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Renal Transplantation

– in the House of Commons at 12:00 am on 13th March 1968.

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3.38 p.m.

Photo of Sir Gerald Nabarro Sir Gerald Nabarro , Worcestershire South

I beg to move, That leave be given to bring in a Bill to permit removal from the body of a human person, duly certified as dead, any kidney or kidneys required for medical purposes, unless there is reason to believe that the deceased during his lifetime had instructed otherwise. The entire civilised world is moved today by the medical achievement of transplanting a heart from a dead person to a living person for the purpose of saving his life. We do not know, and it is axiomatic that we shall not know for years yet, the prospects post-transplant for survival of the heart recipient. So also with prospects for transplants of other major human organs such as lungs, livers, bowels and so on—

Photo of Sir Gerald Nabarro Sir Gerald Nabarro , Worcestershire South

And brains. Probably the use of plastic organs will overtake the transplantation of human organs. That will depend on medical and scientific evolution and discovery during the next few years.

Transplantation of human organs arouses deep emotions, physiological and biological, religious and social. I state my belief today quite simply. Following the diagnosis of death by conventional and accepted means, and death certified by two doctors, other than the surgeon conducting a renal transplantation, it is justified, in my view, on ethical grounds, to remove a kidney or kidneys for prolongation of life of a sick human being, always provided—I repeat, always provided—there should be some safeguard for persons who do not wish this to be done for religious or other reasons.

The Bill that I propose deals with kidneys alone—none other human organ—hence the title "Renal Transplantation Bill". There is a good practical reason for this. It is that only in the field of kidneys, among all the blood-fed organs—that is, excluding corneal grafting, because the cornea is not a blood-fed organ—has there been very substantial success already achieved by doctors during the last few years. At Cambridge alone, Professor Roy Calne has success- fully carried out about 30 kidney transplants in the last two years. Recipients of transplanted kidneys are now living up to five years. As the supply of healthy kidneys increases—and I believe it will increase—and selection and typing of tissue, the donor with the recipient, improves, the whole process will become easier and longevity post-transplant will also increase. My purpose is to seek to increase the supply of human kidneys in order to diminish the 3,000 deaths in this country alone, in a single year, which are attributed to kidney disorders and diseases.

Sufficient kidneys are not, and never will be, available in the present state of the law. I paraphrase the condition of the law very shortly today under the Human Tissue Act, 1961, roughly as follows:

"1.—(2) If any person, either in writing at any time or orally in the presence of two or more witnesses…has expressed a request that his body or any specified part of his body be used after his death for therapeutic purposes or for purposes of medical education or research, the person lawfully in possession of his body after his death may…authorise the removal from the body of any part or…specified part, for use in accordance with the request.

"(2)…the person lawfully in possession of the body…may authorise the removal of any part from the body…if, having made any such reasonable enquiry as may be practicable, he has no reason to believe—

  1. (a) that the deceased had expressed an objection to his body being so dealt with…or
  2. (b) that the surviving spouse or any surviving relative of the deceased objects to the body being so dealt with."
This, in the context of kidneys, is extremely restrictive and makes the removal of kidneys from a dead body in the overwhelming majority of circumstances utterly impracticable for saving the life of a sick person; though no blame attaches to our legislators in 1961, because at that time no successful renal transplantations had been accomplished. This branch of surgery—renal transplantation—has been largely developed only in the last few years, since 1961.

A human kidney, to be of use for transplantation, must be removed from the newly deceased body within one hour of death, either for immediate transplantation into the body of a sick person or for preservation under suitable conditions for future use. Preservation means that the removed kidney is cooled or refrigerated between 0 degree Centigrade and 1 degree Centigrade.

Clearly, in the case of kidneys, the existing law cannot be complied with following death, for example, due to a motor accident, which is the most common case,. Often the next of kin cannot be contacted by the registrar at the hospital in sufficient time. In any event, it would be callous and inhuman to expect the doctor in charge of the hospital to be obliged to telephone, say, a married woman as next of kin and say to her: "Your husband has just been killed and is lying in the South Blankshire Hospital. May we remove his kidneys?" Yet this is what is required under the existing law. Hundreds of relatives, given time for the initial shock of bereavement to wear off, would happily have consented later to the removal of the kidneys from the dead person. But, at the time of notification, they are too grief-stricken to make the decision within one hour, which is physiologically necessary for the kidney transplant. Thus, valuable, healthy, life-saving kidneys are denied to the surgeons for saving human life and diminishing the 3,000 deaths due to kidney diseases and disorders to which I have alluded. Moreover, the majority of our people today accept cremation as an alternative to interment. Cremation involves total destruction by fire of human remains. Most sudden deaths are subject to a coroner's autopsy, or post mortem, involving disfigurement of the body after death. Renal removal is carried out by a surgeon under conditions similar to those of an operation on a living person and involves relatively very minor disfigurement of the human remains.

It is too early yet to talk of legislative reforms for transplanation of major human blood fed organs, other than kidneys—I refer, of course, to such organs as hearts—until greater physiological progress has been made in the massive problems of tissue rejection. The conference recently convened by the Minister of Health, under the chairmanship of Sir Hector MacLennan, President of the Royal Society of Medicine, will doubtless deal with human hearts, lungs, livers and transplants of other major organs which are, as yet, in an exploratory and embryonic state.

I believe that unilateral legislative amendment, at once, is desirable in the case of kidney transplantation, at present largely curtailed due to shortage of kidneys arising from the existing state of the law.

I reiterate that there would be adequate safeguards in the Bill proposed, for any religious or ethical objectors.

My proposed Bill, if successful, would condition public opinion for wider amending organ transplantation legislation later. If permission is given to bring in this Bill today, it will have all-party support. There will be 12 sponsors of the Bill, of whom seven are Tories, four are Labour, and one is Liberal. Of the 12 sponsors, six are doctors of medicine and six are lay members of this House.

3.50 p.m.

Photo of Mr Eric Ogden Mr Eric Ogden , Liverpool, West Derby

I listened carefully to what was said by the hon. Member for Worcestershire, South (Sir G. Nabarro), but I must ask the House to oppose the introduction of the Bill. It might be admirable in intention, but it is abhorrent in principle and would be in practice. The hon. Gentleman has told the House of the need for the Bill, and of the considerable support for it. My decision is personal, and unorganised, and has to stand or fall on its merits.

I shall be as brief as I can. It seems to me that there is a balance between the dignity and the respect of man, on the one hand, and the needs of science, of helping fellow men, on the other. This is a very fine balance indeed. I put it to the House that the human body is more than just flesh and blood, more than chemicals and substances, more than just a collection of spare parts. I agree that it should be the right and the duty of a man in good health and of sound mind to consider seriously and quietly how he wishes to dispose of his body after death. I suppose that by education and encouragement someone could decide in life and in good health what he should do with his body after it has gone, whether he wants to donate his eyes, or kidneys, or the whole of his body. But this should be a conscious act. He should contract into this situation rather than have to contract out of it afterwards.

My whole objection to the Bill centres on the last few words, unless there is reason to believe that the deceased during his lifetime had instructed otherwise. In other words, someone must prove that he is not guilty rather than someone prove that he is. This Measure will be dangerous. The right to enter hospital without fear will be put in jeopardy. The young and the old, the ignorant or the ill-informed, those in prison and those in mental hospitals, will be denied the right of protection by this House. This right

should exist both in death and in life. The hon. Gentleman claims that he speaks for the living. Someone should put in a word for the dead. The human body is a thing of wonder and mystery. It is entitled to protection in life and in death. This would diminish the respect for it, and it would certainly diminish the protection that it should have in death as well as in life.

Photo of Dr Horace King Dr Horace King , Southampton, Itchen

Order. It is not the custom to intervene in a Ten-Minute Rule Bill.

Question put, pursuant to Standing Order No. 13 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of Public Business):

The House divided: Ayes 155, Noes 40.

Division No. 88.]AYES[3.53 p.m.
Allaun, Frank (Salford, E.)Fletcher, Ted (Darlington)Mackenzie, Gregor (Rutherglen)
Alldritt, WalterFletcher-Cooke, CharlesMcMaster, Stanley
Atkins, Ronald (Preston, N.)Forrester, JohnMcMillan, Tom (Glasgow, C.)
Barnett, JoelFraser, John (Norwood)Maxwell, Robert
Beamish, Col. Sir TuftonGiles, Rear-Adm. MorganMaxwell-Hyslop, R. J.
Bence, CyrilGodber, Rt. Hn. J. B.Maydon, Lt.-Cmdr. S. L. C.
Bessell, PeterGoodhew, VictorMendelson, J. J.
Bidwell, SydneyGower, RaymondMiller, Dr. M. S.
Bishop, E. S.Cresham Cooke, R.Mills, Peter (Torrington)
Boardman, TomGrimond, Rt. Hn. J.Mitchell, R. C. (S'th'pton, Test)
Booth, AlbertGurden, HaroldMolloy, William
Bossom, Sir CliveHall, John (Wycombe)Monro, Hector
Boyd-Carpenter, Rt. Hn. JohnHalt-Davit, A. G. F.More, Jasper
Braddock, Mrs. E. M.Hamilton, James (Bothwell)Morris, Alfred (Wythenshawe)
Brewis, JohnHamilton, Lord (Fermanagh)Morris, John (Aberavon)
Bromley-Davenport, Lt. -Col. Sir WalterHannan, WilliamMurray, Albert
Broughton, Dr. A. D. D.Harper, JosephNeal, Harold
Buchanan-Smith, Alick (Angus, N & M)Harrison, Brian (Maldon)Newens, Stan
Bullus, Sir EricHarvey, Sir Arthur VereNicholls, Sir Harmar
Butler, Mrs. Joyce (Wood Green)Heath, Rt. Hn. EdwardNoble, Rt. Hn. Michael
Cant, R. B.Heffer, Eric S.Noel-Baker, Rt. Hn. Philip (Derby, S.)
Channon, H. P. G.Henig, StanleyOrme, Stanley
Chichester-Clark, R.Hiley, JosephOrr-Ewing, Sir Ian
Cordle, JohnHooson, EmlynOswald, Thomas
Corfield, F. V.Hordern, PeterPage, Derek (King's Lynn)
Costain, A. P.Howarth, Robert (Bolton, E.)Pannell, Rt. Hn. Charles
Cronin, JohnHuckfield, LeslieParker, John (Dagenham)
Cullen, Mrs. AliceHughes, Emrys (Ayrshire, S.)Pavitt, Laurence
Dalyell, TamHughes, Roy (Newport)Peart, Rt. Hn. Fred
Davidson, James(Aberdeenshire, W.)Hunter, AdamPentland, Norman
Davies, Ednyfed Hudson (Conway)Johnson Smith, G. (E. Grinstead)Peyton, John
Davies, Harold (Leek)Johnston, Russell (Inverness)Pounder, Rafton
Dickens, JamesJopling, MichaelPrior, J. M. L.
Doughty, CharlesKelley, RichardRankin, John
Drayson, G. B.Kerr, Russell (Feltham)Rhodes, Geoffrey
Dunwoody, Mrs. Gwyneth (Exeter)Kimball, MarcusRidsdale, Julian
Dunwoody, Dr. John (F'th & C'b'e)Kirk, PeterRobson Brown, Sir William
Eadie, AlexLancaster, Col. C. G.Ryan, John
Edwards, Robert (Bilston)Lestor, Miss JoanSt. John-Stevas, Norman
Edwards, William (Merioneth)Lewis, Ron (Carlisle)Scott-Hopkins, James
Ellis, JohnLipton, MarcusShaw, Arnold (Ilford, S.)
Errington, Sir EricLomas, KennethSheldon, Robert
Evans, Ioan L. (Birm'h'm, Yardley)Longden, GilbertShort, Mrs. Renée (W'hampton, N. E.)
Ewing, Mrs. WinifredLoveys, W. H.Sinclair, Sir George
Eyre, ReginaldLubbock, EricSnow, Julian
Farr, JohnMcCann, JohnSpriggs, Leslie
Faulds, AndrewMackenzie, Alasdair(Ross & Crom'ty)Steel, David (Roxburgh)
Stodart, AnthonyWallace, GeorgeWood, Rt. Hn. Richard
Stoddart-Scott, Col. Sir M. (Ripon)Wells, John (Maidstone)Wright, Esmond
Swingler, StephenWhitelaw, Rt. Hn. William
Tinn, JamesWilson, Geoffrey (Truro)TELLERS FOR THE AYES:
Wainwright, Edwin (Dearne Valley)Wilson, William (Coventry, S.)Sir Gerald Nabarro and
Wainwright, Richard (Colne Valley)Winstanley, Dr. M. P.Mr. David Lane.
NOES
Baker, W. H. K.Hogg, Rt. Hn. QuintinOrbach, Maurice
Bell, RonaldHowarth, Harry (Wellingborough)Price, Thomas (Westhoughton)
Biffen, JohnHynd, JohnProbert, Arthur
Blackburn, F,Johnson, Carol (Lewisham, S.)Randall, Harry
Crouch, DavidJones, Dan (Burnley)Rees, Merlyn
de Freitas, Rt. Hn. Sir GeoffreyJones, J. Idwal (Wrexham)Taylor, Edward M. (G'gow, Cathcart)
Dunn, James A.Jones, T. Alec (Rhondda, West)Urwin, T. W.
Ensor, DavidKenyon, CliffordWalker, Harold (Doncaster)
Finch, HaroldMaude, AngusWilkins, W. A.
Fitch, Alan (Wigan)Mawby, RayYounger, Hn. George
Gregory, ArnoldMills, Stratton (Belfast, N.)
Griffiths, David (Rother Valley)Morgan, Elystan (Cardiganshire)TELLERS FOR THE NOES:
Harris, Frederic (Croydon, N.W.)Morris, Charles R. (Openshaw)Mr. J. D. Concannon and
Harrison, Walter (Wakefield)Oakes, GordonSir Myer Galpern.
Hazell, BertOgden, Eric

Bill ordered to be brought in by Sir G. Nabarro, Col. Sir M. Stoddart-Scott, Dr. Bennett, Mr. Cronin, Dr. Broughton, Dr. John Dunwoody, Dr. Winstanley, Mr. Pavitt, Mr. Lane, Sir D. Kaberry, Mr. Emery, and Mr. St. John-Stevas.