Organ Donation Task Force Report
The next item of business is a debate on the organ donation task force report.
I am delighted to open the debate. I fully expect it to be constructive and consensual. There are some real issues at stake, and this is a timely occasion for members to have an initial opportunity to express their views on many of the issues.
First, I underline my personal commitment and that of the entire Government to implementing in Scotland all the recommendations in the report of the organ donation task force, which I launched in January. Let me also record my thanks to the task force for the work that it has done to date and the work that it will continue to do, particularly on presumed consent—a subject that I will touch on later.
It is important to say that, in taking forward the recommendations, we are working and will continue to work closely with other United Kingdom health departments. Issues of organ donation and transplantation are dealt with on a UK basis, and on that issue—if on very few others—I believe that that is in Scotland's interest.
The reason for our commitment to the task force recommendations is clear. Organ transplantation is one of the great successes of modern medicine. I had the great privilege a few months ago of witnessing a live kidney transplant at Edinburgh royal infirmary. That brought home to me how awe inspiring the achievements of modern medicine can be. If there was ever any doubt about that, we would only need look at the extraordinary recent achievement of the transplant unit at the Edinburgh royal infirmary in performing the first living donor liver transplant. That procedure—and the incredible bravery of one woman in donating more than half her liver to save her husband's life—was necessary precisely because we have in Scotland a severe and increasing shortage of organs for transplant. That is why we have a duty to act.
Despite all our efforts to date, Scotland's organ donation rate is the lowest in the UK at 9.8 per million population. That is despite our having proportionally more people on the organ donor register than does any other part of the UK.
Does the cabinet secretary have any idea why that is the case? Is it because we do not implement the existing system well?
There are many reasons for the situation—some are understood and some are not. What the member cites is one of the reasons, so that makes the recommendations of the task force report important.
If we have the lowest organ donation rate in the UK, the UK's donation rate in turn—at 13.2 per million population—is one of the lowest in the European Union. Countries such as Spain show what is possible. Spain's rate is 33 per million and, in some parts of Spain, such as the Basque country, the rates are even higher.
The task force's recommendations are designed to increase significantly the rate of organ donation. The task force is convinced that if we implement its recommendations in full, we can achieve a 50 per cent increase in organ donation within five years. I will spell out what that would mean. It would make possible an additional 1,200 transplants throughout the UK, 700 of which would be kidney transplants. Apart from providing improved quality of life for recipients, those 700 transplants would bring significant savings on the cost of hospital dialysis.
I have asked the Scottish transplant group to oversee implementation of the recommendations in Scotland and it is extremely enthusiastic to do so. In infrastructure, we are rather better off than the rest of the UK, because our transplant co-ordinators are already funded nationally. We also have the experience of piloting the Scottish organ retrieval team, which underpins the task force's recommendations on retrieval arrangements.
I will concentrate on what might be called the performance management aspects of the task force's recommendations, because the recommendations on that need the most modification to suit how the national health service operates in Scotland and we have the most work to do on that. The task force's fundamental underlying aim is to make organ donation a usual, not an unusual, event when someone dies in circumstances that would allow them to donate. We have made a start by highlighting that in "Better Health, Better Care: Action Plan", but I am pleased that the transplant group is setting up a short-life working group to think of further ways in which we can bring organ donation to the proper attention of senior management and medical staff in NHS boards. The working group may want to think about developing a chief executive letter or even a health improvement, efficiency, access and treatment—or HEAT—target. It will also start thinking about targets and performance indicators.
One of the task force's key recommendations is about promoting organ donation to the public. That is already a statutory duty on the Scottish ministers under the Human Tissue (Scotland) Act 2006. Research on previous campaigns shows that for every 100,000 people who put their name on the organ donor register, about three will become kidney donors over 10 years. The clear imperative is therefore to increase the volume of registrations. We need to expose a mass audience to the message.
I am therefore pleased to launch today our main advertising and publicity campaign for 2008. For the first time in Scotland, it will use television as its medium. We have prepared a 40-second advert that builds on the award-winning kill Jill/save Dave approach that has been used in newspapers in the past two years. I will not attempt to describe the advert, which starts screening tonight, but copies of it have been made available to members. To ensure that the advert has maximum effect, from 10 March onwards it will be preceded by one of five one-minute programmes that show the human dimension of organ donation and transplantation and allow the issues to be explored in greater depth.
I encourage everyone—MSPs and the wider public—to sign up to the organ donor register today. It takes only a few minutes, but it could save a life. It is important to ensure that our families know our wishes. None of us likes having such conversations, but they can help to save lives, and knowing what someone would have wanted generally makes things easier for bereaved relatives.
The final and perhaps most controversial issue that I will touch on is presumed consent. I have made my personal view on the issue clear many times. I have increasing sympathy with a move to presumed consent as the basis of organ donation, and I know that many people within and outwith the chamber share that view. However, I also know, from the media and from correspondence that I have received, that some people take a very different view. That is why we need a full and open debate before a decision is reached. Although I am sympathetic to presumed consent, I believe that a move in that direction without widespread public agreement would be counterproductive.
It is important to emphasise that a move to presumed consent is not a panacea and would not be a substitute for implementing the recommendations of the task force. That work will continue to be essential regardless of what we might or might not decide to do, as a Parliament and as a nation, on presumed consent. We need to debate the pros and cons in a non-party-political manner, as I am sure we will. Opinion on the issue is divided within parties as well as between parties, and we need to ensure that the debate is conducted properly and appropriately. We must also be clear about the degree of support that exists for such a change among the public and the health professionals who are involved before we take any concrete steps in that direction.
I am pleased that the organ donation task force has agreed to take a thorough look at all the risks and benefits that a switch to presumed consent would involve. The task force has agreed to produce a report by the summer to inform the way forward. In producing that report, it will hold a series of workshops—some of them in Scotland—to explore in more detail the many clinical, ethical and other issues that are involved. I encourage all members to make their views known and to encourage their constituents to do likewise.
As the debate proceeds, it is important that we continue to pursue vigorously the task force's original recommendations, and I assure the Parliament that we will do so. Too many lives are at stake—lives that could be saved with a higher rate of organ donation—for us to do anything else. I hope that, as we do that, we will have the full support of all members.
I welcome the minister's speech. Labour wants to play a full and constructive part in the debate and we acknowledge the issues that she has laid out. This is an important debate for Scotland and the minister has made it clear that it will continue. It is, undoubtedly, a matter of great sensitivity and there is an onus on us, as parliamentarians, to appreciate that sensitivity. We must be alert to the many members of the community who have serious doubts and concerns about the way forward—perhaps from experience. As the minister said, we must have a full and open debate, and we all have a part to play in ensuring that that is how it is conducted.
Many members will remember the recent members' business debate on presumed consent, secured by George Foulkes's motion. He has played a critical role in bringing the matter to the attention of the public and in facilitating the broader debate that we must have. It is vital that we have that debate ahead of any decisions being made. As was said during that members' business debate, there are many issues that can be addressed as preliminaries to a discussion on presumed consent—issues that arise from the recommendations of the organ donation task force. What also became evident from the members' business debate was what has happened in other countries significantly to increase their rate of organ donation. Those countries improved donation rates by implementing systems similar to those recommended by the task force.
It is fair to say that, both in the chamber—as was evidenced in the members' business debate—and more broadly around the country, the importance of organ donation is understood and people see the impact that it can have in saving lives. It is perhaps the ultimate act of generosity and expression of humanity and solidarity with others for someone to give the gift of life as their final act. When we discuss presumed consent, I know that we will debate what a gift is, but I am using the term in its broadest sense. Most people are with us and understand the significance of that gift in the saving of lives.
The member keeps using the term "presumed consent", as did the minister. George Foulkes has also used it. Does the member agree that we need to find a better term? Consent has to be informed and someone has to have the capacity to give consent. Whatever it is, it is not presumed consent.
That is an interesting point; I know that Mike Rumbles made similar points during the recent members' business debate. I will argue strongly that we need to hear the cases for and against presumed consent and that the issues must be thoroughly tested, as must the language that we use, which is critical. There is no point in thinking that presumed consent is an easy solution while masking some people's doubts; it must be thoroughly tested and I will make that point later.
The point that I am trying to make at the moment is that the public is with us on the need to facilitate organ donation, but how we do it is more contentious. Significant steps were taken during the passing of the Human Tissue (Scotland) Act 2006, and I associate myself strongly with the points that have been made about the need to encourage registration. MSPs should play a role in that. It is very easy to register and we could all highlight that in our constituencies.
Public awareness has grown because of the acknowledgment of the challenges that we face. According to the British Medical Association circular that we have all received, in 2006-07, 100 people in Scotland died while they were on the organ transplant waiting list, or after being removed from it because they were too ill. There is also a gap between the number of people who are willing to donate their organs and the number of people who need a transplant. It is vital that we address that gap.
In Scotland, the number of people who are on the organ transplant waiting list increased by 20 per cent during the years between 2005 and 2007. Without rehearsing some of the minister's statistics, there is a significant gap between us and our European partners. The minister quoted Spain, which is the European leader in the field. In Austria, the figure for organ donation stands at 24.8 per million population. It is less than 10 per million population in Scotland, as the minister said. We have to understand why that is the case and what we can learn from it.
During the members' business debate, Mary Scanlon said that we must take decisive action on the recommendations of the organ donation task force. Those recommendations reflect how Spain increased its organ donations to the current level. It is about retrieval and co-ordination, and working on those issues will make a significant contribution. As long as they are delivered effectively, we could push towards the task forces' estimate that it is possible to increase the organ donation rate by 50 per cent within the next five years. However, effective delivery is vital.
I will not push the minister on this point; I will take her word for it when she says that the Government will work effectively and constructively across the UK to make sure that the required work is co-ordinated and delivered effectively. A great deal could be done through the appointment of national co-ordinators and—I defer to Richard Simpson on this because he knows more about it than I do—the training of all clinical staff. That is significant, particularly in relation to their work with families. As I understand it, the research proves conclusively that trained intervention supports families better. There is a gap between the decisions that people make when they are bereaved and those that they make later. They might regret that they did not decide to donate at the time of the death. We all understand that distress and trauma are involved in such decisions, so trained staff are vital to that process.
I will talk about presumed consent, although I accept that we might need to think about Mike Rumbles's caveat. The issue is obviously very sensitive; that must be emphasised time and again. By definition, the issue will be distressing for all those who are involved. Before we make decisions in the chamber, or come to any conclusions about further work that might be required, it is vital to have a widespread and informed public debate.
George Foulkes will undoubtedly—as he has done so effectively on previous occasions—put some of the arguments for changing the present system, but we must also understand and address the arguments against such a change. One factor that should be highlighted in any move towards such a change is the need to ensure that medical staff, particularly doctors, properly engage with families. The issue that families' concerns might be overridden by doctors needs to be properly addressed and, indeed, was addressed by Richard Simpson during the members' business debate. I think that we can develop approaches to deliver on that issue, but there is a significant need to ensure that we have proper safeguards in place.
As some members may be aware, a doctor in New York is currently being prosecuted for allegedly hastening a patient's death in order to retrieve the patient's organs. Obviously, that is an exceptional case—I do not imply that the same would happen in a British context—but people undoubtedly have concerns and worries about that. Therefore, it is vital that we ensure that proper safeguards are in place. We know from previous experiences how families feel when they are not properly consulted on what happens to their loved ones.
I think that we can still argue that choice can be at the centre of our policy, even if we go for a presumed consent model. People must be able to feel that they have a choice, so a strong opt-out must be available. The system needs to be designed properly.
I do not think that we are equipped to make a decision at this stage in the parliamentary process. It is vital that we have a widespread public debate and that we encourage active participation in it throughout Scotland. We need to be alert to people's concerns—which some members have expressed quite forcefully—about the contradiction, as it were, in presumed consent. We need to be clear about when consent is actually consent and how we facilitate that. At the heart of the debate there must be a real desire to ensure that we increase organ donation throughout Scotland, but we need to be open-minded about all the possible methods for achieving that.
As the Scottish Conservatives have agreed to a free vote on organ donation, the views that I will express are personal, rather than those of my party.
Having previously contributed to the excellent members' business debate that was secured by George Foulkes, I will not apologise for repeating to today's broader audience some of the points that I made on that occasion. However, I agree with the minister that it is essential that we implement the task force's recommendations, regardless of whether we move towards presumed consent.
My first point is that we should not lose sight of the need for prevention. Given the increase in type 2 diabetes and given the fact that diabetes is the main contributory factor to kidney failure, we should ensure that enough is being done to diagnose, manage and prevent diabetes.
Secondly, like Mike Rumbles, I have difficulty with the concept of presumed consent. In my opinion, it is a contradiction in terms. Presumed consent is not consent. To consent means to agree or to give assent. Consent—whether to sex, marriage or the donation of body parts—cannot be presumed; it can only be given freely by an individual. Similarly, a donor of organs is a giver of organs. Donation is by choice, whether financial or otherwise. A donation is willingly given; it is not willingly taken, whether by the state or anyone else.
My third point is that opting out is not a familiar concept to most people in this country. Those should be the starting points for the debate.
Organ donation is a matter of individual conscience and freedom rather than a matter for the state. The fact that hundreds of people die each year because organs are not available is tragic, but the question is whether a system of presumed consent is the answer.
I am pleased to note that the Government will take on board the task force's recommendations, which will potentially increase organ donations by 50 per cent within five years. However, the main point that the report highlights is the current lack of a structured and systematic approach.
The introduction of co-ordinators, not the introduction of presumed consent, is the main reason for the increase in organ donation that has taken place in Spain. When the current Spanish model was introduced, Spanish officials created a network of transplant co-ordinators to act as the main point of contact between donors, recipients and medical staff. According to the UK Transplant website, there are a significantly higher number of road accident deaths in Spain than in the United Kingdom, which suggests that, even if the Spanish model were used in the United Kingdom, we might still not reach the same level of organ donation as in Spain.
Spain has three times as many intensive therapy unit beds and three times as many transplant doctors as the United Kingdom. I am pleased that the cabinet secretary has taken on board the report of the organ donation task force, but there is a desperate need to build up the infrastructure of staff, co-ordinators, beds and systems in order to increase the number of transplants. That is far more urgent than imposing a system of presumed consent.
According to the UK Transplant website, the number of organ offers that were refused by Scottish transplant centres due to a lack of staff or infrastructure problems doubled between 2006 and 2007, from 21 to 41. We also do not know how many people in Scotland were willing to give organs but were never asked to do so. We need to have that piece of information before moving to any system of presumed consent. An increase in the number of organ donations will not lead to an increase in the number of transplants without crucial investment in the NHS.
I hope that the current network of donor transplant co-ordinators will be expanded and strengthened through central employment by a UK-wide organ donation organisation, to ensure a highly skilled and efficient service. We know that 25 per cent of the UK's population have signed up to an organ donation register and that a higher number of people carry the donor card. However, the organ donation task force's report shows that fewer transplants were carried out in 2007 than in 1997. The task force also estimates that there are 5,000 more donors than there are transplants. Why are we talking about introducing presumed consent when we are not coping with the people who are willing to give at the moment? We also need to know why, although more people put their names on the organ donor register in Scotland than in other parts of the UK, we still have the lowest organ donation rates in the European Union.
Margaret Curran mentioned the legal situation, which is crucial. The legal situation regarding non-heart-beating donation is unclear, in part because it differs across the UK. Concerns have been expressed about the extent to which the timing of removal treatment may be influenced by delays resulting from the time that is necessary to complete retrieval. A person can switch status from being a patient to being a potential donor only when care staff have complete confidence in the means by which death is certified. There needs to be a clear legal framework that is consistent throughout the UK and ensures that organ donation is both legally and ethically clarified, for the benefit of both recipients and donors.
The task force's report raises the issue of conflict and seeks to ensure that steps that are taken to facilitate organ donation are clearly lawful. I will use again a quote that I used in George Foulkes's members' business debate on organ donation. It is from Dr Kevin Gunning of Addenbrooke's hospital, who said:
"If as a doctor you have turned your thoughts to your patient being a donor when they are still living, that is a real conflict".
Putting in place an infrastructure of co-ordinators and resources will ensure that those who wish to donate organs can do so. That—and not imposing on the whole population what is called presumed consent—is the sensible and practical way forward.
I am not surprised by the consensus in the chamber on the essential need to increase the number of organ donors in Scotland. That said, there are other issues on which members do not agree.
I particularly agreed with Mary Scanlon's points on the use of language. Those in the chamber who have known me for a long time will know that I am a little bit of a pedant about the ordinary use of the English language, and in that respect I welcome Mary Scanlon's definition of various terms. In fact, this is not a point of pedantry; it affects people's understanding of the issue. If we are seeking to extend public consent, either on a voluntary or an involuntary basis, people must clearly understand what we are trying to do and the basis of such consent.
Like Mary Scanlon, I believe that occasionally a distinction has to be drawn between party and personal positions. My party seeks to promote voluntary consent; however, we would wish to reflect on involuntary consent, which, after all, is a more compulsory measure.
We were very happy to support the Human Tissue (Scotland) Act 2006, which embodied in our law the very important principle of authorisation. That people should have the right during their lifetime to set out their wishes about what happens to their organs after death places a responsibility on the national health service to respect such wishes. Indeed, the General Medical Council's guidance to doctors specifically includes a duty to respect patients' wishes after death. That has fundamentally changed our previous approach to voluntary donation.
I welcome this opportunity, initiated by the cabinet secretary, to debate the organ donation task force report and am pleased that the cabinet secretary herself has unequivocally agreed to implement its extremely important recommendations. I also note her admission that her own position has progressively moved towards what we are calling, by way of shorthand, presumed consent.
However, with regard to the cabinet secretary's wish for a wider consensual debate, I—and my party—have to note her response on 23 July 2007 to a written parliamentary question from Kenneth Gibson, in which she said:
"It is not clear that changing to a system of opting out would necessarily lead to an improvement in organ donation rates in Scotland. Such a move would need strong support from the public and the health professionals involved"—
a point that she has repeated today—
"but the extensive consultations carried out in relation to the organ donation and transplantation provisions of the Human Tissue (Scotland) Act 2006 showed strong support for strengthening the present system … That is the approach which is embodied in the Act." —[Official Report, Written Answers, 23 July 2007; S3W-1787.]
We should also highlight the task force report's crucial findings. As the cabinet secretary rightly made clear—a point repeated by Mary Scanlon and Margaret Curran—its main finding is that we have failed to draw to people's attention the virtues of organ donation because of what the report itself has described as
"the lack of a structured and systematic approach to organ donation, and to a lesser extent organ transplantation."
Those are crucial findings, which are based on the report's wide and highly instructive drawing of evidence from other countries throughout the world. I share Mary Scanlon's view that some of the report's findings point to the fact that the experience in other countries shows that the implementation of such recommendations has probably had more impact on increasing organ donation than have changes to the law.
I welcome the fact that the cabinet secretary whole-heartedly supports the establishment of a UK-wide organ donation body and wants to ensure that NHS boards identify and champion clinical donation campaigns. I assume that if she approves of that cause, she will give generously to it by providing the boards with the necessary resources. In my view, those are critical issues for the ensuing debate.
I have three points to make. First, the debate is to be consensual—the cabinet secretary has said that it should be—so, although there will be differences, we must seek to get the public to understand the issue. For that to be the case, the debate must be informed, and the embodiment in our law of the concept of authorisation must be understood. There ought also to be a decent interval for us to determine whether that has had an impact.
Secondly, if we are to proceed on the basis of the report's recommendations, it will assist the process of having a properly informed debate to allow a decent and appropriate period for it to take place before we start to come to conclusions about what might be a better system.
Thirdly, there is the role of the task force, which has been tasked not only with looking into the practical issues, but with exploring in greater depth the moral and ethical issues that might be associated with moving to a different system. For the avoidance of doubt, I make it clear that I have some grave reservations about moving to a more compulsory system, but I acknowledge that that is a crucial issue, which deserves to be debated more widely.
I say to the cabinet secretary and all the members who are present that if they are genuinely committed to having an informed debate, we are required to reflect on the Human Tissue (Scotland) Act 2006 and on the measures that are to be implemented, and to await the outcome of the relevant report. Like all members, I am in no doubt about the need for us to tackle more urgently and systematically how we can encourage more organ donation and implement the greater regulation that will be required. We must use the international evidence, which, as the report makes clear, shows that the more systematic approach to which the cabinet secretary is committing us will allow us to radically improve and increase organ donation.
We move to the open debate.
I am sure that all members welcome the comprehensive review that has been produced by the UK organ donation task force and the Scottish Government's ready acceptance of all its recommendations.
It has already been stressed that Scotland has one of the lowest organ donation rates in Europe, while our need for transplants of organs and tissue is increasing steadily, in line with the growing average age of our population and the increasing incidence of type 2 diabetes. The situation is seen at its starkest when we consider that, although black and ethnic minority communities make up only 8 per cent of the population, members of those communities make up 23 per cent of the UK kidney transplant waiting list and are more likely to refuse permission for a transplant than the population at large. The rest of us cannot be complacent, given that 40 per cent of relatives refuse consent for organ donation, even though surveys show that 90 per cent of people in this country approve of it.
In the course of my professional life I have had the misfortune to come across several people whose lives could have been extended and transformed by an organ transplant, but an organ was not available when they needed it.
The cabinet secretary reminded us how last month Jennifer Foster donated 50 per cent of her liver to her husband, Daniel, in a procedure that—thank heavens—was successful, but which involved a one in 100 chance of her dying as a result of the operation. Many of us would take the same risk and undergo the same pain to save the life of a loved one, but it is inexcusable that that should have been necessary, given that a properly organised organ donation scheme would have greatly increased the chance of a liver being available.
Will the member explain why, when the number on the organ donation register in Scotland has reached the record level of 30 per cent—
Please speak into your microphone, Mr Rumbles.
Although there is a record number of donors, the number of organ donation operations has reduced. The issue cannot be that we need more people on the register; surely something more fundamental is wrong.
Mike Rumbles makes a good point, which was adequately covered in the task force's report. If we implement the task force's recommendations, as the cabinet secretary says that she will do, the situation will improve.
The task force claimed that it should be possible to achieve a 50 per cent increase in organ donation in the next five years. If that comes to pass and the task force's recommendations are implemented, many of our problems will be solved. We must do better, and we have the blueprint that will enable us to do better.
No doubt all members and the Presiding Officer will be pleased to learn that I do not intend to go over all the recommendations. However, I mention two aspects of the report that caused me concern. In the preamble to recommendation 5, the task force referred to evidence from the United States of America on the development of
"clinical indicators as a trigger for notification"
to transplant co-ordinators that a potential transplant donor is available. In such an approach the clinicians who look after patients are given a greater role in choosing suitable organ donors. In other words, clinicians spot the people who will die soon and pass the word to the authorities.
I acknowledge the benefit of such a system and the efficiencies that it would bring but I also envisage the pressure that it might place on the professionals who would need to initiate action while caring for a live person, albeit that the person had little hope of recovery. Clinicians might also worry about their relationships with patients' families. Therefore, I welcome the recommendation that there be further consultation with intensive care specialists and other people before we move down that road.
The task force did not make a recommendation, because the matter was outwith its remit, on whether transplant units are staffed and equipped to cope with the increase in work that will inevitably follow the success that we are all working to achieve. The task force reported that some units have been
"stretched … almost to breaking point"
by the modest improvements that have been made. It would be ironic if we greatly increased the flow of available organs only to have to bucket them because we did not have the manpower or the facilities to cope. The need for dedicated transplant teams with more members requires careful planning, especially under the exigencies of the European working time directive, which is slowly tightening its grip. I sincerely hope that the cabinet secretary will take the task force's concerns on board, even though it could make no formal recommendation in that regard.
Presumed consent is a controversial topic. An issue that unites Nicola Sturgeon, the BMA and Lord George Foulkes is worthy of consideration, so rare is such unity. In the past I have had no doubt that presumed consent offers the way forward. However, the proposal is controversial and risks dividing our community, so we must give it careful thought before we proceed down that route. I have read the task force's impressive report and I have witnessed how fragmented our service is. Given the potential for great improvement simply by organising the service a little better and by embarking on a publicity campaign, as the cabinet secretary described, we should hold off from initiating a system of presumed consent until all the task force's recommendations have been implemented. Perhaps take-up could be increased if we included consent forms in passport and driving licence application forms, for example.
Even if the recommendations do not achieve all that is promised for them, they have sensitised us to the need for a continuous supply of organs for transplantation. Perhaps implementing the recommendations will also make any future introduction of presumed consent less controversial than the idea is at present.
The time for talking is now over. Let us get on with implementing the recommendations.
As you know, Presiding Officer, from time to time I have been a little critical of some Scottish National Party ministers. At the outset, I warmly congratulate Nicola Sturgeon and Shona Robison on their continuing commitment—not only today but over a long period of time—to improving donation rates; rates that must improve not only in Scotland but across the whole of the United Kingdom. It was encouraging to hear the cabinet secretary's words today. Indeed, en route to the chamber, I saw the save Dave poster. I look forward to the television advertising campaign.
The stark reality is that every day one person who is waiting for a transplant dies and about 9,000 people continue to wait. That thought is sobering; it should inspire us all not only to embrace the excellent recommendations of the UK task force but to implement them, as the cabinet secretary said that she would do. However, we should not only do that; we should go further. As I argued in the members' business debate that I initiated on the subject, we should implement a system of opting out. Many members in the chamber today took part in the debate. Although I do not want to repeat the arguments for presumed consent, one issue that I took from it—Mary Scanlon and Mike Rumbles raised it today—is the need to be careful about the language that we use to promote the case for more organ donors.
Nobody likes the idea of anyone presuming anything, particularly when the state is involved. The strength of what is best described as an opt-out system is that it will achieve a substantial increase in the number of donors while, at the same time, cementing—institutionalising—a person's right to opt out, for whatever reason. All of us should stop talking about presumption and focus instead on the choices that individuals can make. We should also focus on how the Government can offer enough assurances and safeguards to encourage people to make the right choice in the eyes of the thousands of people who are waiting for a transplant.
I thank the member for his comments on presumed consent, with which I said that I had difficulty. Does he also agree that if we change the language from presumed consent to something else, we would also have to change the use of the words "donor" and "donation"? The act of donation would no longer relate to something that is willingly given, but to something that is willingly taken.
Yes, we will have to look at the language in that regard, too.
I spoke about assurances and safeguards, which, of course, form part of the debate. Assurances and safeguards will need to be given in respect of the rights of surviving family members, for example. With the last survey showing that 93 per cent of the population support organ donation and 74 per cent support an opt-out system, it is strange that the gap between the number of available organs and the number of people who need a transplant is not narrowing. In fact, the waiting list for organs stands at an all-time high.
As we go forward, I hope in consensus, we should also accept the many sensitivities and concerns that need to be addressed in the debate. I will touch on just one of them, which Ian McKee raised.
As he said, 20 per cent of people who are waiting for transplants in the UK are from ethnic minority backgrounds, but only 1 per cent are donors. That demonstrates the size of the challenge of engaging those communities in the debate on the case for opt-out and donation. The serious practical reality of organ donation is that tissue and blood types need to be matched carefully. That means that the need to increase ethnic minority donors is very urgent. In addition, South Asian and African-Caribbean ethnic groups have a younger population profile, but—sadly—a higher than average tendency for kidney failure. That compounds the problem, and the demand for organs will only get worse if we do not address those issues. I would be interested to hear from the minister how she hopes to engage Scotland's ethnic minority communities in the wider debate.
It is often said by people who argue against opt-out that they do so because of religious concerns. However, two recent studies reported to the House of Lords committee that is dealing with this issue show that religious belief is not a barrier to supporting an opt-out system. Both studies found that when people know their religion's position—all major religions agree on opt-out—they are far more likely to use that information to make a positive decision. If people do not know the position of their religion, they are more likely to say no. It is not the religion that creates the problem but ignorance, and the fact that people do not know the position of their religion on the issue.
Two weeks ago, Dr Anthony Warrens, a consultant at Hammersmith hospital and treasurer of the British Transplantation Society, told the House of Lords committee that each donor, upon their death, gives 56 years of life to others. That is an astonishing and compelling statistic, which means that the positive, all-party approach that we heard in the members' business debate, and that I hope we will hear in today's debate, will move us towards progressing the case for opt-out throughout the country.
I am encouraged by the task force's straightforward assertion that there could be a 50 per cent increase in post mortem organ donation in the United Kingdom—and presumably Scotland—within five years. It flags up current barriers to that—barriers that need to be addressed. I endorse all of Mary Scanlon's examples of the current unfortunate reality that we have to work in. It is a reality that is failing.
We all know the benefits of organ transplants—nobody denies them. A total of 15 million people in the UK are aware enough of those benefits to be on the organ donation register. However, according to the task force, 40 per cent of relatives withhold consent. It is extremely important for us to understand why that happens. I do not have the answer, but it is not enough to say the figure is too high without asking the serious question of how that figure comes about. Is it a trust issue, for example? If it is, we may be better advised to address that than to attempt to sidestep family opposition. Indeed, the task force report suggests that even in the present scenario, various legal and ethical questions do not seem to have been resolved. For example, doctors have two roles: one to argue for the potential donor, and presumably another to argue for the potential donee.
Paragraph 1.23 of the report envisages a change in health board culture,
"with timely consultation of the NHS Organ Donor Register".
I can envisage "timely" taking on rather a different meaning for the clinicians than for the about-to-be-grieving families. We are already getting into the kind of emotional difficulties that bedevil the issue. I note also in paragraph 1.26 the professional concerns about so-called clinical triggers—referred to by Ian McKee—that would presumably drive the timely consultation of the register. Would it be expected that the family had been notified when those two activities were taking place?
Recommendation 6 says that
"Donation activity should be monitored"
and rates reported, and that those reports
"should be part of the assessment of Trusts"—
presumably it means the boards. What happens if a board fails? Does it mean pressure on the board? Where and to whom is the pressure to be transmitted? Those are questions that need to be considered.
We have heard that an increased availability of organs will not necessarily increase the rate of transplants, but I welcome the task force report and hope that there are answers to some of the questions. In the main, I want the recommendations to be implemented. I was particularly interested in what the task force said in paragraph 1.44, on "Honouring the gift of donation". In a sense, that is key to everything, and it raises two issues. The first is that organ donation is a gift, and the only real meaning of the word "gift" is something that is freely given. My right to give that gift cannot be turned into another's right to demand my organs. Secondly, the private nature of donation means that the family of the deceased see no public recognition of that gift—a recognition that would acknowledge their grief as well as the benefit to someone else. I am sure that implementation of the report's recommendation on that would be extremely welcome.
I hope that improvements in the way that we do things will be implemented on the back of the task force's report and allowed to bed in to give us a better sense of the true need to make further changes. Given that most organs become available after road traffic accidents, we must ensure that apparent success rates elsewhere are not, in part, a result of higher accident rates, as has already been suggested.
Regardless of how we might individually feel about presumed consent—or however we want to describe it—can we at least find out why 40 per cent of families currently do not agree to transplants despite the apparent 90-odd per cent approval for organ donation? The fact is that there are very different actual donation rates from country to country, even countries where presumed consent has been implemented. That suggests to me that something else is going on—something more fundamental and cultural—that should be addressed first. The task force's key approach is surely the right one: to change the culture. The soft consent system that is in place in Spain still gives families the final say, and if we introduced it in Scotland but still had 40 per cent of families saying no, we would not be much further forward, so we need to address that issue. Contrary to Ian McKee's point, any issue that results in Mike Rumbles and me being on the same side is worthy of consideration.
On a slightly more cynical point, I must ask what sums of money have been spent on promoting and publicising organ donation over the past 10 or 20 years. I suspect that they are pitifully small in comparison with the benefits that are to be gained. In those circumstances, what is the likelihood that any more—or even as much—would be spent on a consistent and continuing campaign to publicise an opt-out system? It is vanishingly small, I would say. If we do not want to spend much on promoting the benefits, how likely are we to spend on a campaign to, as some describe it, do the opposite?
I welcome the campaign that has been announced today, but we have had few of them over the past 20 years. Nowhere in any of the literature do I read of the campaigns that must, surely, exist in other countries for precisely this purpose. Is the real truth that most people will be presumed to know and that little money is ever spent presenting them with the options at all?
Those are all serious issues that need to be addressed before we take the matter any further.
I am pleased to take part in the debate and to add to the support that has been expressed for the organ donation task force's recommendations, which could revolutionise the way in which we approach organ donation.
The Parliament has taken action to improve organ donation. The Human Tissue (Scotland) Act 2006—which introduced a new concept of authorisation and made provision for children aged 12 to 15 and adults over 16—combined with promotion of the organ donor register, has led to an increase in donation among all age groups. The previous Executive significantly increased the budget for promotion and, although I acknowledge Roseanna Cunningham's concerns about the size of the budget that is available for such work, I welcome the current Government's continuing commitment to promotion.
A lot of work is also undertaken locally to raise the issue. The Fife Free Press is running a campaign to increase the number on the register in Fife and I am happy to recognise its commitment and enthusiasm. However, although the public focus is on the organ donor register and there is a welcome debate about the merits of an opt-out system, the recommendations in the report are vital for improving organ donation. As the report makes clear, much can be done to improve the system of identification and referral, co-ordination and retrieval. The establishment of a national, co-ordinated, clearly defined organisation is key to success in that, and I welcome the commitment that the Government has made today to delivering that recommendation.
The Spanish example is often quoted as an illustration of the merits of an opt-out system, but the opt-out is only part of the story. As members have acknowledged, Spain has an advanced system for dealing with organ identification and retrieval. The lessons learned from that model could result in more people being given the chance of a good quality of life and good health.
I want to highlight a couple of areas of the task force's report. First, it recognises that many of the issues that we need to address
"should not be particularly difficult, or even that costly to resolve. Overcoming them will require leadership, boldness and willingness to change established practice."
That might be the most challenging aspect. The recommendations need implementation in all areas, and the task force has made bold recommendations about developing a model to ensure comprehensive potential donor identification. It is in that area where we face the greatest challenge, but I have confidence in the task force's recognition of the moral tensions that can exist in very difficult circumstances, and in its acknowledgment that it is proposing a radical change of practice.
The call for a pilot study on introducing clinical indicators is welcome, as support from medical teams is essential for the agenda to move forward. As much as any other recommendation in the report, improving the identification and referral system and removing the barriers that exist in that respect will make the real difference.
The proposals on the co-ordination of donor transplant co-ordinators and organ retrieval teams are critical. Although the UK has highly committed staff, our system is recognised as being unsatisfactory. There must be an increase in the number of DTCs, with one attached to every intensive care unit in Scotland. That expertise in organ donation should be extended to all clinical staff who are likely to be involved in the treatment of potential donors. The report highlights the fact that many critical care staff could go through their training without being involved in the care of a single potential organ donor, and I support its recommendations for mandatory training in the principles of organ donation.
I am interested in the report's recommendation on recognising and honouring individual organ donors, where that is desired and appropriate. When George Foulkes had a members' business debate on presumed consent a few weeks ago, many MSPs spoke of their deep personal gratitude to organ donors who had helped their families. Many donor families find comfort in hearing of the life that their loved one has been able to save. More could be done, if desired, to recognise that.
Speaking in the recent members' business debate, I raised the issue of baby and child donation. I appreciate that it is a highly sensitive area, but it is crucial that it does not get overlooked in the wider debate. I recognise the hard work of my constituent, Anne Fotheringham, in raising the issue of organ donation in Fife and throughout Scotland, and I thank her for bringing the reality of baby and child donation to my attention. The number of children waiting for transplants is not large, but it is significant. Nine children are currently waiting for a transplant in Scotland. Last year, there were 12 recipients of transplants aged under 17. We must do all that we can to help children who need organs to get the chance of a transplant.
The current debate on an opt-out scheme will not do much to improve the chance of a transplant for babies and young children, but an opt-out system, and the debate that accompanies its introduction, could make organ donation a more open subject, which parents will have discussed before being asked for consent. A public debate may provide the opportunity to reflect on the issue, so that parents are more secure in any decision that they might be asked to make.
The implementation of the task force's recommendations, the improved training and education of staff and the resolution of the moral tensions around introducing clinical indicators as a trigger for notification will go a long way towards improving the availability of organs for babies and children. The report recognises the existing barriers, particularly in identification, and I would argue that that issue is sharper when babies and children are involved.
As I said in the members' business debate, I cannot imagine having to make a decision over organ donation for a child. Like other parents, it is not something that I want to think about. However, we cannot exclude consideration of baby and child donation from the discussion.
While the debate around consent attracts leaders and champions, we must acknowledge that cultural change can be achieved only with clear political leadership and commitment. I hope that leadership will be shown by politicians, clinical staff and health boards throughout the UK to deliver the proposed measures to tackle the donor shortage.
I am pleased to have been given the opportunity to speak in this debate, which follows on from the previously mentioned and excellent members' business debate that George Foulkes initiated just over a month ago. The contributors to that debate, in well-reasoned and, at times, emotional speeches, highlighted the urgent need for increased organ donation in Scotland, as well as the ethical and moral issues surrounding it.
Cogent arguments were made for and against a system of so-called presumed consent to donation. It was accepted that we would need to have a full and widespread debate before any such system could be introduced. There was also a general acceptance that many more donor organs are urgently required. I hope that today's debate will send the message that our Parliament takes the matter very seriously indeed.
A number of us will know of people whose lives have been saved or transformed by the transplantation of vital organs and of others who sadly have died of end-stage organ disease without transplant or whose chance of transplantation came too late or was unsuccessful. It is well known here that my son's life was saved and transformed by a successful liver transplant. Conversely, a close friend of mine died without regaining consciousness when the donor heart that he received failed to beat properly after transplantation. That was a failure, but at least he died with the hope of regaining the sort of life that he had lost during the many years of failing cardiac output that preceded his long-awaited operation. Another friend lived well into his 80s before dying of a condition that was quite unrelated to the renal disease that had necessitated a kidney transplant more than 20 years before. Many people have been saved thanks to the generosity of all the families who have turned their personal tragedies into the gift of life for other people—thank goodness for them. Many others are not so fortunate. In the calendar year 2006-07, around 100 people died in Scotland alone before they could benefit from transplantation.
As we have heard, there is already a growing gap between the number of available organs and the number of people who need them. That will almost certainly spiral as the population ages, the incidence of kidney failure from type 2 diabetes increases and the hepatitis C that many people contracted in the 1970s and 1980s takes it toll.
There is undoubtedly a need to boost organ donation in this country soon. My family's gratitude to my son's donor's family knows no bounds and we would not hesitate to consent to donation should the situation arise. However, even though it is 16 years since my son's transplant, I am ashamed to say that I have been on the organ donor register for only about 3 years, having signed up electronically at an event that I attended as an MSP. If someone with my motivation took so long to register consent, there must be many more people who are willing to donate their organs but are not yet registered. Repeated surveys have indicated that 90 per cent of people would be willing to donate their organs after death, but only around 25 per cent are currently on the register.
There is a real need in Scotland to promote organ donation and I, for one, warmly welcome the work that the organ donation task force has done to identify barriers to donation and to consider the issues that might have a bearing on donation rates. I also welcome the cabinet secretary's commitment to implementing its recommendations in full. I sincerely hope that those recommendations will increase organ donation rates in Scotland by 50 per cent in five years, which would enable an extra 1,200 transplants a year to take place.
The task force has emphasised the need to improve donor identification and referral and to enhance donor co-ordination and organ retrieval, all of which depend on all parts of the NHS embracing organ donation as a usual, rather than an unusual, event. That might reduce the number of refusals by bereaved relatives when they face the decision whether to give permission for donation.
I had high hopes that the Human Tissue (Scotland) Act 2006 would result in a significantly enhanced rate of donation. Sadly, so far, that does not look likely. I am increasingly coming round to the view that it might yet be necessary to move to a situation where consent is presumed.
If the recommendations of the organ donation task force result in the concept of donation as a usual, rather than an unusual, event, I foresee that there could be a relatively easy transition to a system of presumed consent, like the one adopted by Spain and other countries, which would make donation the default position from which people could opt out during their lifetime if they so wished. The introduction of such a so-called soft system of presumed consent, with proper safeguards to respect the views and sensitivities of relatives, would lead to a shift of emphasis in favour of donation without major changes to current practice. It might well be the best way of respecting the wishes of potential donors and the feelings of their close family.
Many clinical, ethical, legal and cultural issues would have to be considered before an opt-out system of consent could be put in place, but I am increasingly inclined towards the viewpoint of the BMA and others that we need fairly soon to have a genuine, informed public debate about organ donation and the best way to respect the wishes of those who feel that their organs should be used after death to save and enhance the lives of others. I am pleased that the task force is now undertaking detailed consideration of the presumed consent model for donation, and I look forward to its conclusions later this year.
It is no exaggeration to call organ donation for transplantation the gift of life, and until end-stage organ disease can be prevented or research allows the growth of extraneous new organs, it remains the only hope for many, and increasing numbers, of our fellow countrymen and women. We must examine every possible means of increasing the rate of donation so that that hope can be realised for the many other families who, like mine 16 years ago, are faced with the inevitability of a loved one's vital organ failure.
I thank Lord Foulkes for giving us the opportunity to debate the matter again in Parliament—he should be congratulated—and I welcome the opportunity to contribute to this important debate. I also welcome reports on the BBC that ministers are increasingly sympathetic to a change to presumed consent, and the Scottish Government's latest television advert, which was sent around today. I wish it every success in increasing our pitifully low level of donation.
As some members might know, some six years ago I attempted to introduce a bill to promote the concept of presumed consent to organ donation. I had to abandon the attempt when it became clear that I would have little support from the Labour-Lib Dem Executive, but I think that that is changing slowly—at least, I hope so. I was advised that the Scottish Executive was promoting a bill that would dramatically improve the system and, as a result, increase the number of available organs. I was disappointed, and I continue to be so, as the bill has not improved the situation. Waiting times have not improved, and people die—as we have heard several times—while waiting for healthy organs, which are buried or cremated daily. That seems to be such a great waste and a great shame, when people could make good use of those organs and give them a new lease of life. We have the gift to give them, but we are reluctant to do it.
The gap between the number of people who are waiting for transplants and the number of organs that are available for donation has been steadily increasing over the past decade. There should be swift and decisive action—it needs to happen now. The official register of people who are waiting for organs does not take into account the much larger number of people who never get on to the register, because there is no possibility of their getting an organ for transplant, so they miss out dramatically. Statistics that were published in a BBC report this morning show that although 93 per cent of the population support organ donation—a remarkable amount—only 29 or 30 per cent are on the register. That is a clear indication that we should push towards presumed consent.
However, it is essential that individuals who do not approve of donation are given a comprehensive opportunity, on a national database, to make known their views.
Will the member take an intervention?
I am just coming to an end—I think Mike Rumbles has a different agenda.
Fortunately, political opinion is now swinging in the direction that the British Medical Association has been promoting for a number of years. It continues to campaign for change to legislation in order to secure organs for transplant. Remarkably, as some members might know, the Prime Minister Gordon Brown has stated that he supports the concept of presumed consent. Things are moving in the right direction.
I do not think that the issue should have political bias—I hope that it does not. Fundamentally, it is a matter for the individual's conscience at the time when they are required to make the decision, so politics would be well advised to keep clear of the debate. However, I am heartened not only that the Government is warming to presumed consent, but that Labour members have come to support the concept. When I promoted it six years ago, there was little support among Labour members. I am glad to hear and see that that has changed dramatically.
I cannot speak for my fellow Liberal Democrats, but if the Government chooses to proceed with presumed consent, I give an assurance that I will support it.
I am pleased to follow such a positive speech—one with which I wholly agree.
The generosity of donors and their families enables nearly 3,000 people in the UK every year to take on a new lease of life. It is important for those of us who have grown up with transplants to acknowledge that the first successful kidney transplant took place only in 1954 and the first heart transplant in 1967. I have to say that a feeling of panic came over me when I read that. I remember when the first heart transplant took place and my own mortality was exposed to me.
The kidneys, the heart, the liver, the lungs, the pancreas and the small bowel can all be transplanted. Techniques are improving all the time, and soon it might be possible to transplant other parts of the body to help even more people. However, there is a serious shortage of organs and the gap between the number of organs that are donated and the number of people who are waiting for a transplant is increasing.
Transplants are very successful, and the number of people who need transplants will continue to increase due to the ageing population, an increase in kidney failure due to lifestyle changes, and scientific advances, which mean that more people are now able to benefit from transplants.
The number of organs that are available for transplantation has reduced for several reasons. Mr Rumbles and Mary Scanlon mentioned the issue in their interventions. Only a small number of people die in circumstances in which they are able to donate their organs and organs have to be transplanted soon after death. They usually come from people who are certified dead while on a ventilator in a hospital intensive care unit, usually as the result of a brain haemorrhage, a major accident such as a car crash, or a stroke. The number of people—particularly younger people—who die in such circumstances is falling, mainly because of welcome improvements in road safety, medical advances in treatment, and prevention of strokes in younger people. That goes some way towards answering Mike Rumbles's question about why the number of people on the donor register is increasing but there are fewer people from whom to get organs.
Many people have not recorded their wish to donate their organs, or discussed it with their family: too few people have joined the NHS organ donor register and made sure that their families know their wishes. It is important that the Scottish Government's advertising campaign covers that, as I know it will.
It is important to remember that we are talking about real people and real lives. Someone who received a heart transplant said:
"My transplant gave me my life back. I have seen my children grow up and was able to get back to work. I owe all this to a 19-year-old man who wanted to give someone he had never met the gift of life."
Since 2002, there has been a 16 per cent increase in the number of transplants overall, a 26 per cent increase in the number of kidney transplants, and a 280 per cent increase in the number of non-heart-beating donors. The problem is that demand continues to outstrip supply. Members have not mentioned today the fact that the lack of organs for transplantation has caused some people to go overseas and undergo risky and expensive transplant procedures. I remember reading early last year—in the Daily Record, of all papers—about people who go from Scotland to Pakistan and pay people several thousand pounds to get back-street transplants. That obviously puts in danger their lives and those of the people who make the donations.
We have heard that the only reason why there has been a big increase in donations in Spain—particularly in the Basque country, which has the highest donations, at four times the UK rate—is that there are more car crashes and more transplant co-ordinators. I accept that, but one point that I made in the members' business debate on presumed consent that was instigated by Lord Foulkes was on the regression analysis. In the submission that the BMA sent to all members, it gave some details that are important to reflect on:
"In 2006, Abadie and Gay published a detailed regression analysis of 22 countries over 10 years taking into account a range of determinants that might affect donation rates. They concluded that ‘when other determinants of donation rates are accounted for, presumed consent countries have roughly 25-30 per cent higher donation rates than informed consent countries.'"
Those determinants are gross domestic product, per capita health expenditure, religious beliefs, the legislative system and the number of deaths from traffic crashes, cerebral vascular diseases and so on. It is a red herring to suggest that presumed consent does not increase the number of organs that are available for donation.
It is a question of saving people's lives. Government at both UK and Scotland level has to be commended for the work that has been done in setting up the task force. Like many others, I hope that all its recommendations will be taken on board.
The Human Tissue (Scotland) Act 2006 introduced a new concept of authorisation for cadaveric organ donation, which is a phrase that is intended to convey that people have the right to express during their lifetime their wishes about what should happen to their bodies after death, in the expectation that those wishes will be respected. As someone who is strongly in favour of presumed consent, I think that we need measures to ensure that people do not worry that organs will be taken without their wishes being taken into account. However, we have to understand that the problem is acute and will only get worse. We have to bite the bullet at some point, and from chatting to colleagues I know that many members have realised that presumed consent is the way forward.
We have to take on board all the report's recommendations, and we should take the earliest realistic opportunity to move to a system of presumed consent.
I had not originally intended to take part in the debate, but the more I thought about it the more I felt that I should. I hope that my reasons will become clear during my speech.
My only experience of organ donation came in 2000 following the death of Parliament's first First Minister, the late Donald Dewar. I had the privilege of being one of his special advisers at the time. As people know, Donald died of a brain haemorrhage after a fall. Those of us who dealt with the incident went through all the emotions that people have to deal with when something terrible happens to someone close to them. One minute they are in casualty, consultants are treating the patient, and they are hoping that things will improve, but the next minute they are dealing with the terrible information that the patient's condition will not improve and, indeed, is terminal.
A further complication in Donald's case was that his family—his daughter Marion and son Ian—did not live in Scotland. Arrangements were made for them to get to their father's bedside as quickly as possible. As members would expect, the medical staff who were treating him gave Donald the best possible care, but in truth they were keeping him alive until his family could arrive to say their goodbyes and give permission for the artificial respirator to be turned off.
It was at that point that Donald's children were asked whether they would consider organ donation. I do not know whether Donald had ever expressed any views to his family about organ donation, but I know that they took a brave and sensitive decision that they believed that their dad would have wanted his organs to be used by someone in need. They gave permission.
That made me realise, as someone who has carried an organ donor card for some time, that everything that can be done should be done to make such difficult decisions as easy as possible for the loved ones who are overtaken by such tragedies. When we hear that last year 1,000 people died in the UK—around 100 in Scotland—waiting for a transplant, it is clear that a different approach should be seriously considered.
Before coming into the chamber, I took the opportunity to watch the new advert, which is well done. I hope that it will send a strong message and achieve the desired result—an increase in the number of people who sign up to be organ donors.
Dr McKee's suggestion of issuing applications for organ donor cards with driving licences and passports is excellent, especially for driving licence applications by people who are aged between 17 and 21.
It may surprise John Farquhar Munro—although I was not an MSP when he first raised the issue—that I am in favour of the presumed consent model. As we have heard, it works in 21 other countries, whose opt-out systems allow those who do not want to donate to make that choice clear.
We have heard that the organ donation task force has noted that the UK has one of the lowest organ donation rates in Europe and, as the cabinet secretary said, that Scotland's rate is lower than that for the rest of the UK. I have mentioned the consequences of that for people on the transplant waiting list. The task force's report said that a UK-wide organ donation organisation should be established. I support that, so I was pleased to hear that the cabinet secretary has signed the Scottish Government up to that, and that the other devolved Administrations in Wales and Northern Ireland, along with the UK Government, believe that a UK-wide solution is essential.
As we have heard, it is also essential to recruit more transplant co-ordinators, who work with hospitals and who guide and support bereaved families through the donation process. In Donald Dewar's case, decision making was delayed, as the family had to wait for the transplant co-ordinator to arrive from another hospital. Such decisions are delicate and sensitive and need careful handling. Unnecessary delay should be eliminated if at all possible.
We have heard that the task force believes that, if all its recommendations are implemented, organ donation in the UK could increase by 50 per cent within five years. That would mean an additional 1,200 transplants and an additional 1,200 people who would be helped to have a better quality of life.
However, the issue is sensitive. Many people have ethical, cultural or religious objections to the adoption of a presumed consent model but, as several speakers have said, the evidence from countries that have presumed consent models is that only one in 50 people opts out. The British Medical Association supports the system of soft presumed consent, under which organs would be removed unless the individual registered an objection during his or her lifetime, or it was clear from relatives that the individual had expressed an objection that had not been registered, or it was apparent that to proceed would cause major distress to the individual's relatives. That system should overcome some of the misgivings that Mary Scanlon feels. With such safeguards in place, the public would be moved to support a change to presumed consent.
It is ironic that two of Donald's closest friends—Murray Elder and Sam Galbraith, who is a former health minister—are still alive today thanks to organ transplants that took place many years ago. I am sure that neither of them will thank me for saying that those life-saving operations enabled both of them to go on and make their significant contributions to public life.
I do not know where Donald's organs went—nor should I—but I hope that they helped others to go on and enjoy a better quality of life. As we have heard, at the end of March last year, 7,000 patients were waiting for transplants. The lucky ones were the 3,000-odd who had a transplant in the past year thanks to the generosity of 1,495 donors and their families.
When faced with the kind of decision that the Dewar family had to make, 40 per cent opt for the default position of not donating. Moving to a soft presumed consent model would remove the dilemma of having to make that decision at a time of stress for any family. It would increase the number of organs that are available for transplant and would give the gift of life to thousands who are on transplant waiting lists.
I believe—I am presuming consent from the late Donald Dewar—that if he were still alive, he would believe that changing to a new system for organ donation consent was the right thing to do.
As other members do, I very much welcome the organ donation task force's report. I am particularly pleased that the Scottish Government has agreed to implement all 14 of its recommendations and to work in partnership with the London, Welsh and Northern Ireland Governments to take it forward nationally. Like other members, I was interested to note the suggestion that if all 14 of the task force's recommendations were implemented effectively, that could result in a 50 per cent increase in the number of donations over the next five years. I very much hope that that is the case.
However, when the report was published, given the gathering momentum around the presumed consent debate, I was conscious that there was a danger that some people may argue that we should not implement the report's recommendations because presumed consent may be a much more effective way of dealing with the issue. I am reassured by the minister's statement that presumed consent will not be a substitute for the implementation of the task force's recommendations.
That said, the task force's report raises interesting questions about presumed consent. If the implementation of all 14 recommendations was successful and increased the number of organ donations by 50 per cent, it would be reasonable to ask whether there was still a need to have a debate on presumed consent or to consider such a model. Should we wait for five years, to see whether implementation of the recommendations delivers that possible suggested increase? I do not think that we should. We should move forward now because five years is too long to wait, especially for people who are on the transplant waiting lists. Nevertheless, l believe that the Government should address such questions in the debate on presumed consent.
I have no idea what being on the transplant waiting list must be like, but I have witnessed at close hand the impact that it can have on the lives of people on kidney dialysis while they wait for transplants—the impacts on personal life, work life, leisure life and life in general. At the Falkirk and district royal infirmary, in my constituency, we have an excellent renal dialysis unit that was opened several years ago and was recently extended—the cabinet secretary came to the opening of the extension. That unit has markedly improved the quality of life of my constituents who are on renal dialysis, as they can now go to their local hospital instead of having to travel to Glasgow or Edinburgh.
In particular, I highlight the plight of families with children who have to go to hospital for renal dialysis. When specialist forms of dialysis are required, children are having to travel to Yorkhill hospital in Glasgow, where that service is provided, irrespective of where in the country they live. For people in my constituency, that may not be a big burden, although it still means that such children must leave school regularly throughout the week to travel to Glasgow for dialysis. It is a bigger burden for those who have to travel from Inverness, Shetland or wherever. I know of families that have had to uproot themselves and relocate to Glasgow in order to access the service. The best thing that we could do for those children would be to increase the number of organ donations, in order to allow them to come off dialysis at some point in the future.
We need to consider providing more support for families and children who are in that situation. A small charitable organisation in my constituency—Kidney Kids Scotland—provides financial and practical support to such children and their families. It does a fantastic job, and the Government should consider what further support it could give to families in that difficult situation.
Like Mary Scanlon, Mike Rumbles and Ross Finnie, I have concerns around the term "presumed consent". In my view, consent is an active process, not a passive one, so there is a debate to be had around the terminology. When the debate first began, I opposed presumed consent largely on the basis of the selfish view that I, not the state, will determine what happens to my organs. However, I now believe that we should move towards a presumed consent model in Scotland.
I said that I originally came to the debate thinking that presumed consent was not the way to go but I have changed my view for largely selfish reasons. If I, a member of my family or anyone else, depended upon having a transplant, then I hope and pray that it would happen for them sooner rather than later. The statistics tell the story that, for many people, it is happening too late. If a presumed consent model would help to save lives, I believe that we should do it sooner rather than later.
This has been another good debate on organ donation and transplants.
Nicola Sturgeon said that the debate offered an initial opportunity to express our views on the task force's recommendations, and she signalled the Government's willingness to implement all of them. There is agreement around the chamber that we should accept the recommendations in full and that, if we do, there will be a 50 per cent increase in transplant rates. It must be the right thing to do.
The minister also said that presumed consent is not a substitute for the task force's recommendations. Margaret Curran said that the public is with us on the need to increase organ donations, but she also acknowledged the need for a proper debate around presumed consent. During my intervention on her speech, I pointed out that we need to use different terminology if we are to have a properly informed debate.
Mary Scanlon did not give the Conservative party's position, but instead confirmed her personal view—which I acknowledge and support—that presumed consent is not consent at all. She pointed out the fact that Parliament has been quite clear that consent cannot be presumed in passing legislation that has come before it on sex, for example.
Organ donation rates have risen in Spain because it has a network of transplant co-ordinators, not because it has a system of so-called presumed consent. That is exactly what the Health Committee discovered during the passing of the Human Tissue (Scotland) Act 2006 in the previous parliamentary session; the evidence is there for all to see.
Ross Finnie outlined the fact that the 2006 act gave legal authority to the organ donor card and register for the first time. The wishes of the deceased now carry legal force, and I do not want to lose that. Ross Finnie also challenged the terminology that we used and talked about the shorthand use of the term "presumed consent". We are really talking about voluntary donation, or indeed non-voluntary, or even compulsory donation. It is important to use the language properly if we are to have an informed debate. George Foulkes agreed that language is important and argued that we should stop talking about presumed consent. During her intervention, Mary Scanlon pointed out that a donation is a gift. If something is taken without consent being given, it is not a donation.
George Foulkes wants to use opting out, and that is fine by me, as long as we do not assume that people who neither opt in nor opt out are assumed to have opted in.
I turn to the contribution of my good friend, John Farquhar Munro and I pay tribute to his actions on the issue during the past six years. He was right to bring the issue up, but he was also right when he said that he did not speak for his Liberal Democrat colleagues. He does not seem to accept that the problem of the poor number of organ transplants will not be addressed by pursuing so-called presumed consent. No one has really been able to address the point that, if we have the highest-ever number of people on the organ donor register, but a falling number of transplants in Scotland, logic dictates that the solution cannot be to increase the number of people who are on the register—much as we would like that to happen. The solution lies before us today: implementation of the recommendations of the organ donor task force report.
Mike Rumbles said that it is understandable that John Farquhar Munro did not speak for the Liberal Democrats. Mary Scanlon said that the Conservatives, like the Labour Party, will be given a free vote on the issue because that is sensible. I had presumed—if members will excuse the word—that the Liberals were going to have a free vote as well. Is that the case?
As my colleague Ross Finnie made absolutely clear, we will reflect on that very issue because the matter is of such importance.
I am sure that all members are equally committed to increasing the number of organ transplants, so there is no question about the outcome that we all desire. Today, I have heard no one criticise any of the task force's recommendations. If we are successful in implementing the measures, we will increase transplants by 50 per cent. That must be the way to go.
Some members—probably most of those who have contributed to today's debate—have called for us to go further by adopting so-called presumed consent, but many of us believe that that would be a counterproductive measure. That is an important point. Personally, I do not believe that presumed consent would be successful.
For goodness' sake, we should get on with implementing the task force's proposals, as Ian McKee said in his heartening speech. The recommendations will work. We should put the issue of presumed consent—which everyone accepts is divisive—to one side and implement the 14 recommendations, on which the minister has the support of members on all sides of the chamber.
In a compelling and considered debate, we have heard many admirable speeches from members in all parts of the chamber.
In particular, I note the remarks that were made by the cabinet secretary, by Margaret Curran—I mention her unreservedly on this occasion—and by Ross Finnie. I was also much struck by David Whitton's speech. All those speeches were in addition to those that were made during George Foulkes's members' business debate in January, which was also on the issue of presumed consent. In passing, I might say that things came to a pretty pass today when John Farquhar Munro gave the impression that Lord Foulkes, as a Government minister, initiated this afternoon's debate.
Having reread the account of the previous debate ahead of today's, I should also state that many fine contributions on this as yet unresolved business were made on that occasion by, among others, Claire Baker, Nanette Milne, Cathie Craigie, Kenneth Gibson and Malcolm Chisholm. Several of them also spoke this afternoon. They all, in one way or another, supported a move towards presumed consent. However, the speakers in the previous debate also included my colleague Mary Scanlon and Roseanna Cunningham, who were more sceptical and restated their reservations this afternoon.
The cabinet secretary stated ahead of the debate that she hoped that the issues surrounding presumed consent would be aired today. I will return to those issues shortly, but it seems important first to acknowledge that the discussion on improving Scotland's rate of organ donation has been seamless. All parties, when in government, have tested public temperature and made progress.
As many members have said, the report on which the Government will act is comprehensive. Crucially, if its 14 practical recommendations are acted on as a whole, they have the potential—according to the task force's chair, Mrs Elisabeth Buggins—to realise a 50 per cent increase in organ donation in the UK within five years.
In the previous debate on presumed consent and again this afternoon, Mike Rumbles alluded to the recommendations in their entirety when he made the point that increasing the number of registered donors will not of itself make a manifest difference if the systems for retrieval and proper co-ordination are not vastly improved. That point could not be more emphatically put than it is in the report.
Much more ought to be achievable on a voluntary basis if it is indeed true that, in opinion polls, some 90 per cent of respondents say that they would be willing donors but only 29 per cent of respondents in Scotland go on to register. Given people's apparent willingness to be donors, surely a more overt soliciting of registration would now be appropriate. I fully support Nanette Milne's comments on that.
I note the new media campaign that is under way and do not doubt that it is well researched. We know that reactions to such campaigns must always be subjective but—without wishing to be in any way churlish—I must say that, unlike George Foulkes and David Whitton, I do not much like what I have seen of it so far. While driving to an engagement last Friday, I very nearly collided with one of the new 48-sheet billboard poster sites that feature the campaign. Setting aside the possibility that that was the intention, I wondered whether it was appropriate to confront motorists at a busy traffic junction with a "Live or die" challenge. I would prefer an uplifting donor campaign that focuses on the life-enhancing experience of those who have benefited from the gift of organ donation rather than on the ghastly choice that confronts those who need to make the decision at the critical moment. I fear that the campaign may turn some people off, rather than on, when they consider registration.
I prepared my remarks before I saw the video, which I saw a few moments ago. To me, it seemed like a bleak episode of "Torchwood"—a programme that I normally enjoy—or like a live-or-let-die phone-in vote in a reality show. It did not suit my taste. However, I hope to be proved wrong and look forward to experiencing all the different elements of the campaign during the month ahead.
I return to the fact that 93 per cent of the public indicate that they are willing to register. Like others, I wonder whether an invitation to register might accompany key pieces of national domestic mailing, such as council tax notices, electoral roll registration forms and student examination results. I understand that people are already approached by the Driver and Vehicle Licensing Agency in that way.
Ian McKee proposed that the material be included with passport applications. Offence ought not to be taken if the opinion polls are right and people are looking for ways to access registration on a sustainable basis and not just on the back of one burst of media activity. Although, like the cabinet secretary, I am sympathetic to a move towards presumed consent, such a move must follow and not precede our being able to say—and our being convinced when we say it—that every possible effort has been made to improve registration by other means. We cannot say that yet.
The measures that I have described are vital because I fear that, when examined in detail, presumed consent is less attractive to people than their initial reaction suggests. If we proceed with it, we must be confident that the obstacles can be overcome. I agree that any debate on presumed consent must be informed and extended. In view of the recent and seemingly inexhaustible examples of massive losses of computer data, what confidence would the public have in politicians who tried to assure them that their wish to opt out of presumed consent had been properly recorded and would be respected? Members should consider on whom the public's wrath would turn if examples of organs being harvested from those who had opted out became part of a future media storm—and the potential of such examples to undermine confidence in the whole organ donation system.
Mindful of the personal testimonies that we have heard from the public and from colleagues, we must do all that we can to increase the total number of voluntary registered donors. However, as I said at the start of my speech and as many other members have noted, that is just one aspect of what needs to be done. Co-ordination and retrieval of organs on a UK basis will be the key to our future success.
In the previous debate on organ donation, Malcolm Chisholm pointed out that a simple comparison with Spain is not a solution because, in Spain, which has one of Europe's highest road death rates, more suitable registered donors become available. That is not a development that we are seeking to encourage. However, there are significant operational lessons to be learned from Spain and other countries, which form part of the package of recommendations that the organ donation task force report urges on us. Conservative members will support the Scottish Government as it acts on those recommendations. We hope that it will ensure, during this parliamentary session, that the problems that need to be overcome to implement the report in its entirety are addressed urgently. The prize will be the many lives that the authors of the report believe will be saved or transformed as a result.
It is rare for there to be such unanimity across the chamber. It is clear that there is unanimity on the report of the UK organ donation task force. There is also a fair degree of unanimity on the problem that we face—the fact that the number of transplants in Scotland is so low and the fact that the level of organ donation in the UK is one third of that in Spain. Several members have made that point.
Mike Rumbles alluded to the fact that, despite the Parliament's efforts, the number of donations has not gone up, and he sought an explanation for that. I was the reporter to the former Health and Community Care Committee when it first considered organ donation. One reason the number of donations has not increased is that, fortunately, the number of brain-stem deaths is being reduced because of our ability to tackle cerebral haemorrhage and because of a reduction in the number of road traffic deaths. There are good reasons for the reduction in the number of donations, but it has not been compensated for by increases in the number of non-beating-heart donations, living relative donations and non-relative donations.
The supply of donated organs is not sufficient, but demand is increasing. Kenneth Gibson referred to the fact that many more organs can now be transplanted. Demand is increasing not just as a result of innate need, but because the opportunities that technology provides are increasing. For example, when I began my professional career, individuals with cystic fibrosis had minimal prospects of surviving into adulthood. Now they do, but in many cases they will not survive for the length of time that I have enjoyed without the opportunity for transplant.
Ian McKee, George Foulkes and others referred to the problem in ethnic minority groups, which is a serious issue that must be addressed in any publicity that we produce on registration and on management. Margaret Curran and many other members referred to the sensitivity that we need to show when we deal with the issue. For example, if we have an opt-out system, the register needs to be robust, as Jackson Carlaw said.
Margaret Curran also referred to training, which is fundamental. It is therefore disappointing that, despite the recommendations of the Health and Community Care Committee report, many doctors are still inadequately trained and many other staff are not fully aware of the need to look at organ donation. We need to tackle that.
Ross Finnie rightly talked about the need for a systematic approach. The issue has to be tackled on an organisational basis that manages every aspect and records where we are failing, where things are not going right and what happens when donation does not occur. There will need to be proper recording by the Government and by trusts and health boards. There will also have to be leadership training in this area if we are to move things along appropriately.
Many members have referred to the fact that, in Scotland and in this Parliament, we have made some efforts. As the cabinet secretary indicated, the Scottish transplant co-ordinators are already centrally funded. She also suggested that, to improve performance, we should perhaps consider having a chief executive letter or a health efficiency access and treatment target. I think that that is correct. I also suggest that we do not yet need to move to financial incentives—that is too sensitive an area—but we need to remove the financial disincentive that trusts, hospitals and boards face when they undertake organ donation. That needs to be categorised and the money must be provided centrally as part of the new organisation.
The process of positive registration being referred to as a gift or a donation is important. Many countries that have the system that is known as presumed consent still retain opt-in and opt-out registers. The recognition and registration of the gift is important.
If someone opts in, the need for the family to make the decision is removed because the legal statement of the deceased is clear and has force in law.
Will the member give way?
No, I want to complete this point.
The point is that we still ask the family. That is another reason why the numbers are not going up as much as we would like them to. There are some families that do not accept the wishes of the deceased, which means that although the statement has legal force, organ donation does not occur.
Advertising is important. Claire Baker paid tribute to the Fife Free Press. I join her in that. The Alloa and Hillfoots Advertiser is also running a campaign, as are other local papers. That is to be welcomed. Backed by a national campaign, that might help to improve the level of registration.
Members have referred to circumstances in which registration for organ donation is appropriate. Already, people are given the opportunity to do so when they register with a GP. They should also be able to do so when they register to vote and, as David Whitton said, when they apply for passports and driving licences. Further, when people get their council tax bill, they should get a note that says, "Your council tax is frozen, but we would like you to register for organ donation."
As Nanette Milne said, online registration is also important. She also pointed out that the fact that she took so long to register—even though she undoubtedly had a strong motivation to do so—shows that we have a problem with our ability to acquiesce to the wishes of the population with regard to organ donation. According to polls, 93 per cent of people back the concept of organ donation. The time has come to make a move.
We need to be clear about the legislation on non-beating hearts, as Mary Scanlon said. We also need to ensure that we avoid any conflict of interest between the physicians and clinicians who are trying to get a patient back to health and the teams that are involved in the organ transplant process. There needs to be a clear awareness of the potential conflicts of interest.
The final issue is the vexed one of presumed consent. I use that term only because it is used across 21 countries in Europe. Are they wrong and we are right? Have they had problems, major difficulties and concerns? No. Is the evidence that presumed consent increases the number of donations clear? Yes.
There have been parallel studies in Belgium; one area had an opt-in system and the other had a system of presumed consent. There were before-and-after studies on the introduction of presumed consent. As some members have mentioned, a meta-analysis—a compilation of research—has been done that demonstrates clearly that presumed consent increases the number of donations by about six per million. If presumed consent had the same effect in Scotland, we would not just double, but would increase by 150 per cent, the number of donations.
The time has come for us to do what David Whitton suggested—we need to make organ donation easy for the families. That is crucial to the debate. It is vital that we respect families' views, but we need to make the process easy for them. If someone who has just been bereaved is asked, "What do you think the deceased would have wanted?", they will say, "I don't know," with the result that, as has been said, they will opt for the default position, which is not to donate.
One of the clearest bits of evidence on the issue was provided by a research project that interviewed families a year after they had refused to give permission for donation. It found that 40 per cent of those families regretted their decision. Families are being put in the unenviable position of being asked whether they agree to organ donation when they should be being asked whether they object to it. That might not seem to be a large shift, but it is psychologically crucial to how families manage the situation.
I agree that, "Do you object?" is a much better question to ask families, but Richard Simpson should remember that there has already been a vast increase in the number of people on the organ donation register—30 per cent of people are on it. I would have no problem with the proposal to have an opt-out register if there was also an opt-in register, but there should not be an assumption that people who have neither opted in nor opted out have opted in.
The problem with a soft system is that with quite a number of people who have opted in, their families have nevertheless said no. We must respect families' wishes, so we need to change the culture, as a number of members have said. Ross Finnie used the word "authorisation", which is a good term, but it does not take us a great deal further.
We all agree that the task force recommendations must be implemented in a powerful, organised and systematic way that ensures that chief executives focus on organ donation and that we maximise the number of organs that are donated. We must encourage registration. George Foulkes said that every donor gives 56 years of life to others. The Parliament needs to send out the message that, in the correct circumstances, organ donation must become usual, and we must make it easy for our citizens to donate their organs.
The debate has shown the Parliament at its best. Members have dealt with a sensitive and difficult issue constructively and on a cross-party basis. Of course, organ donation is not a party political issue, as many members have pointed out. The position that people take on it depends on their personal views and beliefs. I confirm that, for that reason, members of the SNP will have a free vote on the matter. We took that into account when we had the debate designated as a subject debate, and I think that our decision has played a part in stimulating high-quality speeches, because—rightly—people have felt free to express their views.
As the cabinet secretary said in her opening speech, we had three main aims in organising the debate: to underline our commitment to increase the organ donation rate in Scotland by implementing the recommendations of the task force's first report; to draw attention to today's launch of the most high-profile advertising and publicity campaign on the subject that has ever been undertaken in Scotland—I hope that Jackson Carlaw will change his view on that as the campaign develops; and to give members an opportunity to debate the risks and benefits of moving to an opt-out system.
Members have raised a number of points to which I wish to respond. Mary Scanlon mentioned the need to clarify the legal position on non-heart-beating donation. As she knows, when a person has given authorisation for organ donation there is no conflict; the 2006 act provides that such express wishes will be fulfilled. We will develop advice for the Scottish Intensive Care Society on the legal position regarding non-heart-beating donation when no wishes have been expressed. I hope that that addresses some of Mary Scanlon's concerns.
Mary Scanlon and Ian McKee talked about the increased prevalence of diabetes and said that we must tackle it, to reduce the need for kidney transplants. I absolutely agree, which is why we are doing work on type 2 diabetes in particular. Some of our health improvement measures are geared towards that issue.
George Foulkes made an important point about language. I prefer to talk about an opt-out system, which better reflects what we mean. We need to be in a position in which we do not presume anything, as George Foulkes made clear. He also made an important point about the need for safeguards in an opt-out system, to guarantee rights. He talked about the need to increase minority ethnic donors. Ian McKee and, I think, Richard Simpson made the same point. We acknowledge that important issue and we will ask the Scottish transplant group to consider how we can ensure that there is an increase in donations from ethnic minority communities in Scotland.
In paragraph 4.13 of its report, the task force said:
"there is a lack of legal clarity around how, if at all, a patient close to death can be treated differently in order to facilitate donation, particularly if their wishes to donate are not expressly recorded."
Will the minister work with members of Parliament at Westminster to ensure that the same legal definition will apply consistently throughout the UK?
As well as working with the Scottish Intensive Care Society, we will of course talk to colleagues at Westminster about the matter.
Claire Baker talked about the need to keep in mind baby and child donation, which is an important point. She will be aware that the 2006 act allows children under 12 to donate organs after death. Of course, in such cases authorisation must be given by the person who has parental rights and responsibilities.
I support Michael Matheson's comments about the important work that Kidney Kids Scotland does. We expect our services to support children who undergo kidney dialysis, and their families, on travel and accommodation issues. I hope that that provides some reassurance.
An opt-out system is the next phase and was the key issue that we considered in the debate. As I said in reply to the members' business debate on organ donation that George Foulkes secured, I am sympathetic to such an approach, but, like many members, I acknowledge the concerns that arise.
Mike Rumbles said that we should not take away choice. We do not want to take away choice; we want to change how choice is exercised. The soft opt-out system would still allow families the final say. Richard Simpson suggested that there might be an issue in that regard. I want families always to have the final say, even when a person expressly wished to be a donor, because to expect health staff to push forward with organ donation against a family's wishes would be to put staff in an invidious position—we would not go there.
I am at one with the minister on the issue. If we look at the law as it stands at the moment, it is all about authorisation. People can pre-authorise with the organ donor register or their families can authorise donation. If we stick to the position that the minister has outlined, I will have no problem.
Yes, but the issue is one of culture change; the question that the family is asked needs to be changed. We need to ask, "Do you object?" Making that change would deal with the clear concern that members across the chamber have expressed. Families find the point at which the question is put the most difficult of all. That is the underlying reason for the high refusal rate. I will say a bit more about that in a minute.
The questions that we need to ask ourselves have been well rehearsed. Would a move to opt-out deal completely with the shortage of donor organs? Can we move to that position without alienating public support for transplantation or undermining the very high degree of support that it currently enjoys? Before we move forward, we must have the answers to those questions.
Of course, those questions address the sorts of issues that the organ donation task force is looking at across the UK. It is arranging events in several parts of the country, including one in Edinburgh at some point in May. We want to ensure that as many people as possible get the chance to attend the event. The task force will also look at other ways of allowing people to make their views known. The cabinet secretary will discuss those issues with the chair of the task force next month.
Margaret Curran, Roseanna Cunningham and other members mentioned the crucial role of relatives. Everyone agrees that, irrespective of whether people opt in or opt out, the process must be made as easy as possible for relatives. Without their co-operation, donation cannot take place because all the information that health professionals need, to be sure that no harm will come to potential recipients, will not be made available. As many members have said, relative refusal rates are over 40 per cent. Whichever system we adopt in future, reducing that refusal rate will be a key factor in its success.
Will the minister clarify a matter of extreme delicacy and difficulty to which both she and Richard Simpson have referred? As it presently stands, the law on establishing authorisation does not allow people to counter at a subsequent time the wishes of the person who gave authorisation for donation. Nothing that the minister said was very different from that, but I think she hinted now and again that she wished to override it.
I accept that that is the legal position, but the reality is that health professionals who work at the front line will never override the wishes of the family. That is just not going to happen. We should not expect health professionals to be put into such a position.
When relatives know that their loved one wanted to donate, they usually consider it their duty to ensure that those wishes are fulfilled. The key factor is therefore to ensure that people who want to donate their organs after death tell their loved ones what their wishes are. It may not be a very easy subject to bring up in conversation, but it is much harder for the family to have to decide, at the very moment that the loved one is no longer able to tell them directly, what a loved one's wishes may have been. Many members have mentioned that, and it is why our advertising and publicity campaign stresses that people should put their name on the organ donor register, given that it is recognised as the way forward at the moment. Doing that also encourages people to tell their nearest relatives what their wishes are. Not only does that count as authorisation under the act, but families are in no doubt about what they are to do should the circumstances arise. That enables them to take the initiative, which makes the whole process much easier for everyone concerned.
We are committed to implementing, for Scotland and with the other countries in the UK, the recommendations in the task force's first report. The task force believes that doing so will make a major difference in as short a time as a year or 18 months. We very much hope that that belief is fulfilled and we are determined that Scotland should play its part in making it happen. We look forward to engaging the Parliament in the process as we go forward.