O'Connor SimonSIMON O'CONNOR (National—Tāmaki): I am delighted to be taking a call on this bill now known as the Compensation for Live Organ Donors Bill and because we do have I believe—with a bit of prescience—support across the House it is soon to be an Act of Parliament after it receives the Royal assent. I begin by acknowledging the member who has sponsored this bill Chris Bishop who has done a tremendous job shepherding it through the House. As many members have noted on any of these members' days it is a very rare chance that the biscuit tin is in your favour. When it is—in fact how many bills have you had out now? Is it two or—Chris Bishop: Two.SIMON O'CONNOR: Two right. So this man is incredibly lucky. But to actually shepherd it all the way through is quite unique. So here we are at the third reading. In acknowledging Chris I do want to acknowledge the other MPs who have been involved in the past. We have heard Dr Cam Calder's name mentioned and before that the initiator of this particular bill the Hon Michael Woodhouse.I do also want to mention—not directly with this bill—Dr Jackie Blue who in her time spent quite a bit of effort; and in that space—and it is a sort of a linkage of names Andy Tookey. I had the pleasure of meeting Andy many many years ago. He will not remember but it was through Jackie Blue and he was as the previous speaker was indicating a very passionate advocate and was speaking with Jackie. So a number of people have been involved. But I think really importantly it is Chris who has brought it to the House and shepherded it through. In that regard too I am very grateful for the work of the select committee. It is a marvellous committee to chair even during annual reviews sometimes. Actually the committee has worked quite cooperatively—first and foremost with the member but also within to try to improve the bill even further.The bill came to the committee in good shape and in terms of the discussions we had we were able to make some improvements. One of them—and Chris was very keen on this—was as simple as the title change. Initially the title mentioned financial assistance" and we then moved it to "compensation" and anyone who has followed any of the speeches in the House knows I am a great believer in words and the importance of words and it was quite critical that we signalled that this bill is based around the altruism of those who are donating.Again we are talking about live transplants live donations and it is a compensation. In fact you could almost go as far as to say it is still only a partial compensation even though I will get to the whole point of 100 percent remuneration around income there is a lot greater well altruism going on here and this bill is an attempt to compensate some of that rather than sort of being some generous action of the State alone to financially assist someone.So the committee moved that change but the committee has also been very conscious that we have—as speakers have mentioned and I am sure we are going to hear it from the remaining speakers—very low donation rates. I think it is about 300 over the last 3 or so years—very low. It is primarily for kidneys but there are other organs that can be live-donated—partial lungs livers and pancreas. Importantly something I was quite keen on—and I am really pleased that Chris Bishop was open to it as well—is making sure that there is a provision in this bill to add in further organs. Of course those who are clinically minded know that there is a limit to just how much can be introduced in before we move from live to well not live but there is an opportunity if developments are such that by an Order in Council extra organs can be added into this bill. In other words we do not have to go through the rigmarole if you will of the House process of introducing a further piece of legislation.As we said we have low donation rates but we also know that about I think 1100 people are actually on Ministry of Social Development benefits related to kidney failure or health issues related to kidneys or other organs. And what this bill represents is actually an opportunity and again I had better be clear before articulating this further that I am not trying to put out a purely utilitarian argument.There are people out there in New Zealand who will obviously benefit from a donation. But from a purely governmental let us say accounting standpoint the fact that there are people currently on the benefit who could actually benefit from live organ donation is not only good for them in their health but also good for the Crown's accounts. That has been I suppose one of the reasons amongst others that we as a committee decided to move the recompense of this bill from 80 percent to 100 percent. I suppose there are lots of nuances in this debate but again although we do not think that simply reimbursing a person 100 percent of their income represents the entire cost associated with the donation we saw this as a really important step. Importantly too we decided not to go beyond 100 percent. There was some conversation about whether we should make this 120 percent or 150 percent. Do you go even as far as 200 percent? It became a tipping point as it were between actively trying to support and encourage donation but not trying to make it too much of an incentive if I can articulate it that way. We feel we have landed in the right space.Importantly too this bill recognises people who are obviously earning an income in some shape or form be it as a sole trader being salaried right through to people on benefits including those on ACC. I talked about this in the second reading. We had a little bit of work to do around the ACC recompense in that we did not want someone to lose their entitlement if they were already on ACC and donating an organ. Under the current structures in legislation someone who is on ACC for whatever reason who then chooses to give an organ would have had to be retested for their eligibility for ACC once they had recovered. With a bit of creativity through the committee and certainly with the advice of the officials we decided that what we would do instead is if someone is getting ACC entitlements they would not actually be taken off but would have their entitlement reduced to zero dollars. In other words it continues but they are just not receiving that particular income. The long and short message there is that regardless of how someone has an income or gains their income this bill covers that.Chris Bishop also acknowledged that we have moved the management for live organ donation from the Ministry of Social Development (MSD) to the Ministry of Health. There was pretty clear feedback pretty early on that it was felt that it was more appropriate first and foremost within the Ministry of Health. Secondly there was some sort of confusion or misunderstanding perhaps with people even knowing to approach MSD. Having worked within the Ministry of Social Development many years ago I would have to say that someone coming in to test their full and correct entitlement for organ donation does not happen all that often and you could perceive it leading to confusion.Jumping back also to the area of income—whatever someone's income is that is what is going to be recompensed. There is no limit. There were lots of discussion in the committee on that. Should we be actually capping the total remuneration? The answer there was no.The other element that I just want to quickly touch on is not particularly on the live organ donation front but the wider discussion around deceased organ donation. New Zealand certainly has a long way to catch up and it was certainly my intention and that of the committee's that we would have those discussions somewhat during this bill's progression. I think it was important naturally that we talked about live donorship but we also tried to touch a little bit on deceased donorship. I have talked about it before but I think the Israeli model has some real value particularly around those who choose to donate—that they are put effectively at the top of the list themselves if they in turn require a donation. The other side—and it is not punitive; I think it is just actually realistic—is that if someone chooses to not donate an organ then they in turn are not to be a recipient of one in the first instance.I do too want to just pick up on something that Annette King was talking about at the end of her speech around how obviously once someone has deceased the family relationships work. This is primarily because although there are some great ideas out there of how we might manage this—and in some ways it sounds really easy—if someone who is deceased had articulated their wishes previously they should be honoured. I think there is real merit to that. It is a difficult area. Having spent a lot of time in hospitals it is a very traumatic moment for families when a loved one dies particularly if they are brain dead which is—being somewhat clinical—an ideal time for a donorship to happen. It is a very traumatic time for families.Having been beside them often when those conversations were being had I suppose I am just wanting to acknowledge that and that obviously this Parliament—I think it probably will be governmental. It is an awkward conversation but it is primarily one that has to be had. It is not a simple issue but I think and I am hoping that through this bill further conversations will be had and more organ donations will happen. Thank you to those who are already engaging on the live organ side."