Below is the text of the debate in Parliament on the Government's Human Tissue Bill.

14 November 2006

Human Tissue Bill

First Reading

Hon RUTH DYSON (Minister of Labour): I move, That the Human Tissue Bill be now read a first time. At the appropriate time I intend to move that the bill be referred to the Health Committee for consideration. It gives me great pleasure to speak to the first reading of this bill. The Human Tissue Bill provides a framework for regulating the collection, storage, and use of tissues and organs, primarily from the deceased. It also regulates trading in tissue, export and import of tissue, and the use of tissue for non-therapeutic purposes—for example, audit, research, and post-mortem.

Once enacted, the legislation will repeal and replace the Human Tissue Act 1964. The current regulatory framework for human tissue spans a number of Acts and regulations. This creates confusion, and there are gaps in the framework that regulates the use of human tissue. Increasingly, issues are raised that either fall outside the scope of the current arrangements or are subject to varying interpretations. The ministry’s 2004 review of human tissue and tissue-based therapies raised a number of issues. The new bill aims to address concerns raised during public consultation, including a lack of clarity around the informed consent requirements for the collection and retention of tissue; the role of family members in giving consent for the collection and use of tissue from a person who has died, and the lack of individual autonomy in the area; a lack of clarity in relation to the donor status on the national register of drivers’ licences—many people think the register records consent, when it records only an indication of wishes—and New Zealand’s organ donation rates, which are low compared with other OECD countries.

The new bill will clarify the consent framework for organ and tissue donation. In addition, non-legislative initiatives are currently being undertaken that aim to improve organ donation rates. For example, the primary focus of Organ Donation New Zealand, set up last year, is the improvement of organ and tissue donation processes in the intensive care unit environment. Since early last year welfare assistance, in the form of income and childcare assistance, has been available to living donors who altruistically donate kidney or liver tissue for transplantation purposes.

The new bill aims to address the concerns raised during the human tissue review. It also provides a more comprehensive and modern regulatory framework for the collection and use of tissue and organs from deceased people. The objectives are to ensure that the autonomy and dignity of the individual from whom tissue is collected is recognised and respected, and that the cultural and spiritual needs of New Zealanders are recognised and respected. Further objectives are to ensure there is clarity for clinicians and the public around the consent process, clear mechanisms for the use and management of human tissue for non-therapeutic purposes, and consistency with regulations in other related areas.

The bill includes a broad definition of human tissue and covers any material, including human cells from whole bodies and body parts through to blood, foetal tissue, and human stem cells. It specifically excludes any material covered under the Human Assisted Reproductive Technology Act 2004. The bill will ensure the safety and quality of the non-therapeutic use of human tissue through standards prescribed or approved by regulation. It also enables regulations to be made with regard to the export or import of human tissue, if that level of monitoring is considered necessary. The bill contains additional requirements for schools of anatomy, including licensing of such schools, given the invasive nature of anatomical examination and the need for public confidence in the process.

 The bill repeals Part 3A of the Health Act 1956, which regulates trading in blood and controlled human substances, and replaces that Act with similar but extended provisions that cover, for example, trading in all human tissue. The sale and purchase of human tissue, including blood, will as a general rule be prohibited.

The bill makes informed consent the fundamental principle underpinning the lawful collection and use of human tissue from deceased people. It specifies who may give consent for the collection and use of human tissue. The primary consent will be of the deceased, if formally recorded before he or she dies, or of someone nominated by the deceased person on his or her behalf. In the absence of formally recorded consent to donation by the individual, or by his or her nominee, the decision can be made by the immediate family. The bill provides for decision making by a senior, available next of kin of the dead individual if the immediate family is unable to agree.

There was considerable support for the deceased’s wishes to be the primary consent, from a broad range of people during consultation on the human tissue review. This approach is consistent with a health consumer’s right to informed consent, as expressed in the Code of Health and Disability Consumers’ Rights, and the existence of appropriate consent would be sufficient for organ or tissue donation to be lawful. However, in practice, there may be a number of reasons why donations should not proceed. The organ or tissue may be unsuitable for donation, the family may be aware that the person had changed his or her mind since recording consent, or the immediate family may be distressed by a decision to proceed with donation.

The bill provides some exceptions to the general rule that informed consent is required to collect or use human tissue—for example, where tissue is collected or used under the Coroners Act 2006, or for criminal justice purposes. The bill also recognises that there are certain limited circumstances where, because appropriate safeguards are in place, the public good associated with the use of tissue outweighs informed consent requirements, as in research approved by an ethics committee, for example.

In general, the bill does not cover consent for the collection and use of tissue from living people, because that is already covered under existing legislation and common law. However, the bill does close an existing regulatory gap in relation to tissue taken from living people. It will include a requirement for informed consent for the analysis of tissue taken from living people where the Code of Health and Disability Consumers’ Rights does not apply, and where the analysis is for the purpose of obtaining genetic or other information about a particular condition or trait of the donor.

The Human Tissue Bill gives recognition to a national organ and tissue donor register. Such a register will support the consent framework in the bill. To ensure that the design of the register is aligned with the consent framework in the bill, work on the register will not proceed until the Health Committee has completed its consideration of the bill. The bill requires medical practitioners, donor agencies, and others involved in the collection and use of tissue to take all reasonably practicable steps, including checking the register, to ascertain whether consent has been given.

International evidence is inconclusive regarding the impact of registers on organ and tissue donation rates. Evidence points to increased public awareness, improvements in processes around donation, and improvements in coordination between agencies as being most likely to lead to improvements in donation rates. A register could potentially have a positive impact by promoting discussion about donation amongst families, and by driving improvements in the governance and clinical processes around donation. Without an integrated approach, however, the establishment of a register could reduce donation rates by failing to register sufficient numbers of people, and there is a risk that families may interpret the absence of registration as meaning a “No” to donation, and decline to donate. I encourage the Health Committee to examine carefully the international evidence in this area, to ensure that New Zealand has an effective and integrated system that is designed to maximise organ and tissue donation.

In May a member’s bill in the name of Dr Jackie Blue, the Human Tissue (Organ Donation) Amendment Bill, had its first reading and is currently before the Health Committee. As both bills propose to legislate in the area of organ donation, I recommend that they are considered in tandem. The key differences between the two bills are that the Government bill is much broader in scope and has a more comprehensive consent framework than the member’s bill. The Government bill aims for a balance between respect for the wishes of the deceased person and the cultural and spiritual needs of his or her family, whereas the member’s bill does not acknowledge the needs of the deceased person’s family.

I propose that the Human Tissue Bill be considered by the Health Committee. I believe that this bill is a significant and logical step forward in the development of legislation for the human tissue sector. The bill repeals outdated legislation, and provides a comprehensive framework for regulating the collection and use of tissue from dead human bodies as well as the trading in tissue, export and import of tissue, and the use of tissue for non-therapeutic purposes. In addition, the bill closes gaps in current regulations around the use of tissue from living people. I commend this bill to the House.

Dr JACKIE BLUE (National): I will take a short call on the Human Tissue Bill. National will be supporting this Government bill to go through to a select committee. The Government’s Human Tissue Bill proposes to replace the Human Tissue Act 1964, which has become out of date. As has already been outlined by the Minister, the Government bill is broader than my own member’s bill, which is now waiting to be considered by the Health Committee.

This bill does differ from my bill in some respects. Both bills provide a consent process and an organ donor register. The current driver’s licence, requiring one to tick a box, does not give informed consent in any real sense of the word. The bills differ on how families can intervene in organ donation. The Government bill makes provision for family members to override the donor’s wishes in exceptional situations; my member’s bill does not.

To date, 42 submissions have been received on my member’s bill, and it is clear that the organ donor register and the issue of whether a family can veto a donor’s wishes are both a source of contention. Interestingly, the main objections to a voluntary opt-on register are from intensive care doctors and some transplant surgeons, who feel that a register would be overly bureaucratic and expensive, and that it would not increase the number of donors. The doctors also consider that families, when asked about donation, do not object in the vast majority of situations, and do not support the donor’s wishes being paramount.

A number of individual submitters had either received an organ or had a family member who had been a donor. There were also submissions from groups and organisations representing individuals who had diseases that could result in the need for an organ donation. Individual submitters and organisations were supportive of the member’s bill, and the sentiment regarding the family being unable to veto the donor’s wishes.

Internationally, countries are taking on organ donor registers, and some countries are going further by basing their registers on presumed consent. Our organ donor rates in New Zealand are dreadfully low and need to be boosted. What we are doing currently is not working. New Zealand faces an increasing demand for organs because of end-stage renal disease as a result of diabetes, and end-stage liver disease as a result of the hepatitis B and hepatitis C diseases. We really have to get this situation right.

This bill has to be right, and for the right reasons. It is entirely appropriate that these two bills be heard together at the Health Committee, which will hear all submissions and evidence. National will be supporting this bill going to a select committee. Thank you.

BARBARA STEWART (NZ First): On behalf of New Zealand First I rise to support the Human Tissue Bill going to a select committee. It is a very important bill, which does need to be discussed by the general public. We really must have their input into a bill such as this.

The bill deals with a very complex area that is shrouded by emotion, at a particularly difficult time for a family—a grieving family. Earlier in the year New Zealand First supported Dr Jackie Blue’s organ donation bill, which focused solely on organ donation. We were looking forward to having public input and discussion on that very important issue, because we recognise that this whole area does need to be addressed. Dr Blue’s bill has been incorporated, in part, into this bill, and we look forward to having the Health Committee work on this very important issue, along with its work on Dr Jackie Blue’s bill.

The Human Tissue Bill also regulates trading in tissue, the export and import of tissue, and the use of tissue for non-therapeutic purposes. Regulations are definitely required and safeguards must be in place.

We have to acknowledge that our organ transplant rate in New Zealand is among the lowest in the world. The human tissue donation rate is an international problem; it is not a problem that only New Zealand has. I know that we are second to last in the world, according to recent statistics that I have read, and that is not a place New Zealand usually occupies in any health matter. We know already that many people believe in recording their wishes through the driver’s licence system, yet there is actually no link between Land Transport New Zealand and any health database. We must wonder why that process has been followed, when any decision actually made and recorded on a driver’s licence cannot be accessed in any way. That process really does need to be stopped, as it does not mean anything at all.

The informed consent process is important, as we know that people may want to specify which organs they wish to donate, and whether those donations are for use by others, for medical education, or for research. It is really important that people are aware of the entire issue. With the increasing need for organs, particularly as a result of the predicted increase in diabetes and obesity in the future, it is absolutely essential that the whole area of human tissue donation is clarified for the benefit of everyone. The Health Committee, over the years I have actually been on it, has received petitions on this subject, and action is definitely required. Along with that is the need for education and increased donor awareness, and it is to be hoped that publicity will result in increased human tissue donations. We must acknowledge, too, how essential it is to respect cultural values. I read a recent press release by Andy Tookey, who is disappointed in the family veto that this bill allows. There will no doubt be further discussion about that during the select committee’s deliberations.

Human tissue donation is an issue that has been left in the too-hard basket for many, many years. It is a very complex issue, but now, after the bill goes through the select committee process, we will have legislation that should serve the organ donation needs of New Zealanders. Evidence from overseas has shown that legislation does not necessarily increase in any way the rate of organ donation or human tissue donation, but New Zealand First agrees with the Minister that an integrated process is necessary to develop a register and to close gaps in the Human Tissue Act 1964.

We look forward to working further on this bill. We acknowledge that public discussion is required, and we are very pleased to support the bill.

SUE KEDGLEY (Green): I suspect that this legislation will be one of those coming before the House that will have widespread cross-party support—at least for consideration of the bill. The Green Party is absolutely delighted to be supporting this bill. We have wanted New Zealand and our Parliament to look at this issue for many years. As the previous speaker said, we have had some petitions before previous Health Committees, and we really believe that it is long, long overdue for us, once and for all, to resolve this issue and, hopefully, to improve significantly the organ donation rates in New Zealand.

It is really just as well that we do have this bill before Parliament, and that we are looking at ways to improve our organ donation rates significantly, because all of the experts are telling us that the number of people needing donated organs inevitably will explode in coming decades. As obesity and the incidence of diabetes increases, the number of people needing renal dialysis, and eventually kidney donations, is likely to explode, as it is, of course, for those with hepatitis B and C. I saw a programme the other day that said an estimated 40,000 New Zealanders had hepatitis C, and the number is growing. The number of people needing organ donations is likely to explode.

In the United States the number of people waiting for kidney organs has more than doubled over the past decade. The average person there is waiting more than 3 years for an organ, and now the authorities are debating whether to set up a rationing system. I was reading an article just a couple of days ago that stated that the young would be given priority, which no one would object to, but older patients over the age of 70 or 79 would no longer be accepted for organ donation. Those age levels are currently being debated. So that is the reality that is happening around the world. There is an extreme demand for organs, such that rationing is being examined and imposed around the world.

The Greens are extremely keen to try to encourage the availability of greater numbers of people to be donors in New Zealand. We would also like to see the focus being on the human donation of organs, rather than on what some people are looking at, xenotransplantation—namely, growing organs in genetically engineered pigs and then transplanting those organs into humans. We feel there are significant—indeed, extreme—risks with transplanting organs from animals into humans. Therefore, we think that the way to avoid this is to increase significantly the rate of human donors available.

The statistics speak for themselves. It was extraordinary that last year in New Zealand only 29 people became donors after they died, which was the lowest number in more than a decade and despite the fact that more than a million people have said yes to organ donation on their driver’s licence. We all know that that the organ donation statement on a driver’s licence is essentially meaningless; it does not provide informed consent. People sign their driver’s licence, but in fact I do not think that information is even collected on a register. Certainly, it is not provided to people. No computer database of information is provided to families when they are considering whether to donate an organ from a deceased person. So we do need to update the driver’s licence system in relation to organ donation. This bill proposes to do that, and we welcome that.

Another statistic that is extraordinary is that there were 104 possible donors last year—I think only 34 were donors—but 35 families were not even asked whether they would consider allowing the donation of an organ from their deceased family member. We have wrestled with this issue for many years, and it is quite clear that the present system is not working. There is no reason why New Zealand should have such a low level of organ donors, when more than a million people have indicated they are very happy to be donors. We urgently need a better system.

One of the interesting things about overseas research is that 95 percent of families—that is what the research finds—agree to organs being donated from a dead relative, if that person had stated a wish to be a donor. The problem is that many of the families are not aware whether the person wished to be a donor, and that is the issue we hope to address when we look at this legislation in the Health Committee. This legislation will be alongside Jackie Blue’s bill, which Green members are very pleased to support.

The Green Party comes to this issue with an open mind. We are happy that we will be considering this Human Tissue Bill alongside Jackie Blue’s bill. We will be listening very carefully to the submissions, and we will support what we believe is the best system. We know that many people, like Andy Tookey, strongly favour the requirement that if someone has indicated that he or she wishes to be a donor, that overrides the wishes of the family. On the other hand, we know that doctors who are confronted with this situation believe that this is unworkable and unenforceable. But it is possibly the case that this Human Tissue Bill will do what it says it hopes to do, which is to strike a balance between the rights of the grieving family, and the organ donor’s informed consent. The Green party is very pleased the bill is finally before the Health Committee, at long last, and that we have the opportunity to resolve this issue.

As previous speakers have said, there are very important cultural considerations around this issue and they need to be respected. I think the Human Tissue Bill does acknowledge the absolute requirement to take into account cultural and indeed spiritual sensitivities around organ donation. So these are important issues that we will need to consider, as well.

Green Party members do have real anxieties about some aspects of the bill—the trade in organs, and the research into organ donation without consent, which I think the bill allows in some cases. We have extreme concerns about that, and will be opposing those sections of the bill. We are also very concerned about the importing and exporting of tissue. So we do have very significant anxieties about those sections of the bill. But we come to this legislation with an open mind and with great delight that this Parliament is dealing, finally, with what is a huge and important issue. As all experts are telling us, there will be a huge explosion of people requiring, in particular, donated kidneys and livers, but also cornea, lungs, and other organs for transplantation. We are pleased that Parliament is finally addressing this important health issue.

TARIANA TURIA (M?ori Party—Te Tai Hauauru): T?n? koe, Mr Speaker. T?n? t?tou katoa. As a nation it appears that we have one of the lowest organ donation rates in the world, yet currently about 400 people are on the organ waiting list, 80 percent of whom need kidneys. We also know that M?ori both donate and receive proportionally fewer organs than non-M?ori. These figures are of grave importance to our survival, and to our right to live a healthy life with our well-being assured.

But the bill we are discussing today is of an entirely different nature. A key distinction we must make is the difference between the donation of tissue from a person who is alive, and the donation of tissue from a person who is deceased. The purpose of the Human Tissue Bill is to help ensure that the collection and use of human tissue from dead bodies is conducted within the context of a consent framework.

The issue of consenting to tissue donation is best understood by M?ori as the difference between life and death. The transfer of organs from one person to another is a major issue for tangata whenua. Indeed, such organ transplantation is critical to the retention of whakapapa—an issue of vital concern to our well-being. As such, we were quite surprised that a recent survey on Radio Waatea confirmed that 79 percent of M?ori believed that M?ori should be donors. It is our duty and responsibility, they said, to do all we can to uphold the sanctity of human life. I remind the House that it was Grant Kereama who donated a kidney to the Tongan rugby player and All Black, Jonah Lomu—perhaps New Zealand’s most famous donor recipient. It was an act of selfless giving by a friend to a friend, and it shows that it can be done.

I return to the hub of the issue: the difference between human tissue donated by a person while that person is alive, and human tissue donated by a person who has passed on. The value of considering organ donation as an option to support the life of a loved one cannot be underestimated, but there is also a very strongly held set of beliefs that must be respected in understanding the relationships between the realm of the living and the realm of the dead. In essence, never the twain shall meet. The spiritual beliefs of tangata whenua around death and dying cannot be smoothed over, rushed through, or minimised, for the purpose of expeditious lawmaking. The beliefs and practices emerging from our values are a living and vibrant aspect of our culture, and they have particular relevance to the passage of this bill.

 A paper by Greg Lewis and Neil Pickering published in the NZ Bioethics Journal explains such concepts: “Maori belief offers fundamental reasons for not donating organs. These include the adverse impact that organ donation may have upon donors and their wh?nau, and the adverse impact that receiving a donated organ may have upon recipients and their wh?nau.” The deep-seated views held within our wh?nau about the relationship between the living and the dead cut to the very heart of our spiritual and cultural world view. The House is not the place to enter into negotiations about either spiritual or cultural philosophies, values, and attitudes. Suffice it to say that the concept of the circle of life is one that has universal application, but special recognition for tangata whenua. In essence, to fail to return an individual whole to Papat??nuku, the Earth Mother, fails therefore to accord due respect to the sacred value of whakapapa.

The Human Tissue Bill states that human tissue donation will occur only with proper recognition and respect for the autonomy and dignity of the individual from whom tissue is collected, the spiritual and cultural needs of those in close relationship with the person who has died, and the cultural, ethical, and spiritual implications of the collection and use of human tissue. The problem is that for M?ori the consistent message we have received is that this bill would not even get to first base, given its flawed assumption that M?ori will accept the notion that organ donation between the dead and the living is appropriate. The circle of life demands that all life is derived from the earth, and returns to the earth complete.

These spiritual concerns surrounding human tissue are also influential in other cultures, and are clearly reflected in the consent rates amongst M?ori, Pasifika, and other peoples, in the context of posthumous donation. We must contrast these very low donor statistics with the growing ethnic diversity our population is experiencing in Aotearoa. Statistics New Zealand advises us that M?ori, Asian, and Pacific populations are all projected to increase their share of New Zealand’s population. In light of increasing ethnic diversity, issues that cut to the very core of cultural beliefs amongst M?ori, Pasifika, and other ethnic populations must be taken seriously, and the key to change is always through education. If we as a nation are truly of the view that the collection and use of human tissue is necessary to advance medical education, investigation, research, or any other purpose, then we are honour-bound to discuss these issues fully as a nation, and this is where the hope must lie. As a nation we need to have that debate.

For M?ori, there will be many varied questions, including what measures might be needed to safeguard the process of removing and transplanting organs for wh?nau M?ori. There will be many other issues, neither appropriate to raise in this forum nor, indeed, restricted to the discussion within one’s own wh?nau, hap?, and iwi. That there will be questions is, however, undeniable. The M?ori Party believes that our communities need time to discuss the issues involved. They need information that is effective and appropriate for such discussion, and the discussions need to be undertaken in ways that can indeed engender the trust and confidence of all concerned.

The issue of informed consent is critical. Any information that is about making a choice needs to be specific to the needs of the particular audience. We need to prepare fully for such discussions, so that we guarantee that the information process is capable of responding appropriately and sufficiently to issues of protection, informed consent, control of information and medical process, access to information, and medical care. I ask whether sufficient regard has been given to exploring the risks.

Communities need to be engaged in a very real way. Having a few token “others” on a committee, or writing submissions, is not enough to constitute proper engagement. Those consulted require comprehensive information and relevant statistics in order to discuss and make decisions. It is not inconceivable that, in future, a wh?nau or hap? may well weigh up all the determining factors and conclude that they may indeed derive some benefit from the donation of human tissue and, as such, it should be up to them to decide. This debate has already been taking place where there are wh?nau and hap? members who believe, in fact, that our bones are probably more important than our organs. If the Government is indeed committed to the use of human tissue after the donor’s death, then we would like to see some due regard accorded to investing in education—such as a nationwide series of hui—on this issue.

 Finally, the M?ori Party wants to place on record its concern at the proposal in this bill that the wishes of an individual can override the collective process of wh?nau decision-making. The bill says that formal recorded consent for organ tissue donation is required from the individual; or, under clause 32, from the person or persons nominated to give consent after the individual’s death; or, if those persons are absent, from wh?nau or a senior next of kin. That does not sit well with our party. No individual stands alone. Our kaupapa, our tikanga as tangata whenua, describe an individual person or body not as merely his or her own but as a connected and vibrant manifestation of whakapapa, the ancestral line. The link, the chain of whakapapa, is therefore of significance to the wh?nau as a whole, and decisions to sever such a link have implications for the well-being of the wh?nau, past, present, and future.

There is nothing more certain in the cycle of life than the inevitability of death. The M?ori Party will not be supporting this bill because it has been a strongly held view at the hui we have been to, where this issue has been discussed, that we will oppose the bill in light of our kaupapa, our tikanga, and our world views. T?n? koe.

STEVE CHADWICK (Labour—Rotorua): I am pleased to take a call on this Human Tissue Bill. I have been very involved with this issue from my previous role at Rotorua Hospital, where we dealt with the issue of organ donation and the desperate need for organ donors for our M?ori population.

I want to acknowledge the role of Andy Tookey, who brought a petition to the Health Committee, and he has been mentioned by other members. I think he made a very significant step in the history of Organ Donation New Zealand, and the Health Committee took great note of the issues of organ donation, the falling rate of organ donation, and some of the cultural sensitivity issues that Tariana Turia has raised tonight.

The Health Committee made several recommendations to this Government and I am really pleased that so many of our recommendations have been picked up. This was the last piece of the puzzle that I tried to begin to get leverage on with a member’s bill until I went to meet the intensivists at Auckland Hospital. They said to me—and this was about an opt-on link, with informed consent at the time of getting one’s motor driver’s licence—that whereas those of us who were benevolent said: “Yes, take every workable part and use them for anybody who is desperate for these organs or tissues.”, the time of death and dying in intensive care was not the time to confront a family with organ donation issues.

The intensivists said that they would not take any notice of an informed consent given on a motor vehicle driver’s licence. I thought about that matter long and hard and then dropped my intention to have a member’s bill. I congratulate Jackie Blue on picking it up again, because the issue is not resolved. But at the time I was doing that work, in 2004, the Ministry of Health was going around and having extensive consultation in the community on this proposed bill. I felt very heartened about that, as a member’s bill is always too small to deal with such a significant and very large issue that will have financial implications.

The Ministry of Health went around several iwi groups and had many, many consultation meetings. I went to one in Rotorua and heard some of the expressions we have heard from the M?ori Party but, oddly, there is always another side. I met several families who said: “If we are involved primarily with our general practitioner and our primary health organisation, and we understand how they take our organs when we are declared brain-dead, what those organs are used for, and that procedure, kai te pai, we do not feel quite so frightened about this.”

Then I had a very dear friend die of a benign brain tumour. Her family went through exactly the issue of what they were going to do with mum’s organs. Seven people have benefited from her organs, and that family today—a M?ori family—feel absolutely delighted that although they lost their mother, seven families have benefited from the sensitive way in which the intensivists carried that family through making the decision about organ donation.

I believe that this bill is a comprehensive and integrated approach to dealing with organ donation, the use of tissue from the deceased, the opt-on provision, and the linking of motor drivers’ licences with the organ donation register, which will only flag to intensivists that a family has had that discussion and that the patient has agreed to be an organ donor. It will help the intensivists, but it will not necessarily mean that they will override the wishes of the family. I think that will be a very interesting issue for the Health Committee.

I agree, and so does the Minister, that along with this bill we have to have other effective mechanisms for raising public awareness, not only on the issue of keeping ourselves healthy but also about why we need to be looking at this exponential rise in the need for organ donation. It is about an integrated approach. I applaud the Ministry of Health for its very considered and consultative approach. We can always criticise those who go out and consult, then find pockets in our community who did not even know that this was in the pipeline.

The bill integrates several Acts around organ donation and the collection and use of human tissue. It has been 20 years in the asking, and I am really pleased that in our time in Government we will be considering this bill. There will be healthy debate and I am sure that the intensivists, the very ones concerned about the timing of the discussion on donation—harvesting, as we call it—will be involved in the procedure of coming before the select committee. It is a great bill and I am really pleased to see it here.

This bill follows on from the Coroners Bill, in which we learnt about the need for cultural sensitivity and education on the care of the deceased and the need to involve the family so as to uphold the family’s wishes for the deceased. I think it is absolutely timely that this bill follows the Coroners Bill.

I find it a comprehensive bill, with a scope far bigger than what a member’s bill could ever hope to address because of the financial implications involved. I look forward to the deliberation of the select committee. I am sure that with Sue Kedgley chairing the committee it will come up with a very sensible outcome.

Hon PETE HODGSON (Minister of Health): I want to make just a few remarks, given that I did not speak earlier when the bill was introduced. My colleague the Hon Ruth Dyson did speak, and I thank her. It has been an interesting debate. I have enjoyed listening to the views of all members of Parliament.

I thank the National Party for its work, and in particular Jackie Blue for the introduction of a member’s bill. It was good of her to acknowledge the contentious issues that surround the rights of a family to override a donor’s wishes. I think it is something that will be before the select committee for a while, and Jackie Blue has done this House a great service in the attention that she has placed on this issue.

I thought that Barbara Stewart’s contribution was pretty useful. I think the select committee needs to look very carefully at the relative importance of a register on one hand and of education and awareness on the other hand. The select committee will probably adduce quite a lot of evidence from offshore, for example from Western Australia, where a lot more emphasis has been placed on education awareness than we have and where there is a much better donor rate than in other parts of Australia. We probably need to be careful that we do not assume that a register by itself will work.

I thought that the contribution from the Green Party was pretty useful when it pointed out that in the US, the land of the free, they are going in for the possibility of an age limitation, quite understandably, because they are facing similar issues to those that we face, and that we will face to a greater and greater extent.

In respect of the contribution from the M?ori Party, I thank Tariana Turia for giving the House her views on a M?ori perspective, but I wonder whether the legislation as introduced allows for the tikanga that she speaks of to be exercised none the less. It seems to me that it does not preclude it.

 Finally, I say to the select committee that the Government looks forward to a quite open debate, and we are open to any suggestions the select committee might have to improve this legislation, or, indeed, to advice offered to the Government on things other than a legislative way forward—whether about education, awareness, or whatever. I think the House is united on the idea that we do need to improve organ donation rates in this country, and if the select committee has any wisdom it wishes to proffer, then I, for one, would be pleased to receive it.

Bill read a first time.