Seanad Éireann debate -
Wednesday, 14 Dec 1988

Vol. 121 No. 12

Adjournment Matter. - Organ Transplantation Programme.

Mr. Fallon

I thank the Minister for attending here this evening. I requested this debate in the hope of creating further public awareness of the problem of organ donation and transplantation. Most people I am sure will be aware of some acquaintance who has a medical problem that can only be cured by transplantation. Indeed, in Athlone two friends of mine are on a dialysis machine, one of them is on a home dialysis machine and the other travels three times a week to Beaumont Hospital in Dublin for his dialysis. Another acquaintance who lives in south Roscommon, in the Minister's constituency, also travels with that person to Dublin three times a week. What all of those people have in common is the aspiration for a new lease of life in the form of a kidney transplant.

Over the past 30 years we have been fortunate to have developed a very fine transplantation programme for heart transplants, liver transplants and, best of all, for kidney transplants. In addition to these more well-known types of transplants is the cornea transplant programme which has restored vision to many people. The kidney transplant programme, which is the largest in the long-established programme in Ireland, brings new life and vigour to those who were previously living with the strain associated with renal dialysis. Benefits also, of course, accrue to the family and friends of those who receive kidney transplants and, through restored health, to the country at large. None of these benefits could possibly accrue without the generosity and spirit of unselfishness which the donors and their relatives domonstrate in a manner which is seldom excelled in the field of altruism.

The abilities of our health services and the professional staff who work in the service to adapt and apply the benefits of the newest and proven technologies and therapies must also be valued and praised. The success of the transplant service is very much dependent on the availability of donated organs from those who die. It must clearly be a demonstrated wish on the part of each of us to be an organ donor by carrying a kidney donor card or a multi-organ donor card. I understand that 75 kidney transplants were carried out last year. There are 180 persons awaiting kidney transplants and this number is growing each year through a growth in the population requiring dialysis and the lack of suitable organs available for those awaiting transplantation.

The numbers who might benefit from heart transplants are quite small at present. About 12 persons might benefit from such transplants. A similar position pertains in the area of potential liver transplants. Obviously smaller numbers do not in any way lessen the desirability of or the need for an enhanced number of suitable organs being available to meet these needs.

The development of a cornea transplant bank in Dublin is a further example of how we are keeping to the forefront in adapting technology to our needs. Such a programme is most welcome and will be of enormous benefit to those 250 persons who at the moment could benefit from such a transplant. However, the number of corneas available for transplant is limited and even more donors are needed.

Ireland is fortunate in having very active voluntary movements who do excellent work in publicising the benefits that can be derived from people carrying organ donor cards. The success which they have achieved can be measured by the fact that there are 1.5 million carriers of those donor cards. This achievement is remarkable by the standards of any country and is indicative of their ability to ensure that the benefits which can be given through transplantation are understood by the general public. What is now happening is that people who had kidney donor cards in the past are now holders of multi-donor cards — a development which will, I am sure prove very helpful, particularly in the area of cornea transplants. The multi-donor cards were recently launched with tremendous publicity and great assistance from the Minister for Health and important people in the public domain.

In dealing with the issue of organ donations there is great need to ensure that the most up-to-date information is readily available to the national transplantation centre. I understand that while we have a transplant co-ordinator for the kidney transplant programme, we do not have any formal national co-ordinating arrangements for the transplantation of all organs. This is something the Minister might consider reviewing with a view to realising the benefit which would be attainable by the establishment of a national service dealing with all organ transplantations. I know that we have developed good links with our English counterparts. These have proved to be of great benefit in that any organs available for transplant which may become available which are not fit for Irish recipients can be made available throughout England and vice versa. The Minister might see whether we could expand the benefits from this inter-country operation on a wider basis throughout Europe.

It is important that we encourage people to carry donor cards and, in particular, that we ensure that the relatives of those who have died are aware of the benefits that can be given to other ill persons, even at a time of great stress and great trauma. One of the concerns which might be expressed about the scheme is that the wishes of the individual might not be carried out. While a person may well wish to donate organs we depend on the relatives of such a person to ensure that their wishes are carried out. It is in this context that it might be desirable for the Minister to consider the establishment of some centralised type of register on which everyone's wishes would be recorded. Perhaps it is time to firm up this aspect of organ donation on a legislative basis.

The question of organ donation must be kept before the public. It is desirable that the benefits and the use that can be made of organs should be centrally publicised in order to ensure that everyone understands the opportunities which are offered to mankind by organ donation. Indeed, it is absolutely essential that the programme which the Irish Kidney Association and the Fight for Sight Campaign have established should be supported fully and perhaps added to by the activities of the health promotion unit of the Department of Health. We should continue to provide appropriate information to the members of the various professions involved in dealing with this issue and keep it updated on a regular basis.

Perhaps the Minister might consider establishing a permanent campaign to promote the donation of organs and also look at the information type campaigns directed at the public. In the short term, I suggest that the Minister might consider writing to each of the eight health boards and requesting them to discuss this problem. In that way there would be immediate debate with the members present at the meetings and in turn the press would take it up so that, in one swoop, every provincial newspaper would write about this problem, thus creating the type of awareness I am looking for and to which we all aspire. This would have beneficial effects down the line because it would go from the health board staff to the nurses to the medical personnel of the various health boards.

I acknowledge the debt of gratitude we owe to all those who carry organ donor cards and to the families of those who give their consent for the use of organs at a difficult time for the betterment of mankind. I hope this debate will encourage those who do not carry an organ donor card to do so from now on and so ensure that the supply of suitable organs is increased for those vital lifesaving transplants.

Mr. J. O'Toole

I express my gratitude to Senator Fallon for affording me an opportunity to speak in this debate and to the Chair for accepting it for discussion. It is an issue that Senator Fallon and I have in common and we have discussed it on a number of occasions before.

What is happening in the kidney transplant programme in many ways goes on without people being aware of it. I would like to put a few statistics on the record. We have a thriving transplant operation going ahead in this country on an annual basis. It compares favourably with other European countries in terms of the resources available to us. It is important to recognise that 1.5 million people now carry kidney donor cards, or at least have kidney donor cards. It is a huge percentage of the population and it is a reflection of the goodwill people have towards this programme.

People see there is something to be gained, perhaps not solace for the family in the sense of replacement of the loss of a close friend. There is some sense of solace in the feeling that a person's life is not completely wasted and that he or she can contribute to the quality of life of other people. Unfortunately, it is not enough for people to apply, get and sign the kidney donor cards; they should also carry them with them. We are failing in this area. Very often they are left at home on the mantlepiece when they should be in people's wallets, or with their credit cards, or in their pockets. That is the area where we must direct our education programme.

There are now multi-donor cards which allow people to donate other organs of their body. It goes to prove the point that public awareness works on this issue. People know it is a relatively easy thing to do; it is something which people feel they can give. It appeals to the generosity in people's nature to give continuing life and a better quality of life to somebody whom they do not know. It has taken nine years to build up the whole area of kidney donor cards and the transplant programme. There has been an increase in the number of donors. Nine years ago roughly 25 to 30 people per year donated kidneys. One hundred people donated kidneys last year. There has been a fourfold increase in eight years as direct result of public awareness programmes on the issue.

Last year 75 kidney transplant operations were performed in this country. Some of these were multi-donational where heart, liver and, in some cases, eyes were donated. Ninety per cent of these were as a result of people having donor cards. This is the point I want to stress here. People made the decision while they were alive and this was conveyed to their relatives.

At the time of the death — a sudden death in particular — of a close member of the family other family members do not think of organ donation. It is not something you think of at a very traumatic time. I had a very traumatic experience recently when I was with somebody who is involved in the kidney transplant operation. It is the last thing that would come into somebody's mind in a situation like that. At present there are 180 people waiting for kidney transplants. The Irish Kidney Association, who do trojan work in this area, would welcome any sort of encouragement in terms of creating public awareness. I know the Minister feels the same way about this. We are all at one in this area. It is just a matter of making people more aware of it and of not letting it die. Every year we have public awareness campaigns and every year there is some response to them.

Kidney transplants are carried out in the national centre at Beaumont hospital. We are often quite quick to run down our country but people may not be aware of the fact that Ireland has one of the highest success rates in transplants in Europe, a 90 per cent success rate. That needs to be put very definitely on the record: a 90 per cent success rate in kidney transplant. Where does it leave us in terms of cost? Preventative medicine and this kind of medicine must always be costed as well, just to satisfy the financial gurus. It is simple. It costs roughly £15,000 a year to keep one patient on a dialysis programme or dialysis machine, whereas a transplant operation costs £12,000. You see an immediate saving from £15,000 a year to a once off payment of £12,000 and a much lower cost per year after that in terms of medication, etc.

The quality of life is improved for people. With 120 people on dialysis at any one time what does a transplant do? One person donating two kidneys means the kidneys go to separate people so there are two people whose quality of life is completely changed. A person on dialysis has no life; it is like being in prison. They spend hour after hour each week in hospital, travelling to and from the hospital for a few days to repeat the process interminably. People are at this for years and years. People cannot be put on a priority list. There must be a tissue type matching and blood type matching before-hand.

Some people have rare blood types and tissue types and have to wait for years before they come off dialysis. To get back to my example — one person gives two kidneys, the kidneys go to two other people who are now on dialysis and the quality of their life is improved. Their whole lifestyle is improved. They become productive people. They are able to live normal lives or as near to normal as is possible. Further to that, there are also two places available on dialysis machines which at the moment are very much overcrowded, so it has a knock on effect.

What we are talking about is a major educational programme. Death is a waste and it brings with it a waste of organs through lack of education and understanding. It is a waste of life. It is a waste of opportunity. We need a major public health education programme to create an awareness in people that they can give and that families can give. We ask the Minister to take on board the idea of setting up such a programme so that people will see that it is not just enough to have a donor card, that they should carry it and make their family aware of it. It is something that should not be discussed in any morbid fashion but in a responsible way with a sense of commitment to the community.

Minister of State at the Department of Health (Mr. Leyden)

I thank Senators Fallon and O'Toole for their contributions to this Adjournment debate. It gives me an opportunity, on behalf of the Department of Health, to explain how I am developing these services and the policy in this important area of organ transplantation.

Recently the Minister has been considering the question of how to develop an effective public awareness campaign in this area with his European counterparts. Earlier this year, he attended a Council of Europe conference of Ministers for Health in Paris and they agreed to develop an information policy on organ donation. He is currently considering how such a policy can best be implemented.

In order to assist the Minister and the Department in this matter, we have asked the transplant liaison committee to give the issue some thought. We formally established this committee earlier this year under the chairmanship of Professor Eoin O'Malley and the specialties of Medicine, Surgery, Anaesthetics, Neurology, Neurosurgery and Paediatrics are represented on it. The committee has already shown how it can contribute to the development of expertise and knowledge in the whole area of transplantation through its recent publication of a very useful document on the definition of brain death.

In the interim, however, Senators will no doubt be aware that the need to increase and develop public awareness in the area of donor organ transplants is already very effectively addressed by voluntary organisations. The Irish Kidney Association launched a uniform donor card in March this year as part of its annual donor awareness campaign. This campaign has been very successful in encouraging people to make arrangements to donate organs and so give others the opportunity to once again enjoy a full life. This uniform donor card is building on the remarkable success which the association has had over the past decade with the kidney donor card of which there are over a million in circulation at present. I note the point made by Senator O'Toole about not just having the card but carrying it which is all important. The Irish Kidney Association is of course also involved in a number of other areas. For example, it helps patients financially and offers a counselling service; it funds research and provides capital moneys for equipment. It also provides annual holidays for renal dialysis patients.

The Irish Transplant Association is another voluntary organisation which assists in the promotion of awareness of the need for donor organs. Earlier this year, we gave the Irish Transplant Association some financial assistance with the production costs of an educational video project to distribute to secondary and medical section and hospitals. While we are considering the question of whether our information policy on organ transplantation can be improved, we are satisfied that these voluntary organisations are doing excellent work in campaigning for donor organs and educating the general public.

The great work which these voluntary organisations are doing is yet another example of how effectively voluntary organisations can co-operate with State agencies in the provision of health services. The enthusiasm, vision and commitment which organisations like these have shown in their contribution is one of the outstanding features of our health care system. Their participation has always provided a strong dynamic force to the development of our services.

Senators may be interested to know how the collection of organ transplants is organised. There is a national organ transplant co-ordination centre based in Beaumont Hospital where the collection of all organ donations is co-ordinated. Since the resources required for transplantation in terms of staff, equipment and back-up facilities are considerable, the policy is to restrict transplant activity to designated centres. Beaumont Hospital is the national renal transplant centre. The Mater Hospital is the national centre for heart transplants. St. Vincent's is the national centre for liver transplants and the national centre for bone marrow transplants is St. James's Hospital in association with our Lady's Hospital for Sick Children in Crumlin.

We are currently considering the question of whether legislation is necessary to facilitate organ donation. The emphasis to date has been firmly on the voluntary nature of the decision to become a donor, where the deceased has not expressed any view on the matter, the opinion of the next of kin has prevailed. Even where the deceased has expressed a wish to donate organs, the views of the next-of-kin are sought and prevail.

I thank Senators once again for giving me an opportunity to explain my policy and the policy of the Minister in this important area. I assure Senators that, while a public awareness campaign for organ donation is already under way through the good offices of the Irish Kidney Association and the Irish Transplant Association, I am examining the whole question of our information policy in this area to see whether it can be improved. The meeting of Ministers in Paris was a very useful development in this area. We are now looking at legislation which many people feel may be necessary in future to facilitate an orderly arrangement for donors.

The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Thursday, 15 December 1988.