Jim Walsh (Fianna Fail) | Oireachtas source

I join those who commended Senator Mark Daly on raising this important issue. It is a matter of life and death for many people. I know he has taken criticism from Members on the other side of the House and from the media. To some extent that is understandable. I too would have been of the view that a simple solution to increasing the availability of organs would have been to move to presumed consent, choosing an opt out instead of the current opt in system. Having discussed this thoroughly with Senator Daly, I discovered that his insight into donation of organs was superior to mine. That highlights the importance of the vocational system of elections to the Seanad because of his involvement with the body who nominated him, he has developed expertise in the area. I commend him on his interest and for fighting in the face of criticism.

Members on the other side raised the question of annulling the statutory instrument. I support the annulment of SI 325. I think it should be replaced by a new instrument with the two important characteristics that have been shown clearly in other countries to have been very beneficial, that is a single national transplantation authority and not the present division between the Irish Medicines Board and the HSE. We see the difficulties and the dysfunctionality that persists in the HSE. The second characteristic is that one must have transplant co-ordinators in the hospitals.

The success of organ transplantation in Spain is attributed mainly to the sensitive way the transplant co-ordinators approach the bereaved family. That is a critical factor and they attribute the highest priority to and focus on it which has resulted in increasing the number of organs that have been donated. The number of deceased donors per million, which is the common benchmark for assessing results in this area has seen an increase from 14 per million of population in 1989 when the system was put in place to between 34 and 35 per million in 2009. That was the highest in the world at that time, but that figure may have been surpassed by Croatia in the past year or two and to which my colleague, Senator Brian Ó Domhnaill referred. The 2008 figures for the comparative rate for the 27 EU members states is 18.2 per million, whereas the corresponding figure for one of the leading countries in this area, the United States, is 26.3 per million. There is a lot of work to be done. We need to achieve progress if we are to meet the demand that is there. It is interesting that Italy and Portugal have followed the example of Spain by putting in place a similar system in order to increase the rates of organ donation. It is notable in Spain that transplant co-ordinators spend hours listening to relatives and asking them to consider organ donation in a private room away from the hospital wards. They develop a relationship and a bond with them. Only about 15% of families in Spain refuse consent for organ donation.

That is a significant drop when one considers that a rate of 40% applied in that country in the 1980s. The national organisation of transplants in Spain would like to reduce the overall refusal rate to just 10%. It is interesting that Ireland does not have any particular target, as far as I am aware. A single decision to donate can help up to four patients who need kidney, lung or liver transplants.

I would like to refer to the system that was introduced in Spain. This will help us to understand some of the criticism we have received. Until recently, I would have felt that presumed consent was the sinecure to the issue. No significant increase in donations of organs was noted in Spain after it introduced a system of presumed consent in 1979. As I have said, the organ donation refusal rate in Spain has improved remarkably since a comprehensive and nationally organised organ donation system, which included many innovations, was introduced there. In the past 20 years, the organ donation rate in Spain has risen gradually to its current enviable level. As I have said, the refusal rate has also fallen. By comparison, the rate of 14% or 15% that was recorded in Britain in 1989 has remained static. It is considering whether to follow the Spanish model.

Interestingly, Spain does not have a donor register. The Spanish organ donation organisation does not actively promote donor cards, which play a pivotal role in our promotion of organ donation. At present, just 8% of the population of Spain is covered by donor cards. Transplant co-ordinators in Spain have a unique profile in facilitating the early identification of potential donors, particularly from small hospitals. They can be appointed at hospitals with a potentially low rate of deceased donors. Their daily work is carried out in intensive care units, where most donors are likely to be found. They have a particular focus on the importance of the family. The primacy of the family's wishes must be accepted as it is in Spain. Otherwise, the organ donation process could be greatly undermined. Trust is a crucial issue because of the unique circumstances surrounding deceased organ donation.

I would like to refer Members to an article in last week's The Sunday Business Post, which pointed out that "we rank low in the European organ transplant league, and Irish hospitals have no personnel on call to approach relatives". The article suggested that the whole operation is divided between two entities: the HSE and the Irish Medicines Board. It referred to Dr. Rafael Matesanz, who is primarily responsible for what is being done in Spain. It mentioned that the "Minister for Health, Dr James Reilly, has initiated a public consultative process on the introduction of an 'opt-out' system [which means] everyone is deemed to have consented to donate". According to Dr. Matesanz, the introduction of such a system did not boost Spain's transplant rates in practice, as the family of the deceased was invariably consulted.

Any public dispute about this sensitive topic can damage the image of organ donation and have a negative impact. Brazil had to change its laws again, some years after the adoption of a presumed consent approach was approved, because of public opposition. Surprise has been expressed about the low rate of organ donor referrals from some of the country's biggest hospitals. St. Vincent's Hospital, which is one of the biggest hospitals in the country, has referred an average of 1.5 organs per year for transplantation over the past five years. There is a real onus on us to take up this issue. If we are to ensure we maximise our potential in this regard and end up with surplus organs, we need to follow the lead that Senator Daly has given us. We should not follow the examples of other areas, which have not actually led to the achievement of targets or to a reduction in the number of people who die as a consequence of not getting organs. I understand that one in ten of those who need transplants do not get organs and die as a consequence. It behoves us all to come together and ensure that state of affairs is put to rest for once and for all. We can do this by having a proper debate on this statutory instrument and on this area as a whole.