On Tuesday . Mr Tam Dalyell, Labour member for West Lothian,
will try to in- troduce a Bill to make bits and pieces of the human body more readily available for transplanting. Few men are better suited to the task, for Mr Dalyell has shown great courage in the past (he was the PPS to Mr Richard Crossman). He also has a healthily scant regard for tradition so that he left the Presidency of the Cambridge Conservative Club to join the ranks of the Labour party and conspired to remain a trooper in the Royal Scots Greys when the regiment was in fact raised by one of his ancestors. This required considerable in- genuity. There are not many more daunting Prospects in the Commons than that of Mr Dalyell bearing down intensely, a vast dos- sier under his arm perhaps bearing the facts about an archipelago in the Pacific, the testing of human urine for the detection of drugs, or the dangers of ice pollution in the Antartic (sic). And he has prodigious energy. This he will certainly need for the Hill he is trying to introduce has had a rough passage, in one form or another, in the past. To examine its background is instructive in the ways of governments and the difficulties of backbenchers who take their jobs seriously.
First it should be noted that the Ten Minute Rule procedure under which he is Introducing his Bill is essentially a prelim- inary effort. Yet the problems raised by Increased medical ktiowledge of transplant technique have been well and truly aired before the House by such unlikely com- rades as Sir Gerald Nabarro and Mr Norman St John-Stevas using the same mechanism. However it may well serve a useful purpose to summarise 'them aeain. The world, at large, became interested in transplant techniques when Dr Christian Barnard inserted a new heart in Mr Louis Washkanski on 3 'December 1967. and then with more success a month later in Mr Philip Blaiberg. In fact unsuccessful transplants, of one sort or another, go back to the sixteenth century when an enterprising Sicilian doctor whipped a bit of skin off a slave in an attempt to improve the nose of a nobleman. The views of the slave were not recorded. More practically great advances were made in recent years an immuno-suppression which controls the body's natural rejection of a foreign organ. The result was that kidney transplantation `as well under way before Doctor Barnard started to transfer hearts.
The success rate was, striking. as illus- trated in the book A Gift of Life by Profes- sor Roy Caine published last year. He quoted a study carried out hi the United States among more than 2.000 patients all round the world who had received a kidney transplant. More than a thousand of these Patients had received the organ from a cadaver. and 40 per cent of that group were still alive two years afterwards, with the longest recorded period of survival being five years. Considering the fact that the breakthrough in immunology which made this. possible was less than ten years old it was a significant achievement, and
since 2.000-3,000 peop e d'e from kidney diseases in Britain every year the advan- tages of the technique are obvious.
However, there is a distressing shortage of available kidneys and Dr Barnard's work on the heart—through no fault of his own —sent a wave of superstitious resentment round the world. It was not really a matter for surprise that certain religious groups which at different times had persecuted Copernicus, denounced the use of anaesthe- tics and found religious merit in painful childbirth, should be unable' to see the heart as a pump. just as the kidneys are a pair of filters. Although most superstition surrounded heart transplants, politicians became sensitive to the pressures on all the techniques. This is not to deny that there were, and are, significant ethical problems. Among these are the question of determin- ing the moment of death, and the relative ethical responsibilities of the medical pro- fession to the recipient, the donor and the donors relatives.
The law governing. the use or organs from dead bodies is contained in the Human Tissues Act 1961, which is. to say the least, ambiguous. Apart from allowing a person to donate his body for spare part surgery, it also lays down that the 'person lawfully in possession' of a body, 'having made such reasonable inquiry as may be practicable' believes that there was no objection on the part of the deceased to his body being used in this way, nor any objection by 'any sur- viving relative'. it is a merry hotchpotch, which boils down to some doctor having to approach a relative when they are about to suffer a bereavement, or immediately after. and ask for permission to remove an organ. To add to the difficulties certain assessments, such as blood typing, must inevitably be made beforehand.
Sir Gerald Nabarro introduced Bills in the 1968 and 1969 sessions of Parliament which would allow doctors to remove kid- neys--his Bills were confined to these organs —unless they believed the deceased ob- jected. The 1968 Bill went through the second reading and committee stages but fell through lack of time when the session
came to an end. in 1969 the Bill failed by thirty-eight votes to eight. During the 1968 debate the Labour MP for Liverpool, West Derby, Mr Eric Ogden apparently thought. it witty to call the Bill The Nabarro. (Nationalisation of the Dead) Bill. I am. happy to say that Mr Ogden, to the best of my. knowledge, has nothing wrong with his kidneys. In February 1969. between the Nabarro Bills, Mr St John-Stevas used the ten-minute rule procedure to introduce a Bill making three points: to tidy up the law in respect to the wishes of the deceased; to remove the right of veto from relatives: and to ensure that the doctors certifying death would have no connection with those carrying out the transplant operation. The Bill proceeded no further.
Then a committee, consisting mainly of distinguished doctors, under the chairman- ship of Sir Hector MacLennan, examined the subject and reported in July 1969. It suggested safeguards along the same lines as Mr St John-Stevas had done earlier. By a majority of six to five it also recom- mended that this country follow various others such as Italy, France. Israel. Den- mark and Sweden. by insisting that people would have to contract out of giving their organs. Registering this disapproval would be quite simply recorded on a computer which could supply the information to a transplant team in a matter of moments.
The government did nothing about the report but some of the replies by ministers of that administration to subsequent in- quiry are classics of their kind. At one point the then Mr Julian Snow told Sir Gerald : 'I wish that i had as much faith in computerk as has the hon gentleman. Judging by some bank statements I have received, perfection in that science has not yet been reached.' Yet Mr Wedgwood Benn was busily establishing the groundwork for a national computer network and hospitals controlled by Mr Snow's department were merrily setting-up a national computer system holding the most intimate details of patients' lives.
Mr Crossman also told Sir Gerald in November 1968 that his Bill was too narrow in concentrating in kidneys alone. Yet noth- ing was done about Mr St John-Stevas's wider Bill and. when questioned just over a year ago. Mr Crossman was saying that in this matter it was most important that public opinion should have time to reflect and determine itself, and i do not think that the time has yet been long enough.' but that there should be no further inquiry because 'it was a subiect on which people were now able to think for them- selves, without much. further stimulation.'
The need for a stimulant was, of course, the government's, and the under-secretary let the cat out of the bag as early as January 1969 when he put forward as a major reason for the government's refusing the Bill the fact that objections had been regis- tered by 'certain religious bodies'. How refreshing it would be if the present gov- ernment were willing to listen to the silent majority of heathens in this country rather than be blackmailed by the electoral threats of religious and other superstitious minori- ties. All that Mr Dalyell's Bill will seek on Tuesday is to establish a register of those wishing to contract in. That at least .would be a start. ,
The .grave's a fine and private place But none, 1 think, do there embrace.
And they do not need their kidneys either.
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