Mark Daly (Fianna Fail)

I welcome the chance to speak in this worthy debate because a time when we stand in this House with the opportunity to help create legislation that can actually save lives is all too rare. I thank Senator Quinn for his contribution in highlighting the issue and I have no doubt his actions in raising this matter will form part of the Government Bill being proposed.

I am certain of one thing in tonight's discussion, that the debate on the issue of organ donation is absolutely necessary. Beyond that point I am here to listen and learn from the opinions and research of my esteemed colleagues and offer my own views on the issue. I know the number of organ donations in the country must definitely increase and would like to consider the various ways this can be achieved.

One of the criticisms of presumed consent is the impression it is part of a nanny state operation in that it takes the right of the person to consider and is involved in the decision to bestow the gift of life to another person. To assume one would do this belittles the act and takes for granted what a miracle organ donation is. If the harvesting of organs becomes as routine as any other procedure, grieving relatives can feel their loved ones, even before their passing, are viewed as vessels carrying organs to be removed and can find this grotesque and difficult to allow in this stage of grief. Studies have found that families are more likely to rebel if their role in the decision making process is removed.

It may be far more effective to encourage the discussion of organ donation with families and loved ones to normalise the process for everyone involved. Public awareness campaigns and facilitation of discussion in schools, colleges and work places could have the same effect as introducing presumed consent.

A survey by Spanish researchers found that of 200 families that declined to have their relatives' organs removed, 78% changed their mind after the process was explained in detail. Very few organ donation awareness campaigns have concentrated on encouraging an individual to communicate about organ donation with family members. As organ donation does not take place without the permission of a person's next of kin, Government agencies and organ procurement organisations must target communication with family members as a primary objective of organ donation campaigns.

A 2002 US study noted that because the quality of discussions between the potential donor and his or her family will depend on how well the donor is able to address vital issues regarding donation, it is recommended that campaigns seeking to promote communication between family members about organ donation must simultaneously seek to increase knowledge, debunk myths, and bolster positive attitudes about donation.

The United Network for Organ Sharing's ethics committee has written that: "Intrinsic to the present approach to organ donation is the autonomy of each person to decide." Autonomy, a paramount value underlying much of ethics and political philosophy, means that each individual has a right to choose and has final say over his or her own body. In this light it is supposed that a perfect organ transplant system would satisfy three criteria: first, that every person would make a fully informed choice about whether to donate; second, that choice would be communicated to the surgical team; and, third, that the surgical team would act accordingly.

Clearly, under presumed consent the first principle of every person making a fully informed choice is compromised. Only those who go to the trouble of educating themselves and then either opting in or out of the system have made any decision. However, under the current system, often both the second and third criteria for the perfect organ transplant are removed. In Ireland today a person can expressly indicate by carrying a donor card or ticking his or her driving licence that he or she would like to donate organs in the event of demise but have this wish overturned by relatives who are not aware of the dying person's convictions or are not educated on the process of organ donation. The tendency to follow this trend is so prevalent that one could die with an organ donor card in every pocket, and another one pasted on one's forehead, and the family would still be able to overturn these wishes.

This challenge to organ donation occurs because a person's decision to carry a donor card is not legally binding. It is only considered an indication of their intention. Consequently, a once competent person's wishes, which are known either orally or in writing, can be overruled by the next of kin. If the organ donor card becomes a legally binding will, and this is accompanied by a massive public opinion campaign to sign one, I believe the situation would improve. I am not sure this is the route we should go down. This option is known as first person consent. Under this system additional witnesses or family consent is no longer required to carry out wishes in the event of death. In the event a person has not had the option to join the first person consent registry or is under the age of 18, next of kin will still be approached for consent.

A properly signed declaration, such as the back of a driving licence or an organ donor card, is a legal document under the Uniform Anatomic Gift Act in the US and is effective to authorise donation in every part of that country. Moreover, the relevant laws specify that consent of the donor's relatives is not needed in such circumstances. The relatives do not have legal authority to undo the donor's wishes.

Whereas the family's permission may no longer be required under first person consent, effective systems will still include relatives in the process by explaining the donation process to the donor's family, answering questions and providing additional support. The family will be asked for the donor's medical and social history to help determine which organs or tissues may be transplanted. Family members are also asked whether they wish to receive follow-up information, such as general information about organ or tissue transplant recipients.

I commend Senator Mullen on offering his heart to us and much of what we have discussed has already been covered. Spain has been mentioned time and again but it is not the presumed consent model that works there. That country has an effective system with transplant specialists and counsellors who can speak to families and educate them in their supreme hour of grief.

I ask that we begin by having people signing the back of their driving licence and having the information pooled in Clare. We have 1,550 people on dialysis in this country, which costs a staggering €100,000 per annum per person. If we spent that money on an effective organ donation system, it would be money well spent. Lives would be more fulfilled and other lives would be saved.

In my own county, it is somewhat encouraging to note there were nine times more organ donations in Kerry General Hospital than in a major hospital in Cork, and 18 people's lives were transformed forever by the actions of the Kerry hospital. It is the staff in the hospital who took the initiative, went to the families and looked for organs from the grieving families. In the Cork case, only two kidneys have been donated from that hospital in ten years.

Ultimately, we are failing because as legislators we have not put a system in place. To say we are tied at the bottom with Malta is not a record we should have this time next year.

We will not vote on this Bill but as I indicated to Senator Quinn a Bill is coming. His input from the outline of this Bill has started a debate that will end in lives being saved. Even if what he started today saves one life, I remind him that the Bible states that if a man saves one life, he saves the world entire. I thank Senator Quinn.