MPs call for measures to encourage blood, organ donations

MPs from both sides of the House yesterday called for initiatives to encourage more people to donate blood and organs.

The appeals were made during the second day of debate on the Human Blood and Transplants Bill. Its purpose is to transpose three EU directives setting quality standards and procedures relating to blood donations Nationalist MP Joe Cassar highlighted various aspects of the directives.

The bottom line, he said, was that these directives ensured high and uniform quality standards in the EU. The directives covered the collection, preparation and storage of human blood and its distribution in designated establishments under monitoring by the licensing authority. The authority would also set quality standards on the storage of human tissue.

Such legislation assumed even more importance when one observed medical developments regarding DNA and human tissue.

An important aspect of this legislation was traceability, with the authority knowing exactly where every pint of donated blood had come from.

There could also be a situation where blood and its components were imported from third countries. This bill would therefore be a gatekeeper to ensure that standards were maintained.

The directives provided for the examination of potential donors and the screening of blood and its products. They also laid down that donations should always be voluntary and not against payment.

Anglu Farrugia (MLP) said organ donation for transplants was a worthy initiative and measures were needed for more people to offer their organs upon death.

The Bill should recognise the efforts of organisations involved in the donation and transplanting of important organs.

Dr Farrugia said it was a pity that while organ donation and transplantation in Malta were done on a purely voluntary basis, there were no legal provisions on this activity. Donor cards should be recognised as being an official document which could not be over-ruled. The existence of a sort of Uniform Anatomical Gift Card, as existed in the USA, would give the authorities legal authority to remove organs from the card holder's corpse.

Dr Farrugia said authorisation for the removal of organs could also be vested in somebody through the deceased's power of attorney which, in this case, would also apply after death. There could also be such powers of attorney specifically for organ donation.

Such progress towards a national conscience on the donation of organs would inevitably bring on problems of how and where to store blood, tissues and organs. There should be legal instruments to regulate and facilitate all this. At the same time, no payment for organs should be allowed.

Mario Galea (PN) praised the staff of the National Blood Transfusion Centre and the way they ensured safe blood donations for people to have confidence in the process.

He asked how the licensing authority was to monitor training levels when there were other authorities, such as the Council of Nurses and Midwives, that already had such a role.

Would this Bill also cover immunisation? How would it affect the taking of blood samples for testing or human tissues for biopsies?

Mr Galea expressed concern that the number of blood donors had decreased. New initiatives were clearly needed to encourage more people to donate blood. Perhaps MPs too should donate blood during the passage of this Bill.

People should feel duty-bound to give blood. Giving blood was a relatively painless process which did not take more than 40 minutes.

Mr Galea said the mobile blood donations unit was proving to be very useful, although it had problems because of parking restrictions imposed by its size.

He regretted that the National Blood Transfusion Unit was next door to the Detox Centre. People attending the Detox Centre sometimes created incidents and problems. People going to give blood needed to feel safe and welcome. It was bad enough that parking was a problem and one risked a parking ticket, not to say having one's car stereo stolen by the Detox Centre clients.

Mr Galea said that in the past, people who donated blood could take the day off. That was not necessarily the best system and could attract the wrong sort of people. Nonetheless employers should not discourage workers from going to the Blood Bank whenever they wished.

Perhaps talks could be held with employers' representatives.

One could also encourage more people to deposit their own blood before surgery.

George Vella (MLP) said that although Malta had made great progress in the area of blood donation, there was still much more that could and should be done.

There should be incentives to get more people to donate blood; too many people still did not bother unless a problem involved members of their families. The need for blood had burgeoned because of the present lifestyles and progress in modern surgery. People should be encouraged to donate blood out of duty. While no payments should be involved, other incentives could be considered, such as an occasional lottery among donors.

There should also be campaigns on blood and organ donations in schools, although, obviously, this did not mean that children should donate blood.

Other problems to address included the need to allay many people's fear of needles.

The Bill also mentioned blood cells, blood products and human tissue. One particular aspect that was much in evidence today was that of stem cells that could be taken from embryos; something that was highly controversial. However blood from the umbilical cord could largely be used for the same purpose as stem cells, without the ethical problems, even though the density of blood did not compare with the density of blood in an embryo.

There was a European project underway in which blood banks were keeping cord blood in storage for use when time would allow it. There was already a danger of commercialisation of these blood products, as could be seen in the USA. Malta should be very wary of the ethical aspects involved, because there were already offers for the storage of cord blood, at a price. Issues could crop up when somebody wanted to acquire cord blood from somebody else, for example.

Parliament should discuss such issues to guard against unwelcome developments in this sector.

Turning to the donation of organs, Dr Vella said this involved not only dead donors but also living ones in several cases. A number of people were already living in hospital without kidneys, waiting for some accident to happen so that an organ could be donated. Ways should be explored for more organs to be available for transplant.

Most people did not even care if their organs were used on other people after their death. Therefore one should discuss the possibility of introducing a system, found in other countries, where everyone was considered a donor unless a specific prohibition was made in one's life.

Dr Vella said it was right and proper that the authorities guarded against anyone offering to sell his organs, but at the same time, kind-hearted individuals who offered their organs, such as a kidney, altruistically and without payment, should not be looked at as traders, as sometimes happened.

Dr Vella said medical practitioners should be kept constantly in the loop for the best possible advantage to be taken of organ donation for transplant.

In his speech Dr Vella said that while medical standards in Malta were high, standards of care in state hospitals were far from ideal, with overcrowding and poor hygiene standards. For example, something needed to be done to rid the hospital of the hundreds of pigeons in its environs which littered hospital windows with their droppings.

Michael Gonzi (PN) said methods of testing and guarding against specific illnesses had changed and progressed along with the times. The HIV outbreak in 1982 had led many people to lose confidence in the blood donation process. To counter this, the procedures for blood donation had become more and more rigorous.

The fact that Malta had not had any significant history of infections from blood transfusion or donation spoke volumes for the Health Department's practices. This brought out more forcefully the importance of the bill under debate.

Malta satisfied all eleven criteria on blood programmes as set out in a paper on safe blood by the World Health Organisation (WHO).

Malta had successfully solved several logistic problems inherent in blood donation, especially through the use of the Blood Donation Unit, but other problems such as difficulty of parking close to the blood bank could still be blamed for the drop in blood donors.

The donation of organs for transplant was also very important. In one particular year there had been almost 200 donated organs, a number of which had been sent overseas because there was no match with a patient here.

Care must be taken to avoid any commercialisation of organs for transplant, which sometimes led to the death of the donors because of lack of adequate care.

Dr Gonzi suggested that the Bill should define the word "cells" in greater detail to preclude misinterpretation or abuse, making clear, for example, that it excluded the removal of stem cells from embryos.

There should also be a register of imported or exported tissue, concluded Dr Gonzi.

Franco Galea (PN) urged persons receiving a transplant to share their experiences to encourage others to be donors.

Mr Galea said that in the absence of a written note by the deceased, the state should automatically consider a person as being an organ donor.

The debate continues on Monday.