Soper Lesley: Human Tissue Bill — Second Reading 
Soper Lesley: Human Tissue Bill — Second Reading 
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LESLEY SOPER (Labour) 
: 
 As a member of Health Committee I rise to support the Human Tissue Bill—actually a very important bill—and I want to thank the many submitters and particularly those who came to present to the committee in person. I intend to speak on the issue of maximising organ and tissue donation. 
During the select committee process a number of submitters took the opportunity to discuss organ donation and various solutions to increase the very low donor rate within New Zealand. We heard some very heartfelt and emotional debate on organ donation including personal stories from some submitters on their experiences in the intensive care setting faced with a decision about the organs of a loved one sometimes with no idea precisely of what that person had wanted. We also heard about a lack of clarity in relation to the donor status of the current driver’s licence register. Many people think that the current register records consent when it is actually only an indication of wishes. That register is not routinely accessed by many health professionals involved in organ donation. 
It is fair to say that all submitters to the bill were united in their desire to see the rate of organ donation increased in New Zealand but the views of submitters differed on the best way to achieve that result. To provide some context to this debate: as at January 2007 there were 433 people on the waiting lists in this country for a kidney transplant 13 for a liver transplant five for a heart transplant eight for a lung transplant and four for a combined pancreas-kidney transplant. Even if organs were retrieved from every potential deceased donor in this country the supply particularly for kidneys would still fall well short of the demand for them. Kidney transplants from deceased donors can only ever be a small part of the response to growing levels of kidney failure amongst New Zealanders. 
What we heard on the select committee was that only a very small number of New Zealanders die each year in circumstances that allow them to become organ donors. Organ donation is possible when an individual is determined to be brain dead prior to his or her blood circulation ceasing and that occurs only within an intensive care unit. A 2002 estimate put the number of medically suitable potential donors per year in New Zealand at approximately 100. That will come as a shock to many New Zealanders who believe that there are hundreds upon hundreds of potential organ donors out there being prevented from making donations. 
In recent years there has also been a reduction in brain death rates in intensive care units and that is due to a declining road toll continuous improvements in clinical practice and survival rates from trauma. Data from Auckland City Hospital alone shows an overall trend of fewer patients becoming brain dead with a reduction of about one-third between the years 2000 and 2006. 
When the bill was introduced to the House the Minister encouraged us as a select committee to carefully examine the international evidence on the impact of registers on organ and tissue donation rates. The committee did that quite extensively and recommends that a register is not established at present. However the committee does recommend including a clause that permits the establishment of an opt-on register by regulation at a later date should it become desirable to do so. In other words and contrary to much media misinformation we have set in place the framework for a register when the evidence shows conclusively that a register will actually be effective in increasing organ donation rates in New Zealand. 
I want to emphasise here that the vote to not proceed with the Human Tissue (Organ Donation) Amendment Bill in the name of Jackie Blue which we considered at the same time as the Human Tissue Bill was unanimous. To the best of my recollection as a member of the Health Committee there was no voice arguing to proceed with that register bill when the select committee came to make that decision because the evidence did not support it. I wanted to say that particularly tonight because some of those members on the other side of the House would have left a different impression on that point. It is important that New Zealanders know that that decision was unanimous by the committee. 
The international evidence tells us that registers are limited in their usefulness in increasing the number of available deceased donors because of the small number of people who actually register. Registers are not a significant influence on the number of deceased donors available for transplantation. Other factors such as the religious and cultural views towards death and the body the predominant cause of death and the number and efficiency of transplantation coordinators make a much more significant contribution to the number of organs and tissues available for transplant. 
The evidence actually suggests three main approaches to maximise organ and tissue donation. Work is already under way on the first two and the select committee heard that. Those are developing clinical expertise to improve identification and management of potential donors and processes used to request donation from family members; and coordination between various parties involved in organ and tissue removal and transplant processes. 
Organ Donation New Zealand has an ongoing role in training intensive care unit and operating theatre staff and intensive care medical trainees in processes supportive of organ donation. This includes delivery of the Australasian Donor Awareness Programme training and hospital study days for staff involved in organ and tissue donation. Organ Donation New Zealand has also started training for the implementation of donation after cardiac death. It is estimated that this could increase the number of deceased donors by about three per year but there is still uncertainty about that. 
Organ Donation New Zealand also provides the Link Team programme that ensures that every New Zealand hospital with an intensive care unit has a designated and trained senior intensive care nurse operating room nurse and doctor with direct links to Organ Donation New Zealand. Organ Donation New Zealand is developing a system of death audits in intensive care units which will when implemented provide more information on processes such as identifying potential donors and requesting donation from families. It was heartening to hear during submissions that medical intensivists themselves did acknowledge that more could be done by them in dealing sensitively with families at this difficult time and I look forward to their work helping to improve New Zealand donor rates. 
The third approach to maximising organ and tissue donation involves carefully developed social marketing and public education. Preliminary work by the Ministry of Health suggests an approach that includes both general messages and initiatives targeted to specific communities. The ministry is working with the sector to develop options for promoting organ and tissue donation. There is also no doubt that the consideration of this bill itself has already raised public awareness and I have certainly been in discussion with many individuals who have stated that they intend to discuss the issue of organ donation with family members so that there is clarity as to their wishes. 
While it is reassuring to see that the number of deceased organ donors so far this year is higher than for the same period last year none of these approaches will result in a sufficient supply of organs to meet current or likely future demand. The best hope for reducing the excess demand for transplant tissue over time in New Zealand is to reduce the preventable causes of demand for organs such as type 2 diabetes. That of course is the subject of the August 2007 report of the Health Committee to this House  
Inquiry into Obesity and Type 2 Diabetes in New Zealand 
. I recommend that all New Zealanders with an interest in life-long long-term health status of New Zealanders read and support the recommendations in that report. The select committee spent a great deal of time carefully considering this bill and its provisions. I commend the bill to the House.