Dáil Éireann debate -
Wednesday, 1 May 2013

Vol. 801 No. 3

Organ Donation: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Tom Fleming on Tuesday, 30 April 2013:

That Dáil Éireann:

notes:

— the life-saving and life altering gift that is organ donation;

— the incredible generosity such gifts represent on the part of families of donors at times of great loss, and of those individuals who make their wish to be donors known during their lifetimes; and

— the significant contribution made to the lives of organ recipients by those involved in operating, supporting and advocating for organ donation and transplantation services;

recognises that not only do organ donations offer life-changing outcomes for recipients but also represent the potential for significant savings to the State through reduced dependency on services such as dialysis and other acute supports, as proven in the Spanish and Croatian experiences; and

calls on the Government to immediately devise and implement a multi-pronged approach aimed at improving donation services through legislation that will:

— institute a system where everybody is deemed to have opted-in for organ donation, and if any person opts not to be part of that system they sign themselves out of the automatic donor involvement scheme;

— provide for sufficient numbers of specialised donor coordinators to be put in place in all major hospitals of Ireland to create a national network of expert personnel charged with operating this vital service;

— establish a national donor registry that facilitates engagement among prospective donors and is accessible by all acute hospitals; and

— initiate a nationwide and effective public information and education campaign that will promote the vital importance of organ donation, the very real and life-changing difference it can and does make for so many and, most vitally, the urgent need for an increase in donation levels in Ireland.

Deputy Caoimhghín Ó Caoláin

I commend the 15 Deputies who tabled this motion on the very important issue of organ donation. It is a timely debate on a pressing health matter that requires concerted and early action on the part of the Government.

We need to address the question of organ donation and transplant in its entirety. There is, clearly, 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 last week at the Joint Committee on Health and Children, Professor David Hickey, director of the national kidney and pancreas transplant programme, identified the three big gaps in the current system. These are lack of organ donors, poor infrastructure in which our 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.

The motion focuses on what is called "presumed consent", a system where all persons are deemed to have opted in for organ donation and they opt out if they do not wish to be donors. As a matter of party policy, first adopted by the Sinn Féin Ard-Fheis in 2008, Sinn Féin supports the "presumed consent" or opt-out rather than opt-in system of organ donation. That reflects our desire to meet the need for greatly increased donations and transplants which, as the motion states, are life-saving and life-altering gifts. That desire is shared by all, whatever their views on the best model of consent for organ donation. I acknowledge that there are differing views on the issue but it is important that we say to each other, irrespective of our disposition, that we are all on the one page hoping to get to a much better place in this regard.

Underlying our position are a number of key principles which we believe should underpin the delivery of health services. We believe that 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 their health and to have their concerns heard. This means that individuals must be empowered to exercise control over their own health and to participate in the decision-making process around health law and policy and, very 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 the cases where the organs of children were removed without parental knowledge much less consent. On this basis, we believe that a complete and comprehensive public consultation should take place on the issue of organ donation, in order to canvass clear public and professional support for a policy of presumed consent. We have called on the Irish Government, British Government and Assembly Executive to ensure that the principle of presumed consent will operate only with regard to organs available for donation to other patients and will not extend to reproductive organs, other tissues and organs for research; presumed consent will operate based on the idea that everybody carries a donor card; 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 the age of 16 years and with legally recognised mental capacity; for children under 16 years of age 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 inform comprehensively the public of a presumed consent policy 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 register officially 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; and an all-Ireland national register on withholding consent to organ donation should be established. This would be automatically accessible to the organ procurement services and managed by the health departments.

The State currently operates under an opt-in scheme. There is no legal restriction on the age at which one can choose to donate organs in the event of one's death but one must carry an organ donor card should one wish to donate, or otherwise register one's willingness to opt-in with a voluntary organisation such as the Irish Kidney Association.

There is no legislation governing organ donations and the law regarding consent and who can provide it is, therefore, unclear. There is currently no legal definition in the State of what constitutes informed consent. In some cases where there is no registered opt-in the medical team may request the next of kin to donate the organs of a deceased person but there is no law governing this practice. Generally, the consent of the next of kin is accepted as valid and a refusal by the next of kin is not contested. Those over the age of 16 may consent to medical treatment and organ donation on their own behalf. Where a person is under this age a medical professional can take consent from the next of kin.

All organ donations are coordinated by the national organ procurement service at Beaumont Hospital, Dublin, under the authority of the Department of Health. An opt-in system also operates in the Six Counties. All organ transplantation within the North is governed by the British Human Tissue Act 2004. Transplant NI is accountable to the Six Counties Minister for Health in the Assembly and to the British Parliament through the English Department of Health.

Transplantations occur when a person has died in hospital, usually when brain stem death is confirmed using strict criteria. Consent is needed – either given previously by the deceased making her or his wishes known or being a registered donor through the NHS Organ Donor Register – and a nominated person or qualifying relative can also consent on the person’s behalf. As in the Twenty-six Counties a child of 16 years of age will have capacity to consent to organ donation. Where they are under 16, they are governed by the Gillick competency rule which stipulates that as a matter of law, the parental right to determine whether or not their minor child below the age of 16 will have medical treatment, or opt-in to organ donation, terminates if and when the child is able to understand fully what is proposed. However in practice it is generally the family of the child who have legal power to donate organs.

Research published in 2009 in the British Medical Journal found that donation rates do increase after the introduction of presumed consent systems. That position has been contested in terms of other jurisdictional experience and very particularly to members of the Joint Committee on Health and Children last Thursday by professionals who have a particular and clearly expressed view. However, the British research seems to support the presumed consent approach. The same research showed that legislation, availability of donors, organisation and infrastructure of transplantation services, investment in health care and public attitudes to and awareness of organ donation all play a role.

This latter is an extremely important point. It is far from a one-dimensional issue. Changing the donor consent system is not by any means a panacea. It may form a key part – but still only a part – of a more comprehensive approach. That was well put by the leading transplant surgeon in the country, Professor David Hickey, when he addressed the Joint Committee on Health and Children. He said:

The other area that will certainly help increase donation rates has been Joe Brolly’s initiative re the so called ‘presumed consent’ or ‘opt out’ option. Much has been said about the unfortunate wording of presumed consent, and I believe that this has to be removed from the lexicology. The presumption should be that the medical and nursing staff bring the topic to the awareness of the potential donor family to allow them the opportunity to think about this process and decide whether it is suitable for them. It must also be remembered that this is a service to the donor family and immense consolation can be derived from donating. Conversely there is also immense desolation derived from not being afforded the opportunity...

However, it has to be accepted that in the countries that have seen a significant increase in organ donation and this increase has been attributed to the adoption of presumed consent, in reality has been the result of massive investment in both physical and personnel infrastructure.

I wish to lay emphasis on that holistic approach that Professor Hickey has outlined and was at pains to point out to us as members of the Joint Committee on Health and Children last Thursday.

I also pay tribute to Joe Brolly's powerful example and his advocacy for the importance of organ donation, in his instance a living donation which, all too sadly, failed in the transplant that proceeded. He is a voice and an example that needs and deserves all our respect.

Again, I commend the proposers of this motion, which we in Sinn Féin will support. We must address all aspects of this issue, most especially the need for greater resources to be devoted by Government for organ transplant. This would result in significant long-term savings for the State but, far more important, it would save and enhance the lives of so many who would benefit from it.

Acting Chairman (Deputy Tom Hayes)

I call Deputy Jerry Buttimer who, I understand, is sharing with a number of speakers.

Deputy Jerry Buttimer

Is it agreed that I can share time with the Deputies on the Acting Chairman's list?

Acting Chairman (Deputy Tom Hayes)

Agreed. They are Deputies Patrick O'Donovan, Michelle Mulherin, Dominic Hannigan, Alan Farrell, John O'Mahony, Paudie Coffey, Peter Fitzpatrick, Pat Deering and Paul Connaughton.

Deputy Jerry Buttimer

Deputy Mary Mitchell O'Connor may also be included. I am not entirely sure of that.

Acting Chairman (Deputy Tom Hayes)

We are short of time so I will have to keep all of you rigidly to time.

Deputy Jerry Buttimer

It is my privilege to speak on this motion, not least as Chairman of the Oireachtas Joint Committee on Health and Children which had the privilege in the past two weeks of hosting witnesses and kidney and other organ donors and recipients in its rooms. I am very conscious that Joe Brolly and Shane Finnegan have become poster people for organ donation and, as Deputy Ó Caoláin noted, they have raised the profile and created a new template for how we can promote advocacy for organ donation. We must change the cultural attitude towards donation and make it the norm in our country. An opt-out system would require an extensive and well-resourced communication strategy, along with other infrastructure. In the four minutes available to me I will not go through all of that. However, this issue has been debated in many countries and it is time that we, as a Government and as a country, began to look seriously at how we can make changes and increase our rate of organ donation. Countries that have changed to an opt-out system have seen a significant increase in their organ donation rates. Over a three-year period Belgium has seen an increase of more than 100% and Singapore has had a massive 700% increase. Any similar increase here would make a positive impact for those who require a transplant.

Those of us who attended the presentation in Croke Park last night can testify to the improvement a kidney or other organ donation makes to the life of a person who needs and deserves one. If we change to a soft opt-out system we must ensure there are simple and convenient procedures that allow people to opt out. We must also make it possible for people to change their mind at any time. Equally, we must ensure that poor language or reading skills, educational levels or the socio-economic, health or other status of individuals will not limit a person's ability to opt out of the system.

I am pleased the Government has put into the programme for Government this proposal to change to a soft opt-out system, with presumption of consent to donation upon death, unless specifically stated otherwise. I commend Deputy Fleming for his motion and thank him for participating at our health committee hearings. The Minister for Health and his Department have confirmed to us there would be no instance where organ donation would proceed without the consent of the deceased person's family. A person's family will always have the final say, which is the way it should be. This maintains the principle that donation is a gift that will help to change the life of another person. As legislators and Members of this august House, we must help not only to change public opinion and perception but must also lead it so that organ donation becomes the norm rather than the exception.

Equally, I praise Deputy Patrick O'Donovan who recently held a very informative presentation on organ donation given by people from my county, Cork, and from County Limerick. Legislation alone will not solve our shortage of available organs. We have heard this from Jim Egan and David Hickey and others at our committee. We must look at the overall infrastructure, at our systems and how potential donors and their families are encouraged to donate.

I hold up this iPhone to demonstrate that we can all download an e-app which in this era can make it easy for all of us to opt in, even those of us who are technically challenged. I commend the Bill and look forward to further discussions on this issue at the health committee.

Deputy Patrick O'Donovan

I thank and pay tribute to Deputy Tom Fleming for bringing forward this motion. It is an example of what can be achieved in Private Members' time, when motions that really mean something to many people in their lives can be agreed, rather than have some of the political posturing that happens, week in, week out. I compliment Deputy Fleming on what is a very mature motion.

I wish to pay tribute to three people who came to the Dáil last week at my invitation, as Deputy Buttimer noted. The Acting Chairman will be familiar with them: Mr. Michael Kiely, Ms Noreen O'Halloran-Hannon and Ms Annette Beston. They came to tell the human side of the stories of a person who received a kidney from his sister and another who received one from an anonymous donor. They spoke of the life-changing experiences those people underwent, both donors and recipients, as well as the persons on the waiting lists. In Ms O'Halloran's case this was her father who undergoes dialysis in a hospital in Cork.

One thing I learned last night at the presentation organised in Croke Park, in conjunction with the GAA and Joe Brolly, is that although there have been almost static numbers of those who donate organs and those who are suitable for transplantation the reality in this country is that rates for procedures such as dialysis are growing exponentially and at a frightening rate. Some aspects we need to address, which are relatively urgent, are to have a national register that makes it easy for people to register, regardless of the opt-in or soft opt-in options, and to have co-ordinators. We must ask ourselves why it is that some small hospitals, such as the one in Bantry, have a great track record in encouraging families at a very vulnerable time in their lives to donate organs. We must ask why this is not the case in the larger and more acute hospitals. There is an interesting piece of work that needs to be done regarding co-ordinators.

I was also struck last night in Croke Park by comments made by those people who ultimately hold people's lives in their hands concerning the standards required and the facilities that are available for the carrying out of organ transplants in Beaumont Hospital. There is no doubt that throughout the great days of the Celtic tiger we left a very poor national infrastructure in place in terms of the facilities that are needed for organ transplant and organ donation.

I compliment Deputy Fleming for introducing the motion. I have invited Members to join an informal all-party working or discussion group on how this can be advanced, outside the hustle and bustle of the health committee. I pay tribute to Deputy Jerry Buttimer for the work he is doing in the committee. I encourage Members to engage in this process because, politics aside, this is something by which we, as Oireachtas Members, can make a real difference to people's lives. I compliment the motion and thank its proposer.

Deputy Dominic Hannigan

I too welcome the motion proposed by Deputy Fleming and am happy we have cross-party agreement on it. A great deal of work has been done in the health committee by Deputies Jerry Buttimer, Ciara Conway and others to progress this scheme and they must be complimented on the work they have done.

The setting up of an organ donation system is a programme commitment of the Government. I understand that work on this has already been commenced, which is good. The next step must involve public consultation. It is important that we give everybody an opportunity to make their views known and to make submissions so we can understand what type of opt-out system would work best in this country.

In the short time available to me, I will outline some figures about donations in Ireland and talk about some e-mails I received from some of my constituents. Last year, there were 78 people who unfortunately passed away but also gave great hope and additional quality of life to other people because they donated their organs. In all, almost 250 people were given the gift of a new organ last year which obviously made not only their lives better but also those of their friends and families. That is not enough, however. Currently there are 650 people on waiting lists for organ transplants, which shows that the current system is not sufficient to deliver the number of organs needed.

I have been contacted by various constituents on the issue, including an individual with a lung disease that has much reduced his quality of life. A new drug which could vastly improve his quality of life is unfortunately not yet available. He wants an opt-out transplantation system to be introduced because he has been on the transplant list since last June. Such a system will offer great improvements to many people in Ireland. This motion is a step forward and it will give hope to many people.

Deputy Paul J. Connaughton

I commend Deputy Tom Fleming on tabling this motion and welcome the cross-party support for it. Much work has already been done on this issue and the heads of the human tissue Bill are at an advanced stage of drafting. That Bill will deal with the removal, use, storage and disposal of organs and tissues of deceased persons and provide for consent on the use of organs from a living person for transplantation and research. It reflects a timely transposition into Irish law of European Union regulations which came into effect last August.

The need for this Bill is apparent for several reasons. The issue of retaining tissues from deceased babies arose a number of years ago and safeguards must be put in place to ensure proper consent for the donation of tissue. The aspect of the Bill which relates to tonight's debate is its provisions on organ donation. The lack of an opt-out facility for organ donation has resulted in many deaths but while the vast majority agree with the introduction of an opt-out system, the arguments of those who disagree must be considered. It is important that the new opt-out is properly explained and widely advertised because the issue of organ donation only arises in the most difficult and traumatic circumstances.

The number of deceased donors has remained steady over the past ten years, with a small increase from 76 in 2005 to 93 two years ago. Advances in medicine have resulted in an increase in the number of living donors but deceased donors remain key to many types of transplant and consent is therefore vital to the success of the organ transplantation programme. Patients awaiting organ transplants will welcome the EU action plan on organ donation and the strengthened co-operation it envisages between member states after 2015. At a national level we must bring the human tissue Bill before the Dáil at the earliest opportunity so that the opt-out facility becomes a reality and the lives of the many people awaiting transplants are enhanced.

Deputy John O'Mahony

I welcome the opportunity to speak on this motion and thank Deputy Tom Fleming for tabling it on behalf of the Independent Group. I discussed organ donation with the Minister for Health several weeks ago and I am delighted not only that the Government is supporting this motion but also that the Minister has indicated his intention to bring forward legislation to address the issues raised.

I was glad to be able to facilitate the visit of a cross-party delegation of Deputies and Senators to Croke Park. We were invited to Croke Park by the ard stiúrthóir of the GAA, Páraic Duffy, in order to meet Joe Brolly, who is leading an all-island campaign to introduce an opt-out system. Having listened to Professor David Hickey, Professor Jim Egan and other eminent experts in organ transplantation, I suggest that we cannot afford not to introduce such as system. Evidence from other countries shows that we need to put an infrastructure in place and develop a public awareness campaign.

It is not often one hears a Mayo man praising Joe Brolly but he has led by example on this issue and I commend the GAA for supporting him. The GAA could be a vehicle for persuading Irish people to support the legislation the Government will be introducing in the near future.

Deputy Paudie Coffey

I welcome the opportunity to contribute to this important debate and commend Deputy Tom Fleming on introducing this reasonable and logical motion. I also commend the Joint Committee on Health and Children on the cross-party approach it has taken to this sensitive issue. When I attended a meeting of the committee last week I was delighted to hear contributions from live donors and people working in the area of organ transplantation. Joe Brolly is a high profile donor but many people around the country have donated organs to siblings and people close to them.

I come from an organ donor family. I tragically lost a sister 23 years ago. At the aforementioned committee meeting I spoke publicly for the first time about my late sister, Ita, who died at the age of 22. My family had to make a tough decision about whether she would donate. I was happy that we decided she would because her tragic loss has resulted in life changing events for two families. A young man her own age and an older man received her kidneys and it changed their lives forever. I am happy to report that my family built a long-lasting relationship with these individuals, who have now become family friends. We have found a sense of fulfilment from our tragedy by offering new lives to others.

I welcome that the Government is supporting the motion. It is important that we appoint co-ordinators for donations in all acute hospitals in this country. At the very least we must establish a donor registry, which is best achieved by means of the soft opt-out option. However, we must also listen to the concerns that have been expressed about such a system. We have an opportunity to work together to provide adequate resources and offer a life changing solution for those who need it.

Deputy Peter Fitzpatrick

The programme for Government envisages the introduction of an opt-out system of organ donation with a view to improving the availability of organs for patients in need of transplantation. The introduction of this opt-out system will mean that the consent of an individual to organ donation is deemed or presumed to have been given, unless he or she registered a wish not to become an organ donor his or her lifetime. However, even though consent will be presumed the family will in practice always be consulted prior to organ donation and if it objects the donation will not proceed. This is known as a soft opt-out system. The Department of Health plans to undertake public consultation on the practicalities of introducing a system of presumed consent. It is proposed that the consultation process will comprise an invitation for written submissions from the public followed by a workshop with key stakeholders.

The most significant issues to be addressed include the difficulty of ensuring the correct identity of individuals in the absence of a national unique health identifier.

Funding would be required to establish and maintain a robust and secure national information technology system to record a person's wish to opt out of organ donation. Funding would also be required for an ongoing advertising campaign to advise people of their right to opt out of the new system.

The new driving licence application form includes an option for applicants to tick a box if they would like a code to be included on their licence indicating their wish to become an organ donor. However, in keeping with the current legal position, it states that applicants' next of kin will be consulted in the event of any decision being taken on organ donation. Since the introduction of the new type of driving licence on 19 January 2013, some 115 people have indicated that they wish to become organ donors.

Last night, I met Professor David Hickey, the director of the national transplant centre at Beaumont Hospital, Professor Jim Egan, the overall national director of organ procurement and transplantation, Mr. Philip Watt, the chief executive of Cystic Fibrosis Ireland and chairperson of the national donor network, and Mr. Joe Brolly, an organ donor. I commend all of them on the work they have done to date.

Deputy Alan Farrell

I thank Deputy Tom Fleming for introducing the motion. As with previous speakers, I welcome any measure that will result in an increase in rates of organ donation. The reference to "presumed consent" in the programme for Government opened up a conversation on this issue and it is appropriate that the Chairman of the Joint Committee on Health and Children, Deputy Jerry Buttimer, arranged for a discussion of organ donation to take place in the past two weeks.

We stand to gain a great deal from the reform of the organ donation system. Figures from 2011 suggest that, notwithstanding the low level of organ donations, 64% of Irish people would be willing to donate an organ. Ireland is one of a small number of countries in Europe that continue to operate an opt-in organ donation system, the others being Germany, Denmark and the United Kingdom. The introduction of presumed consent is not straightforward, however, and I would be interested to ascertain the Minister's view on whether the unenumerated right to bodily integrity, which has been found by the courts to be present in Article 40.3.1 of the Constitution, will have an impact on possible legislation. The courts have interpreted the article as inferring the right to "bodily integrity", which is the inviolability of the physical body, personal autonomy and self-determination of the physical body. I am interested in hearing the Minister's view on the possibility that any legislation for presumed organ donation would be unconstitutional on that basis.

In practice, the Department of Health would have to provide a robust database and high profile awareness campaign to advise people of their opt-out rights and procedures for availing of them. If we are to invest valuable resources into such a system, it would be imperative to first hold a full consultation process with expert groups before making any legislative changes. I understand such a process is under way. In the United Kingdom, an expert group commissioned to report on the impact of presumed consent recommended retention of the opt-in procedure and the establishment of structures aimed at achieving a meaningful increase in organ donation rates.

I was pleased to hear a principal officer in the Department of Health recognise during last week's committee hearings that it is not legislation but the infrastructure and systems in place and the way in which potential donors and their families are encouraged to donate that make a difference in increasing the number of donations. Family participation in the discussion on organ donation is essential. While I recognise the considerable work that has been done by a number of organisations and individuals, including Joe Brolly, in encouraging people to carry a donor card, it is high time the State, through the Department of Health, assisted in this process.

Deputy Pat Deering

I compliment the Technical Group, in particular Deputy Tom Fleming, on initiating this constructive debate. This is an example of how the Oireachtas can hold constructive discussions when people think outside the box. While I normally visit Croke Park to watch GAA matches, my visit last night was to attend a discussion on organ donation. I was especially struck by the presentation given by Joe Brolly about whom we have heard a great deal recently in which he highlighted the need for to increase efforts to promote the Opt for Life initiative.

I compliment Páraic Duffy, Ard Stiúrthóir of the GAA and Liam O'Neill, its president, on taking on the issue of organ donation. The GAA is involved in every community in the country, all which have been affected by the shortage of organ donations. I was approached recently by a constituent whose name was recently added to the list for a heart transplant and who will have to wait until an appropriate heart becomes available. Without a donation, the lifespan of those waiting for a donation may be shortened. As the former county chairman of Carlow GAA, I urge the organisation to do more to try to educate people about the importance of organ donation.

The proposal to adopt a system of opting out is an important one. The reason many of us do not carry organ donation cards is that we are too lazy to bother. For instance, I have not given one drop of blood, which is a matter I must address. The opt-out clause would help us to increase the number of organ donors within a short period. It is great that a life can be saved through organ donation.

Joe Brolly related a poignant story last night about a person who thanked him for the work he was doing before recounting a case where one individual was able to save the lives of seven different people by donating organs. It is important to communicate the benefits of organ donation to help us make progress in this area.

Another important point made last night was that while the cost of transplantation may appear expensive, that is not the case. For example, a kidney transplant costs €74,000 in addition to a further annual cost of €10,000 per annum for patient care. However, a transplant will save an astronomical amount when one considers the costs of dialysis for a patient for a number of years. This is another example of thinking outside the box. Appropriate care must also be provided for patients.

I compliment the outstanding doctors and consultants in the health system, in particular Professor David Hickey in Beaumont Hospital, on their work. While this initiative is now coming to the fore, Professor Hickey informed us last night that he is working in Third World conditions in a prefabricated building in the hospital in which the transplant unit is located. This is not good enough in 2013 and the issue must be addressed. While finances are scarce, it is important not only to introduce legislation, but also to provide infrastructure to follow it up. I am pleased to support the motion and compliment Deputy Tom Fleming again on proposing it.

Deputy Joan Collins

I am pleased to speak to the motion and thank Deputy Tom Fleming for tabling it. It is good the Government has agreed to accept it.

I have a personal interest in the issue of organ donation. I attended the meeting in Croke Park last night at which Joe Brolly stated that when the issue of organ transplantation impacts on us at a personal level, it heightens our awareness. One tends to go about one's business without considering the option of giving blood or carrying an organ donor card. However, when the issue hits close to home, one starts to think that it is necessary to carry a card, especially when one sees that transplants can save lives.

We heard poignant words in the audiovisual room last week when speakers addressed Members on kidney transplants. We learned there was a chronic shortage of kidneys in 2011 when only 165 kidney transplants were performed and between 250 and 300 transplants were needed.

What are the next steps? I understand the reason people do not like to discuss organ donation as it relates to what happens to the body after one's death.

The legislation, particularly if it encourages people to become donors, will change the thinking in respect of organ donation. This is very important, particularly as provision is made for people to opt out. If, for example, a person who is in hospital dies, the consent of his or her family or next of kin will still be required in order for his or her organs to be donated. Co-ordinators are crucial to the process and they have made a massive difference at Beaumont Hospital, where they talk to people and work with families to ensure kidney donations.

I spoke to a few doctors last evening and they indicated that what is really needed is a single transplant unit. This is because the infection which arises in respect of all transplants is the same. If all transplants were carried out under the one roof, it would be fantastic. In that context, reference was made to the conditions in the prefab units at Beaumont Hospital. Those who work in those conditions at that facility are doing tremendous work.

On public awareness, organ donation week took place some three weeks ago. I do not believe that too many people were aware of its passage. We need to put plans in place to get a message out during organ donation week. Perhaps the public broadcasting company, RTE, could do a programme on people who have undergone kidney transplants and the positive things that have happened to them, those who have become live donors and those who have undergone heart and lung transplants.

I am sure previous speakers referred to the model in Spain. In Northern Ireland, an all-party group involving politicians, clinicians and groups which are part of the transplant family have entered into discussions on this matter. In the South, Cystic Fibrosis Ireland, CFI, and other organisations operate in this area. An important first step in the process might be to pull those groups together to discuss what is practical and what is needed. We do not need a debacle like that which took place with the national children's hospital, where the various institutions tried to have the hospital located at their facilities. We need to begin very soon the conversation about what is needed.

I must admit to being somewhat frazzled because I have just returned from the May Day march in O'Connell Street. I take this opportunity to express my solidarity with my former work colleagues in An Post, with the members of the United Left Alliance and with all my friends here. I wish everyone a happy May Day. This year is, of course, the 100th anniversary of the great Lock-out.

Deputy Finian McGrath

I welcome the opportunity to contribute to this important and urgent debate on organ donation. I thank my colleague, Deputy Tom Fleming, and the other Independent Deputies for bringing forward this motion and commend them on it. The motion shows how Independent Deputies can work together in respect of a very important issue such as organ donation. This motion contemplates humanity, the importance of care and the need for support both for individuals who are trying to stay alive and for their families. The bottom line is that we are trying to save lives. This motion is all about life and I commend the Government on accepting it. This is an important decision because it clearly demonstrates that it is possible for us all to unite around sensible proposals put forward by Opposition Deputies.

I was present in Croke Park last night with Deputy Joan Collins and representatives from all the political parties. The event we attended there was a very moving and professional one. We met Joe Brolly, Shane Finnegan and many other amazingly brave people, including Professor David Hickey and Dr. Rory Dwyer from Beaumont Hospital. The individuals in question made a massive impression on all the Deputies present. They were sincere, professional and had their figures ready. The presentation they made was excellent. Above everything else, however, one was struck by their sincerity. I was extremely impressed by their presentation. My colleagues from across the political spectrum were both delighted and honoured to be present. When I heard that the Government had accepted the motion, I was absolutely delighted for the families and for everyone who has worked in respect of this matter. I met one particular little girl last evening who had a transplant and I was struck by the amazing and dramatic change which has occurred in her during the past nine months. As I stated, Joe Brolly was at the event, and he had donated a kidney to Shane Finnegan, who was also present. I understand that in the region of 470 people require transplants. This motion is about giving those individuals an opportunity to lead real lives. I take this opportunity to thank the GAA for its magnificent support for Joe Brolly and Shane Finnegan and I commend the organisation on allowing us to use its facilities.

In the context of the economic position, the cost of running the health service is a matter which regularly arises in the presence of the Minister for Health, Deputy Reilly. The cost of keeping someone on dialysis for ten years is €750,000. If that person underwent a transplant, the position would be different. We should all make an effort to become donors. I have been one for a number of years. However, there is a need for public representatives to show leadership in respect of this matter. When one witnesses the impact a transplant can have on a family, then one realises the importance of what is being done.

A number of speakers, including Deputy Joan Collins, referred to the conditions which obtain. We have top quality doctors in this country, such as Professor David Hickey, Dr. Rory Dwyer and others, but they need our support in the context of the provision of proper infrastructure. We must focus on matters of this nature. We have skilful individuals but we have a difficulty in that there has been an exodus of many of the top medical people out of Ireland. I have major concerns about this matter. We spend millions training these people and suddenly, as a result of the economic climate and issues relating to pay, they are going elsewhere to use their skills. This is an issue we need to consider carefully.

I am very close to Professor David Hickey, who does a great deal of work with the health service in Cuba. Beaumont Hospital, which is located in my constituency, has many links and is involved in many projects with the health service in that country. People might not necessarily agree with everything that goes on in Cuba but their health and education systems are world class. We can definitely learn something from them. I recall having a pint with a medical student in Havana on one of my visits there. There is no smoking ban in that city but I will not go into that matter now. The student in question told me that as part of his training as a doctor, each summer he is sent into the mountains to work with poor families on a voluntary basis. When doctors in Cuba qualify, they work in the health service and give a commitment to it. This is almost regarded as being a patriotic duty. We have top class doctors and nurses in this country and we should look after and develop them.

One hears a great deal of criticism of the North. If, however, Sinn Féin, the DUP, the Alliance Party and the Ulster Unionist Party can agree on this issue, there is no reason we cannot do so. I am glad that all the parties on the two parts of this island have come together on this matter. "Make Life Your Legacy" is the slogan used by campaigners in this area. A good infrastructure for organ donation and transplantation is in place in the North. There is now a proposal for a modern, fit-for-purpose organ donation system here in the South. We also need a stable donation transportation infrastructure.

It is important that we should learn from what has happened in the North. In that context, on 5 February, the Executive formally announced that it is moving forward with its legislative plan. All of the parties in the Northern Ireland Assembly fully support the proposal and it has been endorsed by the British Medical Association, BMA. All the patient groups, including the Northern Ireland Kidney Patients Association, the Northern Ireland Transplant Association, the UK Heart Foundation, and others, support it. An all-party group comprising Assembly Members, clinicians in the relevant fields and leaders of the patients' associations was formed at Stormont on 24 of February 2013 with a view to spearheading the move towards the new system and dealing with all the other relevant issues. Public consultation is to be announced shortly and the Executive's ambition is to have the new legislation in place by the end of 2014.

The Assembly is working closely with these groups.

The proposed legislation has two components. The aim is a system that accurately reflects the view of society that organ donation is a good act and thereby maximises the number of donors after death. Under this system, we would all start as donors. Those who do not wish to be donors after death will be able to register their objection by opting out of consideration for donation online. Importantly, this will be a confidential process. Have I gone over time?

Acting Chairman (Deputy Paudie Coffey)

No. The Deputy has two minutes remaining.

Deputy Finian McGrath

Even if someone does not register an objection to donation, the family or loved ones will need to give written consent at the hospital in order for the donation to proceed. Therefore, this system is based on informed family consent. It is critical that this central message be communicated strongly and simply to the public to prevent misunderstandings about the new system. The importance of good public education cannot be understated. As such, we all have a role to play in this debate. Last night's meeting at Croke Park played another part. We need to develop that approach and improve our game.

Family consent will be required because organ donation is a sacred gift from one family to another at a difficult time. The new law will enshrine the principle that donation after death is a gift freely given. In turn, this will ensure public support. Under this system, the fact that citizens will decide whether to opt out will effect a change in society's mindset.

I welcome the debate and the Government's acceptance of the motion. I commend my colleague, Deputy Tom Fleming, who has led on this issue and has brought us all on board. He has shown courage and vision and has sent out a simple and straightforward message, namely, we care about people and must do something for the 470 patients currently awaiting transplants. I commend the motion to the House.

Deputy Seamus Healy

I welcome the opportunity to contribute on this Private Members' motion. I commend my colleague, Deputy Tom Fleming, for introducing the motion and for presenting it in a simple and straightforward way. It brings the topic of organ donation to a new level and puts on the agenda a call for new legislation to ensure the future availability of organs for transplantation. I welcome the Government's decision to accept the motion and I hope it will introduce legislation urgently to implement a new system of organ donation.

Undoubtedly, organ donation is a life saving and life altering gift that shows incredible generosity on the part of families at times of great loss and sadness and on the part of individuals who have made their desire to be donors known. Transplants transform the lives of recipients. As some of the literature on the matter reads, organ donation is the ultimate act of love.

It is important to mention Ireland's proud record of organ donation since it first began in 1964. Transplantations have been carried out in three hospitals, namely, St. Vincent's Hospital in respect of liver transplants, the Mater hospital in respect of heart and lung transplants and Beaumont Hospital in respect of kidney and pancreas transplants. Since 1964, the total number of deceased organ donors recorded is 2,272 and the number of transplants performed is 5,183. The majority were kidney transplants, followed by heart, pancreas, liver and lung transplants. In 2012, deceased and live donors numbered 78 and 32, respectively. In December 2012, the number of patients on the transplant list was 563, 35 more than at the same point in 2011. The number of donations fluctuated in 2010, 2011 and 2012, with 2010 seeing lower numbers than in previous years. In 2011 and 2012, however, the numbers increased again. All of this places on the agenda the question of a new approach to our system of organ donation, the matter with which this motion is concerned.

Per head of population, Ireland has one of the better records of organ donation, placing us above our nearest neighbour, the UK, where 16 donations are made per million of population. We fluctuate between 18 and 22 donations per million. We use the opt-in system, which is under review. The programme for Government proposes a soft opt-out system, whereby it is presumed that individuals have opted in unless they have deliberately opted out or their relatives indicate their wishes not to donate. Such a system has provided higher numbers of organs for transplantation in other countries. While it would do the same in Ireland, it would need to be placed on a legislative basis. The motion calls for the implementation of a system whereby everyone is deemed to have opted in for organ donation. If anyone opts not to be a part of that system, he or she must sign out of the automatic donor involvement scheme. As such, legislation must be introduced.

Another question is that of the availability of co-ordinators at acute hospital level, particularly in intensive care and accident and emergency departments, to organise this vital service. In other countries, co-ordinators have been found to be the key to an increased number of donations. They must be provided as quickly as possible.

The motion correctly calls for the establishment of a national donor registry that would facilitate engagement with prospective donors and be accessible to all acute hospitals. This element of the scheme would be beneficial.

An information campaign does need to be rolled out. The four elements outlined, namely, a soft opt-out system, the appointment of co-ordinators, the establishment of a register and a publicity campaign, are necessary to provide a successful system for this vital service. I commend the motion to the House and I thank Deputy Tom Fleming for introducing it.

Deputy Maureen O'Sullivan

Gabhaim buíochas don Teachta Tom Fleming as ucht an obair a dhein sé ar an ghnó Comhaltaí Príobháideacha seo atá á phlé againn. I will begin with a personal story. Some years ago a young male relative of mine contracted a viral infection when working abroad. The hospital where he was treated identified that he would need a heart transplant at some stage. He came back to Ireland and over the next year or so his physical deterioration was visible. During that time he received various treatments, medication and procedures in the cardiac section of the Mater hospital. Eventually, he had to be taken into hospital because it was identified that he needed a heart transplant. He was connected to machines to keep him alive. When visiting him in hospital during those weeks the care and dedication of the team was obvious. We were also aware that in order for him to get a heart it would mean another person losing his or her life. While hoping for life for him we were also conscious of the implications of that.

I spent a couple of weeks visiting him and then I remember getting a call one afternoon from his mother to say that a heart had become available and she asked me to stay with them while they were waiting. I went straight to the hospital. I clearly recall the emotion and tension during the wait while tests were carried out on the heart and various other procedures to see whether it would be a match. Once the word came that it was a match I can remember the rush to get him into the operating theatre. It was about 11 p.m. and we thought we would be there all night but the operation was relatively short and after a couple of hours the surgeon same in to say it had been successful. I would love to say that the story had a happy ending, it did not but he did get about three or four years with the new heart, which gave him a great life, one that he did not have for the previous couple of years when his health was deteriorating. Unfortunately, he passed away in spite of getting a new heart.

Being in that situation made me realise the importance of organ donation. I had always carried a card but that experience brought it home to me how vital it is that we are aware of the need for organ donors. I am conscious of the other lives that might have been saved if more people carried organ donor cards or if families or next of kin knew the wish of their loved ones to donate organs in the event of the situation arising. As the motion states, it is important to emphasise the incredible generosity of families who give consent for donation because it is at a time of great stress and great loss for them.

The motion refers to the Spanish and Croatian experience where there is a cost saving. Apart from the moral and ethical reasons, there is also an economic one. In Croatia, organ donation structures resulted in increased donation rates to 30 per million of the population compared with 18 per million of the population in this country. What is significant in Croatia is the network of hospital physicians responsible for organ donation within intensive care units and also that the legislation there was adjusted to include the opt-out in keeping with Spain, Belgium, Austria and Portugal. The countries that have made serious efforts on organ donation and transplants have seen major benefits, both medical and financial.

This country did have one of the highest rates of donation but, unfortunately, it has fallen. It is interesting to note that in 2010 there was a record low of 58 donations, in 2011 there was a record high and in 2012 the figures were below average at 17% less than the previous year. The first step is to introduce legislation as that is a major way forward. Another step is to intensify a public awareness campaign to address the need for donors. One aspect of that is the opt-in system for organ donation. If a person decides not to be part of the system, he or she can sign out of the automatic donor scheme. Those who do not wish to donate have an opt-out, otherwise they are presumed to have opted in.

According to Mark Murphy of the Irish Kidney Association, even in countries which have the opt-out clause the law still dictates that relatives have the final say and can veto any decision. Presumed consent is not always feasible in practice. If presumed consent is the way forward in this country then citizens must be informed and know as much as possible. A donor should be able to have the satisfaction of knowing that he or she will be a donor if the situation arises. A clear public campaign is needed in order for people to know what they are doing and that it is a very important civic duty. Equally, the campaign must ensure that people who opt out know the position. It must be phrased in language that can be understood by everybody, including those who have literacy issues.

Demand is outstripping supply. Organisations such as Falun Gong tell us of the growing black market for organs. That can be eliminated if we all have the same system of presumed consent. I note that a couple of years ago the Irish Medical Organisation advocated for a hard mandated choice model which takes away the burden of decision-making from the family. That would help both the family and the medical workers during times of traumatic or sudden death.

The team in the Mater hospital was excellent. I can see the need for more such teams with trained personnel to co-ordinate the donor system so that we have qualified donor co-ordinators in hospitals across the country. It is important to acknowledge the three transplant programmes we have in Beaumont Hospital, the Mater hospital and St. Vincent’s Hospital. Because of the increasing pressures on them there is a need to ensure that the work is not just confined to those three hospitals in Dublin. We know the cost effectiveness of organ donation. Treatment for people waiting for organs costs the health care system more than the organ transplant operation so investing in donor co-ordinators would be cost effective.

I read a recent article by Professor Jim Egan in The Irish Times. He also made the point about the need for an independent national organ procurement office. If we had different policies on alcohol, drugs and diet we could eliminate some of the need for organ transplants. In the article to which I referred, Professor Egan outlined that there are 685 people awaiting transplants. I know the stress of waiting for a transplant for my young cousin and I can only imagine what those families are going through now as they wait for another family to experience loss and distress so that their loved one will have a chance of life.

I will conclude by quoting Professor Egan:

Organ donation and transplantation in Ireland is at a crossroads. With both the proposed “soft opt out” legislation and infrastructure support there is an opportunity to provide enormous benefits for generations to come.

It is excellent that we have had another experience tonight of across-the-board support for the motion.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I congratulate Deputy Tom Fleming and everyone who has contributed on the issue. It genuinely shows how we can operate in a very effective way when we co-operate. I speak about both Government and Opposition. It is rare enough that we agree on issues even when they are clearly of benefit to society but when we do it is illuminating and we do it well.

I am responding to the debate on behalf of the Minister for Health, Deputy Reilly. I thank Deputy Tom Fleming and members of the Technical Group for raising this important issue. It is encouraging that there is agreement throughout the House on the motion that is aimed at increasing the number of organs available for transplantation. I was listening to the debate and while it may be a cliché it is nevertheless true that the gift of an organ is the gift of life.

Those who receive and those who give benefit in equal measure.

Many Deputies mentioned Joe Brolly and the positive impact of his gesture in terms of increasing awareness of organ donation. Indeed, we must consider organisations like the GAA and the impact they can have. The GAA is in every parish in the country and can have an enormous impact when it gets involved in any issue. Of course, members of Irish Donor Network already host a Organ Donor Awareness Week, which is all about keeping the spotlight on the issue.

I listened with interest to Deputy Maureen O'Sullivan's speech. I have an experience from the other side, that of the donor. I agree there is great joy associated with the gift of an organ, whether it is a retina, heart, lung, kidney, or in some instances, liver. At the same time, I must commend the bravery of families who make the decision to donate the organs of their loved ones. Having seen that at very close quarters, I know how difficult such a decision is. We speak about issues such as opt-in and opt-out systems but without having had any personal experience of these issues, we sometimes do not realise the difficulties involved in making the decision to donate. Once again, I commend the bravery of those people who have to make such a decision. They make it in the knowledge that there is no hope for their own loved one. They also make it in the knowledge that there are people who are desperately awaiting those organs, which will make an enormous difference to their lives. The most spectacular changes I have seen have been with people who get kidney transplants. There is nearly an overnight change in their condition. It is quite spectacular to see that and to see the joy it brings to them and their families. However, we should never forget the courage and bravery required in order to ensure that this happens.

The Government has recognised that improving organ donation rates is a national priority. That is why the programme for Government contains a commitment to the introduction of an opt-out system of organ donation. The overall objective of this commitment is to improve the availability of organs for patients in need of transplantation. Those who have received organs and who have gone on to have different lives as a result have become very involved in this campaign. Deputy Sherlock and I know a lady, Noreen O'Halloran-Hannon, who is a recent recipient of a kidney and has become hugely involved in the organ donor awareness campaign. Her own personal experience tells her the benefits that organ donation can have. We should not forget those people either. Those waiting on an organ donation are in the need of the gift of life.

Prior to introducing this new opt-out system, the Department of Health will be embarking on a national consultation process on how such a scheme should operate. Of course, changing the consent system alone will not improve donation and transplantation rates. Many times in the course of the debate on this motion Deputies emphasised that consent must be part of a package of measures which will serve to improve the infrastructure within our hospitals to support the teams who already do sterling work in this area. Donor co-ordination, education and awareness about the benefits of transplantation must be part of the package. Deputy Kelleher said last night that he wanted to see a broad-based consultation and information campaign undertaken and research conducted into the most successful methods employed in other countries, a statement echoed by many other Deputies. We know that some countries which have an opt-out consent system do not have good donor rates which indicates that other factors must also play a role. We will analyse practices and patterns of donations in other countries. We will also ensure that the views of the voluntary agencies, through the Irish Donor Network, are an integral part of the process, as their members have a wealth of knowledge and experience in this area.

Deputy Boyd Barrett questioned whether our air ambulance service was adequate to meet the needs of patients. I assure the Deputy that all of the recommendations made by HIQA in 2011 following its investigations into why a patient was not transported in time to receive an organ donation have been implemented. A national aero-medical co-ordination centre ensures that all transport between hospitals, including transport of retrieval teams for organs, takes place in a timely fashion.

As a nation we have proven many times in the past that we can change our cultural attitudes and adapt to new ways of thinking and working to achieve our health goals. Similarly, the Government wants to see a change in our cultural attitude towards organ donation so that in the future organ donation becomes the norm.

I thank everyone who contributed to the debate in a very genuine fashion. Simply changing the system by which people give their consent will never be good enough on its own, however. There are, for example, very small hospitals in Ireland which have a very high rate of organ donation, while some of the biggest hospitals have a lower rate. That is more than a systems issue. That clearly demonstrates that some people in certain hospitals have a particular interest in this issue and take the time and summon the courage to broach what is a very difficult subject.

Deputy Thomas Pringle

I wish to share time with Deputies Donnelly and Tom Fleming, with the agreement of the House.

I commend Deputy Tom Fleming for tabling this motion for debate, which is very worthwhile and timely. This is something to which we must commit ourselves wholeheartedly. We must commit to changing the system we have for organ donation. I welcome the Government's commitment to initiate a consultation process and I hope that it will commence and conclude sooner rather than later. We must change the system of organ donation with the aim of having an enormously positive impact on people's lives.

The current situation in Ireland is that if one wishes to become an organ donor after one's death, one needs to inform one's next of kin of that intention. Consent is never presumed and even if a donor card has been signed, the next of kin will always be asked for consent for the organs to be donated. If the next of kin refuses that consent, even though the donor card has been signed, the donation does not take place. It is very difficult for the next of kin, who may be in a very traumatic situation, to have to make decisions like that when they are consumed with thoughts of the loss of their loved one. They should not be put in that position and asked to make those decisions at such a difficult time.

Several Deputies made reference to the opt-in or presumed consent system and asked whether it would be viable and would work here. In that context, we must look to the Spanish experience. In 1999, the Spanish introduced a presumed consent system but it did not increase the organ donation rates and did not have the desired outcome. They then realised that they needed a system of informed rather than presumed consent, so that people at all stages of their lives, be they children in school or adults at work, could be informed constantly of the benefits of organ donation. In that way, people became very aware of what the process involved, the benefits to be achieved and they then gave their informed consent. That appears to have worked and to have significantly increased the organ donation rates in Spain, leading to the improvement of so many lives.

During the consultation process we must explain the process fully and explore how informed consent could work in practice. If we do decide to change the consent system and work towards an automatic opt-in system, we must continue with the education process on a constant and well-funded basis. The education programme must work all year round, every year so that we can improve donation rates here.

There are currently 650 patients awaiting transplantation around the country and one deceased donor can potentially help nine other people and have an enormous impact on many lives. We must recognise the value of that and develop a system to greatly enhance and improve it.

One of the hard facts of increased transplantation is that it assists the Exchequer. Figures were given out last night indicating that a patient on dialysis who receives a kidney transplant saves the Exchequer in the region of €750,000, which is not insignificant and may be a hard fact to be considered by the bean counters. Perhaps it will make this policy change possible if they can see those benefits.

This has been a very worthwhile debate and we will also look forward to and will participate in the consultation process that is commencing. We will be looking to see how the issue changes. I pay tribute to Mr. Joe Brolly and his selfless act in being a live donor of a kidney to somebody he did not know all that well. He tried to help that person but unfortunately it did not work out. That kind of act has put this issue front and centre, making us all focus on the donation system and the need for developing informed consent. It is a great tribute to Mr. Brolly, and I know many other live donors in the country who may not have the same profile. His action has raised the profile of this issue. We must have informed consent and I look forward to the start of the consultation process and the change it could bring.

Deputy Stephen S. Donnelly

I start by congratulating Deputy Tom Fleming on putting down this very sensible motion. It is fantastic that we have the time in the Oireachtas to raise it. As I examined the statistics of the issue, I was most puzzled by the fact we do not have a donation programme, and it is obvious that this is the right way to go. There is no compunction on anybody to be a donor and it is a very simple psychological switch between opting in and opting out of such action. That is not a criticism of the Government but I am puzzled as to why the Oireachtas has not debated this issue. I am delighted to hear there will be what sounds like a very comprehensive review, and as part of that the Government might examine why something that is so obvious and useful has not yet happened.

I was quite taken by the effectiveness of the opt-out policy. Austria has such a policy and has a registration rate of 99%, which is eight times that of Germany, which operates an opt-in policy and has a registration rate of 12%. There are 24 European countries with opt-out policies, so it is great that this issue has been raised. I am genuinely puzzled as to why it has not happened before, as there is obviously a great need for it. I have examined the figures and only 25% of the population hold donor cards; I hold up my hand, as I do not have one and I will have to get one after this debate. Last year, we had 560 people on the donor list but only 110 donors. It is a no-brainer, as there are waiting times of six to 12 months and our ranking in Europe is pretty bad. We are ranked 24th with regard to heart transplantation, 12th for pancreatic transplantation, 12th for liver transplantation and 15th for lung transplants. There is an obvious solution to that problem and there is a great need for us to improve. I hope that will happen soon.

There has been cross-party support in the Dáil for this process but the public does not seem to share our view. That may be why the rates are so low, and perhaps there has been political self-interest exhibited by Governments over many years that has led to the matter being neglected. A survey was done by thejournal.ie just a few days ago on 26 April, and I imagine to Deputy Fleming's credit, it was down to him putting the issue on the agenda. It is interesting as 46% of people indicated we should move to an opt-out policy, 45% indicated we should not and a small margin had no opinion on the matter. It was not a statistically significant sample and it clearly was not randomised but it indicates the responding population was split almost down the middle. There is an interesting disconnect between what we are saying in here and what the people we represent are saying around the country. It sounds like serious communication and debate must happen on the issue, and I was surprised that the public seems to be in no way fully behind such an initiative.

As Deputy Pringle and others have said, the acts of the Gaelic Athletic Association, GAA, and Mr. Brolly in particular, will go a long way, I hope, in raising the issue. I read in the papers yesterday that the GAA will have a full page in all match programmes throughout the year highlighting the matter, which I hope will be a phenomenal help. The Minister of State and her Government will have to bring the public along on this issue.

I will conclude by congratulating Deputy Fleming and welcoming the Minister of State's comments. I did not hear the Minister of State speak about timelines and it would be great to hear them. It is fantastic that there will be a report, as although it is in the programme for Government, it is not on the legislative agenda; no Bill has been tabled in this regard. I understand the need for a report but it would be great to have a specific timeline. We are approximately halfway through this Dáil and there may be a significant lead time if we take into account public consultation and debate, an expert group process and drafting of a Bill etc. I apologise if such a timeline has already been given but if it has not, perhaps the Minister of State could revert to the House to outline how this may be turned into law.

Deputy Tom Fleming

I will be brief in summing up the debate. Some vital components must be put in place and there is no major cost to the Exchequer in dealing with some of these basic matters. For examples, the establishment of a national organ donor register would encourage more people to sign up and be willing to be a donor. It would be most effective in this technological age, providing a central database that could be accessed by all hospitals. The UK has a similar register, and the country ran a campaign at the beginning of last year to highlight organ donation. Some 157,000 people registered in that instance, although I realise we cannot necessarily make comparisons because of a significant variation in population. It is nonetheless a tremendous response so we should immediately look to forming a register.

A new driving licence format has been introduced, giving an opportunity for people to agree to become an organ donor, designated by the code "115" printed on the back of the licence. The Government is essentially collecting information in this process, which is most important, and it will be a natural starting point for a national database at no extra cost to the Exchequer. Nevertheless, we must not forget that there are many people out there with no driving licence, so we may need to work out other mechanisms to bring in those people in a simple manner. There are people with no access to computers and organ donor cards could be allocated through other ways, including using a prepaid envelope to send details to the register.

We must continue to promote the idea of living donors and reduce the time taken for cross-matching and other aspects involved in the process. I applaud Mr. Joe Brolly for publicly becoming a living donor, as well as the recipient, Mr. Shane Finnegan. Such an act is the ultimate gesture of selflessness and bravery. It is really beyond the call of duty.

All those living donors who would do likewise are giving people life saving opportunities to live a normal life and they deserve the highest commendation. A high profile person like Joe Brolly is highlighting the issue for the public and raising awareness. He is a well known figure from his involvement in the GAA and what he did is to be highly commended.

We cannot forget the excellent work being done by the co-ordinators. There are six of them in Beaumont and we must provide more of them. It is an essential service and I hope the Minister will note that tonight and make proposals to develop it.

Given the current financial constraints on the health service, a primary barrier to the development of a successful programme is the requirement for a commitment to additional allocation of both financial and human resources to enable the service to develop and deliver. This will require a number of key elements including investment in infrastructure in the national renal transplant centre in Beaumont Hospital and investment in the development of the transport team, and the reorganisation of general urology services regionally and nationally. The kidney transplant programme is at a critical juncture; development of the programme needs further investment. The investment will result in the doubling of life expectancy of patients with renal failure and will save the health service in excess of €240 million in the next ten years. We should not overlook the financial gains or the new lease of life that is given to those who have been affected. The extension of the kidney transplant programme to cover 250 kidney transplant would result in enormous benefits.

I thank the Technical Group for allowing me to put forward this motion. I also thank Ms Yvonne Murphy, the secretary to the group, for her input and help with this. I am grateful to Deputy Patrick O'Donovan who brought in the transplant expertise group to Dáil Éireann. I approached Deputy O'Donovan saying I had an opportunity to keep up the momentum on this issue and he liaised with the Chief Whip who put me in touch with a very helpful senior civil servant in the Office of the Taoiseach who very generous with his time and services. We reached a consensus across the political divide and I welcome that. We should not make a political football of these sensitive matters.

I thank everyone who contributed over the two nights. The "Healthy Ireland - A Framework for Improved Health and Wellbeing" document was given to every Member today. In the forward by the Taoiseach, the last line is "We are in turn calling on leaders from every sector of society to join us, and help us. By getting involved, by working together, we can make real progress in making Ireland a healthier nation." We have set out, tonight and last night, down that route.

Question put and agreed to.