My Lords, the concept of organ transplantation has developed worldwide and, over recent decades, we have witnessed a significant increase in the number of organ transplant operations undertaken. The issue of organ donation must register as one of the most important challenges in the area of health policy and delivery. In the United Kingdom, around 7,500 people are waiting for an organ transplant and some 400 people die each year waiting for a transplant, including 100 children. These are frightening statistics and we need to consider how best to try to reduce those numbers.Organ transplants are good and have saved countless lives, including making considerable improvements to the quality of life for many patients. For example, a kidney transplant can release patients from the inconvenience and discomfort of undergoing dialysis for as many as three sessions per week, a process that can take quite a few hours, and, unfortunately, the condition can be life-threatening. It is therefore imperative that we increase the number of donors and achieve that by effective persuasion and setting up suitable mechanisms.In December 2006, the Department of Health established an Organ Donation Taskforce, with the remit of investigating the barriers to donation. I understand that the Government are now in possession of its report and recommendations, which were published on Wednesday. Notwithstanding that, the Minister will want to consider the content and the detail of those recommendations. I hope that this debate will provide a platform for the Government to furnish us with some feedback.There is a contradiction between the language that we use and what is in this Bill. A donor is, by definition, one who chooses to donate. Donation is, by implication, a voluntary act. The Bill seeks to turn volunteers into conscripts and, whether or not that is the underlying purpose of the measure, it is offensive and wrong. People should be encouraged to donate their organs, but the ultimate decision must rest with the individual, and the fundamental presumption must be to respect the human body unless an individual has chosen to make his or her organs available for donation.The debate today focuses on one fundamental point: whether we should work on the basis of explicit consent, under which a donor must specifically authorise the removal of an organ, or presumed consent, under which the onus is on individuals to state explicitly that they do not wish to have an organ removed. I strongly take the view that there is something profoundly wrong with the principle of presumed consent.There is a weakness in the Bill as it refers only to an advance decision known to next of kin. It says nothing about asking the next of kin after death. Furthermore, it will not take long before a suspicion arises that doctors will not do all that they could to save a life, but will allow a death for harvesting purposes. Yesterday, I was informed by a coroner that he was dealing with the death of a young person in a road crash when the deceased’s mother raised this very question before the inquest. We are not, therefore, talking about a theoretical fear.The Bill refers to kidney donation, but we should also consider the potential consequences relating to other organs. Once the principle of presumed consent for kidney donation is established, that may result in pressure to include other body organs. If the Bill is enacted, this will be the thin end of the wedge. It is, therefore, necessary that donation is looked at for all body organs and whatever is agreed must apply to all organs.I chair the Ethnic Diversity Council of the Conservative Party and I respect the beliefs and principles of all religions. The British population is now made up of people of different religions. I would like to explore, for a few moments, the cultural side of this debate. To my knowledge, the five major faiths in the United Kingdom do not object to the principle of organ donation. Christians, Jews, Muslims, Hindus and Sikhs have all endorsed organ donation and transplantation. That is not to say that there is not a lively debate within particular groups, but it might be helpful if a more robust lead were demonstrated by religious leaders so that ambiguities that might exist within their particular faith were cleared up.My understanding is as follows. A Christian who chooses to donate an organ is following the example set by Jesus of demonstrating love. Sacrifice and helping others form a key part of Christianity and, in the Bible, Christians are invited by St Matthew to “freely give”. Jews are required to obtain consent from a competent rabbinic authority before any organ donation procedure can commence, but nothing in principle in Judaism conflicts with organ donation in order to save lives. Jewish law prevents the unnecessary interference with the body after death and requires immediate burial of the complete body. In Islam, violating the human body is normally forbidden, but it is permitted to save another person’s life. Indeed, the Holy Koran states in chapter five that,“whosoever saves the life of one person it would be as if he saved the life of all mankind”.“Daan” is a word in Sanskrit for donation, which means selflessly giving to a Hindu. That is the third of the 10 niyamas, which are virtuous acts of the faith. Actions that sustain life are accepted and promoted as dharma, which means righteous living. Hindus believe that the soul is invisible, and that it is wrong to grieve for the body. A key feature of Sikhism is the requirement to put the needs of others ahead of one’s own requirements. As with most of the other religions, the soul of an individual is separate from the physical body, and Guru Nanak taught, in the Guru Granth Sahib, that:“The dead sustain their bond with the living through virtuous deeds”.I recognise that there is work to be done in persuading more people to donate their organs. The Chief Medical Officer’s annual report in 2006 quotes surveys showing that around 70 per cent of the population favour the principle of donating their organs after death, but only 20 per cent of people are on the NHS organ donor register.The best way to combat what can be described as a transplant crisis is a robust, proactive and continuous programme encouraging more people to be donors. This programme needs to be adequately resourced by provision of funding and staffing, and in all other ways. We should encourage more people to be donors of various organs and suggest that the matter be discussed by the potential donors with immediate relatives. About 40 per cent of families refuse consent for organ donation even where the individual has offered their organ as a donor. In addition, we must enhance and resource organ retrieval and transplant teams who are available at all times and appoint more donor liaison officers. These people need to be adequately trained to handle sensitive issues suitably.I have just returned from the Indian sub-continent, and of interest at all margins of this debate is the issue of westerners travelling abroad to obtain organ donations and the practice of purchasing organs for transplant. There are abuses relating to this practice and I have heard a number of horror stories. I find organ trafficking repugnant, and tackling the problem of scarce supply may reduce the demand for this abhorrent practice. I repeat, however, that using the strong arm of the state and the force of statute to achieve more transplants is not acceptable. I urge the House to reject the Bill.
Lord Sheikh asked Her Majesty’s Government:
- Whether the cosmetic and herbal products advertised on television channels aimed at certain ethnic minorities are subject to safety tests; and, if not, whether they will consider the introduction of such tests. [HL3824]
The Parliamentary Under-Secretary of State, Department of Trade and Industry (Lord Truscott): All cosmetic products, whatever their composition or target market, sold in the UK must comply with the Cosmetic Products (Safety) Regulations 2004 as amended. That requires that cosmetics undergo an independent safety assessment to ensure that they comply with the regulations.
It is not clear what other type of herbal products apart from cosmetics are concerned. If they are medicines or healthcare products, they are regulated by the Medicines and Health products Regulatory Agency.
Lord Sheikh asked Her Majesty’s Government:
- How many hospitals are being cleaned to the National Health Service specification for cleanliness published in December 2004.
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, every NHS trust must show that it meets the national specifications as part of the Healthcare Commission’s annual health check. Trusts must declare themselves non-compliant if there has been a significant lapse from those standards.
Lord Sheikh: My Lords, I am grateful to the Minister for that response. I declare an interest as my company provides specialist insurances to the cleaning industry. We all appreciate that there are problems relating to hospital cleanliness. Does the Minister support the conclusions of the recent Patient Environment Action Team survey, which shows a better performance from contracted-out cleaning services?
Lord Hunt of Kings Heath: My Lords, the comparison of in-house services and outsourced services has been discussed by noble Lords on a number of occasions. I have not seen any hard evidence to suggest that a decision to outsource services has a direct impact on the quality of cleaning. Ultimately, it depends on the nature of the contract in relation to outsourced services or the nature of management in relation to in-house services. The key factor is leadership. When NHS trusts give a clear indication that cleanliness is a high priority, good services follow from it.