Madam, - Senator Feargal Quinn's proposed legislation for presumed consent on organ transplantation is undoubtedly offered with the best intentions. However, if enacted, all it will divert energy and focus away from what is really required to address the problem.
At best, it will have little or no impact on organ (and in particular lung) transplantation. At worst it will diminish the chances of those waiting for a transplant of ever receiving one.
We are deluding ourselves if we think that "presumed consent" legislation will improve matters. Senator Quinn refers to the excellent Spanish performance in this area, and in this he is correct. However, "presumed consent" was introduced in Spain in 1979, but for 10 years the new policy had little or no effect on the number of transplants. The improvement came about when the Spanish authorities addressed the real issues inhibiting transplantation.
The Spanish policy was changed in 1989, with the establishment of "ONT" - a transplant authority independent of all hospitals (and of the consultants within them). ONT acknowledged that classic approaches - legislation changes, donor cards, advertising, etc were useless.
It set up a system of transplant co-ordinators inside hospitals whose role was to counsel the families of recently deceased people in an appropriate and sympathetic manner. The purpose of this skilled counselling was to encourage the families to consider, at a traumatic time for them, donating the organs of their loved ones. This is not an easy conversation to have, and requires great care and sensitivity.
In addition, the financial cost to hospitals of preserving remains until transplant could occur were addressed. After all, if a hospital has financial incentives to free up hospital beds as quickly as possible (to reduce pressure on AE departments), why should it keep a person on a life-support machine (and occupying a hospital bed) pending organ removal?
The results of the ONT programme were remarkable. The donor organ rate from hospitals with the transplant co-ordinators is now 50 per cent higher than from those without. This excellent performance resulted, not from legislation, but from careful attention to the process surrounding organ retrieval.
It is reasonable to assume that a similar approach could work in Ireland, and if successful, could transform the appalling performance here to a level approaching that of Spain. Since 2005 there has been just one double lung transplant in Ireland for a cystic fibrosis sufferer.
To put this evidence in context, at least 30 people with CF died in Ireland in 2007, and to date this year at least 15 have died. The overwhelming majority of these are young people. It is not known how many of these died while awaiting a lung transplant, but some of them certainly did.
Adopting the Spanish approach would require the establishment of an independent transplant authority, together with networks of qualified co-ordinators in various hospitals, and the appropriate technical expertise to preserve remains so that the maximum number of organs - of all types - can be retrieved from deceased persons with their families' permission.
In the absence of such action, Senator Quinn's well-meant legislative proposals will be a sideshow diverting legislators' minds from the real issues involved. And even more youngsters with CF will die as a result. - Yours, etc,
DAVID FITZGERALD,
Knocknashee,
Goatstown,
Dublin 14.