 social norm. It does not devalue organ donation as an extraordinary gift from one family to another.

Since the soft oft-opt out measure is part of the Human Tissue Bill, I urge the Minister to enact it speedily. This Bill was originally promised in 2009 and has still to be enacted. This is a source of considerable frustration for patient groups. I am confident the current Government, unlike the last one, will ensure the Bill’s enactment. Legislation in isolation does not enhance organ donation. For a successful transition to a soft opt-out system, organ donation and transplantation infrastructure must be greatly improved and prepared.

I thank the Minister for allocating the €2.9 million for 19 new posts in the HSE service plan for 2014 in respect of organ donation and transplantation. However, I urge him to expedite recruitment of the relevant staff, allocated in the service plan, for the National Organ Donation and Transplantation Office. This office will play a vital role, working with transplant centres, donating hospitals, patient groups and other agencies to ensure improved organ donation rates. According to Professor Jim Egan, director of the office, the deployment of the office would help bring Ireland in line with international practice norms, save vast sums of money and, most important, save lives.

It is essential that the main transplant hospitals - Beaumont, the Mater and St. Vincent’s - be provided with the appropriate infrastructure to cater for the expected increase in the number of organ transplantations. I am confident the Minister will note both the committee's report and my recommendations today in taking his next steps regarding organ donation and transplantation.

1:00 pm

Photo of Joan CollinsJoan Collins (Dublin South Central, People Before Profit Alliance)
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I am thankful for my having been allowed time to speak today because I am not a member of the Joint Committee on Health and Children and, therefore, was not involved directly with the discussions and debate. However, I have been keeping an eye on the debate because it is of particular interest to me. The Minister made a point in his contribution that it is sometimes hard to grasp the emotion of somebody who is waiting for the telephone call and for the ambulance to take him or her to hospital. One must consider the daily lives of the patient's family and the patient's efforts to stay well, which include dietary and other measures. At times, a patient is brought to hospital only to be sent home again. It is deflating for the family and it can be quite an experience. The soft opt-out arrangement will really transform the lives of those waiting for a transplant of any organ. It will be revolutionary for patients if we put in place the necessary staff, infrastructure and supports.

There is always a budgetary aspect to be considered but this is secondary to a person's long-term health. It is an economic matter, however, because a state that must provide long-term care for the very ill ends up spending more in the longer term. The alternative, which can be only good, is to have infrastructure in place that can transform people's lives, including their financial lives.

The €2.9 million is greatly welcome. It has allowed for the appointment of staff working on organ donation and the supporting of families in honouring the decisions of their loved ones who have died. What more does the Minister believe is needed to strengthen the infrastructure in Beaumont, the Mater and St. Vincent's hospitals? This infrastructure is crucial if we are to sustain the soft opt-out arrangement.

The most pertinent question for me concerns the timeframe for the introduction of the human tissue legislation. It is needed and should be introduced as quickly as possible. When does the Minister believe it will be introduced? It will allow for the legislation on the opt-out arrangement and become part of the State's thinking on organ donation. Not everybody is in agreement with what is proposed. There are still people opposed to the opt-out arrangement and even the Irish Kidney Association is not convinced about it. If more of us send out a positive message on what is a gift for life, an increasing number of people will realise the approach is correct and support it. It is crucial that we send out the message that organ donation transforms patients' lives and those of their families, including extended families. Everybody is involved, including friends and workmates.

New transplant consultants in the Mater hospital have made a big impact on changing the attitude of staff towards transplantation. There is now a machine with which one can wash out lungs. This is certainly transformational for those awaiting transplants.

When will the human tissue legislation be introduced? Is there a date set? The Minister said the Department is working on it. What resources will be needed to cater for more organs entering the hospital system? How does the Minister envisage the support being developed? Hospital infrastructure will be very important. Can the Minister put more meat on the bones in this regard so people will have a better understanding of how progress will occur in the near future?

Photo of Frank FeighanFrank Feighan (Roscommon-South Leitrim, Fine Gael)
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I am delighted to speak on the important and very detailed report on the public consultation on consent for organ donation. I thank those involved in its production, including the Chairman of the committee, Deputy Jerry Buttimer, and the clerk. Producing it was not easy. One thousand and thirty-eight submissions were received from individuals. Thirty were received from organisations, including the Alpha One Foundation, An Bord Altranais, Cystic Fibrosis Ireland, the Irish Donor Network, the Irish Hospice Foundation, the Irish Heart and Lung Transplant Association, the Irish Kidney Association, the national liver transplant unit in St. Vincent's University Hospital, and many more. The process involved consultation at its best.

I am delighted there was such a wide range of consultation and that a wide range of views was included. Some of the views varied, but this report highlights the fact that we have not been doing enough for organ transplantation over the years. One need only look at the figures for Ireland.

I and many other people would love to think that in our passing from this life we could help to save another life. I am familiar with this situation. In 2001, my father had to go on dialysis. He was too old at the time to seek an organ transplant, but even if he had been young enough it would have been very difficult to get one. I recall the first time we went to Beaumont Hospital. We were very encouraged by the resources there and by the system organised by the Irish Kidney Association, which assisted us. It has a place in the grounds of Beaumont Hospital where my mother could stay. The support the association gave us, not of a financial nature but in terms of information, made us feel we were not alone. It was much appreciated. I got involved in the Irish Kidney Association, as most people do, because of that assistance. We did not seek it but it was given to us.

I have been involved over the years in national collection days, selling flowers, seeking donations and so forth. In fact, my political career in the Oireachtas was due to the Irish Kidney Association nominating me to run for election to the Seanad for the Administrative Panel in 2002. Thankfully, I was elected. I owe a huge debt of gratitude to the Irish Kidney Association and, of course, to the councillors who voted for me. I enjoyed my time in the Seanad, where I could raise issues such as this. I was spokesperson on health. The Seanad has been retained and sometimes it is a great forum to raise issues. One could raise issues on the Order of Business and it was not as busy as the Dáil from a legislative point of view. I am delighted the Dáil has sittings such as this. It allows government backbenchers, of whom there are many, to put their views on the record of the Dáil, as we are doing today.

My father was not the best patient. He used to travel to Sligo for dialysis. The service there was great and the nurses and doctors were excellent and very patient. However, when he came home from the dialysis, which he received three times per week, he would go next door to have a pint of Guinness. That did not help my mother's patience, but the health system was very good to him. He passed away 13 years ago but I do not think he fully appreciated the issues involved in kidney donation. Again, I am grateful for the work done for him in Beaumont Hospital and in Sligo and for the support of the Irish Kidney Association.

I thank the Minister for allocating the €2.9 million. We genuinely need those additional resources in 2014 and the staff additional to those the HSE already has in the national organ donation system. We must now push for increased organ donation with this extra funding and staff. A system whereby the consent of an individual to organ donation is deemed to be given unless the person has specifically opted out during their lifetime is very welcome. Every year, members of the Irish Kidney Association spend their time distributing cards to pharmacists and doctors and urging people to get an organ donation card and keep it in their wallet. However, with all the preaching I have done in the last ten years, I do not have a card in my wallet. We all have great intentions but this is something we always put on the long finger, or we sign the card and then take it out of our wallet one day and do not put it back. This has hampered the level of donation in this country. As Deputy Mitchell O'Connor said, we have much to learn from other countries such as Spain.

This is a case of the Minister and the committee grasping this issue and saying, "We are sick and tired of talking about this. This has been talked about in good times and it should have been dealt with in those times." The soft opt-out system provides a comfort to people who do not share my view. The deceased's next of kin will have a very important role in the process of organ donation. If they feel uncomfortable, they will have a view as well. That is very welcome.

There was a degree of controversy about this issue. In politics, the Opposition must oppose and hold the Government to account. That is fine. However, opposition for the sake of opposition is wrong, and it is certainly very difficult with regard to health issues. People can stand up and make outlandish and outrageous accusations and allegations which are featured on every local radio station and website and even here in the Dáil. Fortunately, after a week, two weeks, a year or even 20 years they are proved wrong. I was on the radio recently talking about a report that should have embarrassed people holding certain positions regarding health. I must defend the report and I am held to account, which is correct. However, what about the people who make outrageous, outlandish and untrue statements? Perhaps it is time for the media to confront them and say, "You made this statement a year or two years ago. You said people would die and that this would close. Are you proved wrong?".

The Minister and the Government will get it wrong and when that happens we will put up our hands and admit it. But what about when we get it right? When I was in the Opposition I held the then Minister, former Deputy Michael Finneran, to account when he was wrong but when he was right I acknowledged that the Government had made the right decision and welcomed it. That is what it is about. Let us not oppose for the sake of opposing. Most Deputies in this House are united on this matter and I thank Deputy Ó Caoláin and all the other Deputies for their submissions. However, there is a race to the bottom. In the case of opposition for the sake of opposition and deriding what is happening in the health area, there must be a little generosity. Sometimes one must say, "Yes; maybe we got it wrong," but nobody seems to do that anymore.

I thank the Minister. The most important matter today is, I hope, that this increases the number of organ transplants in this country.

1:10 pm

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I welcome the opportunity to speak in this debate. This issue is all about making choices.

Following consultation with the relevant stakeholders and a series of in-depth meetings last year, the health committee, of which I am a member, compiled its report on organ donation and recommended changing the current opt-in organ donor system to an opt-outsystem. The committee members believe that changing to an opt-out system could significantly increase the rate of organ donation in this country. However, it is important to note that the family or the next of kin will still have the opportunity to say "No" if they desire when their loved one is in this difficult position.

Most countries in the EU have already changed to an opt-out system, where patients must express their wish not to donate.

Otherwise, medical staff will presume that they are donors. However, in this country we use an opt-in system, which means that people have to give consent before their organs can be donated. The proposal for an opt-out system has the potential to deliver real long-term savings for the health service, not to mention the long-term benefits for the lives of those who have organ transplants.

To introduce this new opt-out option, we must also plan ahead and ensure the health service is equipped to deal with increased organ donations. For example, we would need more transplant surgeons and trained support staff. I, therefore, welcome the decision by the Minister for Health to include in the HSE service plan for 2014 an additional €2.9 million for organ donation and transplantation, which will go towards the provision of 19 new posts in this field. I also welcome the Minister's announcement last year of approval for 30 posts at various levels for the expansion of kidney transplantation services at Beaumont Hospital and the development of urology services at Connolly Hospital, Blanchardstown. The Minister also approved €5 million for phase 1 of the kidney transplant expansion programme in Beaumont Hospital.

It will also be important to introduce a dedicated public awareness campaign once the system is implemented in order that people will know their options. If they want to opt-out, the system must be straightforward. An online opt-out system has been suggested and this suggestion should be carefully considered. We need to make it as simple as possible for those who need to make such choices. Awareness of this issue is very important and the annual organ donor awareness week is central to improving it. It is also important for each of us to talk to our families and loved ones about how we feel about organ donation. It is not an easy conversation but an important one.

Let us remember that at the heart of this issue is the generosity of grief stricken families who make the agonising decision to allow the organs of a loved one to be donated. They give many people who are seriously ill a second chance, a lifeline. Many recipients can continue to live a normal life and see their children reared. People can see fathers, mothers and loved ones continue to have some semblance of life. On Tuesday, 24 February 20 years ago my brother-in-law, Mario Byrne, was taken from this earth. He had been involved in a hit and run incident. We got a call that evening at about 10 p.m. to go to St. James's Hospital where he was in a serious condition. I did not go, but my husband did with his mother and father. Mario was transferred to Beaumont Hospital. I received a call in the early hours of the morning from my husband to say the doctor had told him, his mother and father that Mario was on a life support machine and that the chances of him surviving were very slim. We took the opportunity in the following couple of days, while waiting for loved ones to come from America and other parts of the world to see Mario before he departed this world. I remember being in the waiting room where all of us had gathered when the consultant came in. He said Mario had a donor’s card which he had signed a long time ago. We were all so proud to think a young man of 20 had made a decision unknown to us all. When the doctor turned to my mother-in-law and father-in-law, he said they could make the decision also, if they did not feel they could go through with it. Mario’s mother’s words were that if Mario’s organs would give life to somebody else, then the doctor should take what he wanted. To this day I am reminded of the words, “Take what you want,” because we live in a world where people do take what they want and sometimes do not appreciate what they have. As I am a religious person, I do believe blessed is the man who gives up his own life to save others. I will continue to believe this because there are so many people who are willing to take up a donor’s card and the new system will help this to an even greater extent. Each year I attend the Irish Kidney Association’s special donor mass. It brings comfort to those who have lost loved ones and gives an opportunity to recipients to say, "Thanks," even though we will never know who the seven people were whose lives were changes forever by the donation of Mario’s organs.

I agree with Deputies Caoimhghín Ó Caoláin, Mary Mitchell O'Connor, Frank Feighan and others who spoke previously about the health committee. Deputy Caoimhghín Ó Caoláin said it more eloquently than I could ever say it. It is a committee of which I have been a member since I was elected to the House and it works well. It holds no political stance and is admirably chaired by Deputy Jerry Buttimer who, when it is in a difficult situation or holding difficult hearings, keeps calm and shows sensitivity to speakers and witnesses alike. It was a very sensitive time for many of us when we debated the issue of organ donation. I found it stressful at times to listen to some of the contributors. As others have done, I thank the staff because without committee staff, we would not be able to function or to do so as well as we do. I pay tribute to those delegates who attended – the experts, non-experts, those who had lost loved ones and especially those who had gained their life back because that is what this debate and report is all about. I commend the report to the Minister and urge him to put his ducks in a row as speedily as possible to bring forward all of the recommendations made in the report. Many families are waiting at home for a call to say their loved one has been chosen for an organ, which is a lifeline.

I thank the Minister for his presence. I also thank Deputy Jerry Buttimer for his wonderful commitment and all of the members of the health committee who do an extraordinary job. I am privileged to be part of the committee.

1:20 pm

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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Following Deputy Catherine Byrne’s contribution, in some ways it would be best if it were left at that because I cannot think of a more eloquent way to end the debate. I thank her for her contribution.

I thank all Deputies for their contributions because the issue is a very important one that goes to the core of the values of society. It is fair to say all sides of the House are in agreement on the aim of increasing Ireland’s organ donation and transplantation rates and that any difference in approach is about how best to achieve this aim. The enormously positive impact an organ transplant can have on the life of a recipient and the lives of those around him or her cannot be overstated. Deputy Catherine Byrne has made this very clear. We all have a duty and responsibility to do everything we can to ensure as many people as possible benefit from the gift of life that is organ donation. I am aware that there are differences of opinion on the introduction of an opt-out system of organ donation. I respect these opinions and assure the House that the various viewpoints will be fully considered as my Department progresses the legislative proposals to give effect to the opt-out system of consent for organ donation. Many people have asked me to expedite the process. We hope to have the draft heads of the Bill later this year, with which we will go back to the committee.

I am also aware that a number of practical issues need to be addressed before the opt-out system is introduced, including the establishment and implementation of a register. These issues will be addressed in the coming months as the legislative proposals are drawn up and an implementation plan is developed. I wish to ensure the system of consent we put in place will be a pragmatic one that will operate effectively in hospitals throughout the country in a manner that will be sensitive to bereaved families. I also wish to ensure the next-of-kin of the deceased will continue to have an important role in the process of organ donation. Most people never give much thought to organ donation during their lives.

This is perfectly understandable, as it can be a difficult topic to consider about one's self or a loved one in normal times. However, the benefit of considering these issues in advance and making clear one's position to one's next-of-kin are that it can ensure that one's wishes are met. It also provides peace of mind to those left behind, who have the consolation of knowing and implementing those wishes. It is my intention to emphasise this point in any public awareness initiatives undertaken in conjunction with the introduction of an opt-out system of organ donation.

I hope the introduction of an opt-out system will focus people's minds on organ donation and encourage them to consider their options. At the end of the day I do not expect large numbers of people will choose to opt out. Irish people are known for their altruistic and generous nature and many people know of a person who has benefited from an organ transplant or who is awaiting the opportunity to avail of one. In most cases they will be anxious to help those in need if ever they find themselves in the unfortunate situation in which donating their organs becomes a possibility.

What those who are supportive of the introduction of an opt-out system and those who have reservations about its introduction have in common is that they all want to increase the number of organs that become available for transplantation and they want to ensure our organ donation and transplantation services are on a par with those of the most successful countries in the world. Success can be measured in a number of ways - for example, based on the number of organs donated, the number of organs transplanted successfully, and the quality and safety of the organ donation and transplantation services. Ireland has a reasonably high rate of organ donation, but we all agree that we need to improve our current figures. Last year was a record year for organ transplants, with 294 transplants performed as a result of the generosity of 86 deceased donors and 38 living donors. It was a particularly good year for lung transplants, with 32 such transplants being performed, which was more than twice the total for any previous year. I would also like to pay particular tribute to the 38 living kidney donors. Their generosity is an example to all of us. Last year's figure of 38 was a record, and we are hopeful that we can take steps to facilitate a continuation of this trend.

While all those involved in making 2013 a record year are to be congratulated, we need to build on this improvement in 2014. Last year Ireland had an organ donation rate of 18.7 per million, and I would like to see this rate rising to 22 per million in 2014. However, we must accept that this is an inexact science and the potential for transplantation depends on suitable donors being available, as well as on the aspects we can control in terms of identifying potential donors and following through successfully. It is important that we have robust systems in place to maximise the supply of organs, match up these organs effectively with potential recipients and carry out successful transplants. I am confident that with the allocation of an additional €2.9 million and the appointment of 19 whole-time-equivalent staff, involving consultants, network link nurses, organ procurement co-ordinators and quality officers, we can make this year's challenging target a reality. For the first time we will have dedicated teams who are experienced in counselling and dealing with bereaved families, rather than leaving it, as has been the case in the past, to sometimes very inexperienced senior house officers to approach families. Encouraging staff throughout the hospital network to focus more on recognising potential donors will be a major step forward. Experience in other countries shows that having specially trained staff speak to bereaved families helps to increase the number who confirm their consent for organ donation, as I mentioned.

The issue of a consultant cardio-thoracic surgeon was raised by Deputy Ó Caoláin. The post has been approved. If it was not advertised today, it will be next week. I hope the position will be filled in the coming months. It takes time to get people of such calibre into the system, as they have commitments elsewhere and must work out their contracts. I pay tribute to Dr. Jim Egan, whom some call Professor Jim Egan, who has done a sterling job and is driving our transplant service in the direction it needs to go. I am also very pleased to state that in recent weeks a new unit opened in the Mater hospital with facilities for heart and lung transplantation.

Increasing the number of donors is just one aspect of increasing our organ donation and transplantation rates. A key performance indicator is the conversion rate, which refers to the number of organs successfully transplanted from each donor, in line with the wishes of the donor and his or her next of kin. Generally, potential donors will be encouraged to donate multiple organs, although the conversion rate also depends on the nature of the organ, with kidneys having the highest conversion rate and hearts and pancreas having the lowest. Although we have not had a huge increase in donors in the past year, our conversion rate has improved hugely, with many more successful transplants.

I again thank the House for the opportunity to address it today on this important issue. I congratulate the Joint Committee on Health and Children, particularly its Chairman, Deputy Jerry Buttimer. As Deputy Ó Caoláin stated, our committees are working much more productively now than previously and they inform and have an impact on legislation. I very much value the work they do. There will always be political differences, different emphases and sometimes frank and downright disagreement, but in the main the work that the committee has done in this area, on the Protection of Life during Pregnancy Act and on tobacco will stand the test of time as a true testament to it, its members and its Chairman. I will take very seriously and examine the issues raised today as I continue to develop the legislative proposals which will implement the opt-out system of consent for organ donation.

Transplantation is an area of health care that brings many benefits to the lives of patients and their families. We all rightly agree that it needs to be improved and we all wish to see this happen. I assure the House that I will continue to work to enhance donation and transplantation rates to the benefit of patients and their families. We should all be very proud of the generosity of our people to one another. There is no greater gift than the gift of life. I thank everyone for their support to ensure this generosity is fully converted into a meaningful improvement in life for others.

1:30 pm

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank the Minister and everyone who took part in the debate. This is an example of how Friday sittings can be of benefit. The quality of the debate on this report, in contrast to others, was breathtaking.

Donation is a gift and it offers consolation. As the Minister stated, the generosity of the Irish people knows no bounds. I thank all those who work in our hospitals and those who tend and care for people affected by renal failure and other issues which involve transplantation. The movement to a soft opt-out system gives families the important option to opt out if they wish. I welcome the Minister's commitment on the human tissue Bill and his comments on the filling of posts.

It is important that we thank the families. During its hearings the committee heard from many people. Phyllis Cunningham, the senior transplant co-ordinator of the national organ procurement service, left us with an important legacy as she read into the record a letter that I wish to share with the House. She stated:

I will share an example of the gratitude felt by recipients by reading an excerpt from a letter written by a 16 year old to his donor family on the anniversary of his transplant. He said:I know this time of year is very hard for you but I hope it helps to know that I think of you every day and how grateful I am for the wonderful gift you gave me. Everything I do, everything I achieve, I do it for you. Most especially, I bring your loved one with me and I will try never to let you down. Once again, thank you for changing my life, from a kidney recipient.In reply, the family wrote back, "Our lives will never be the same because of the loss of our loved one but your letter is beautiful remembrance. Take care and best wishes for the future".

When appearing before the joint committee, Professor Jim Egan stated, "The goal of [the] soft opt-out [system] is to allow organ donation to be the society norm" and he is correct. In his presentation to the joint committee Dr. Liam Plant stated, "In the absence of a robust organisation and infrastructure to support this endeavour, any legislative framework is unlikely to achieve its maximum potential in increasing [organ] donation." One cannot but be struck by the great work done by the Irish Kidney Association and its many volunteers nationwide. I hope the position espoused by its chief executive can evolve over time and that, together with his organisation, he will come to support the movement Members are professing to support.

I thank the Minister for his commitment and appreciate the warm embrace by all members of the joint committee of the report and the movement in the system. This is about people's lives and ensuring those who deserve to can get a second chance at living, as the 16 year old boy mentioned has shown today in the letter referred to.

Question put and agreed to.

The Dáil adjourned at 1.40 p.m. until 2 p.m. on Tuesday, 25 February 2014.