 hwmaintysiw authorisation Scotland Bill. Rwy ffeith y cyndag isell locker ziaeth gallwn hefyddo yn ei chdrive da valan. Rwy'n credu ioundesor anginnwg ulygonod dawnod am gangwch operth a gyllidwyd John organ and tissue donation and transplantation to remind ourselves of the bigger picture. The transplantation of donated organs and tissues is one of the most incredible developments in modern healthcare. It reflects the best of humanity, responding to acute need with incredible generosity, and it is a testament to the wonders of the national health service, to the skills of our nurses, clinicians and surgeons, and to the organised efforts of everyone who works to make those life-changing gifts possible. In Scotland, we have seen tremendous progress over the last decade, following our work to build and strengthen the system, and as a result of the incredible generosity of donors and families, we have seen a significant increase in the number of donors and in the number of organs and tissues transplanted. Transplants that have saved and improved lives have allowed people to live fuller lives, to be less dependent on a hospital visit and healthcare, and to get back to work and contribute to society. For the transplant recipient, the gift that they have received represents the opportunity to start life anew. Of course, not everyone receives the organs or tissues that they need. While many lives have been saved and improved over the last decade as a result of the hard work that has been taking place to build the necessary infrastructure, too many people are still waiting for the organ transplant that could save their lives. Over 500 people in Scotland are waiting for an organ transplant at any one time. Those are people who want to live their lives to the full, who want to work, contribute and support their families. I believe that it is my job, I believe that it is our job to make sure that we are doing all that we can to get as many of those people the transplant they need. There will always be an absolute limit on the number of people who can ever become donors in Scotland. Only around 1 per cent of people die in circumstances where donation is possible, but if there are steps that we can take to allow more of that 1 per cent to donate, I hope that members will agree that it is important that we do so. The primary purpose of the Human Tissue Authorisation Scotland Bill is to introduce a soft opt-out system of organ and tissue donation for deceased donors. The bill amends the existing Scottish legislation that supports donation, the 2006 Human Tissue Scotland Act, by introducing a new additional form of authorization called deemed authorization. In practice, that means that where a person was not known to have any objection to donation, donation may proceed. Deamed authorization will apply to most adults from the age of 16 who have not otherwise explicitly opted in or opted out of donation. However, the bill contains safeguards to ensure that donation won't proceed if that isn't what the person would have wanted. The bill also provides safeguards for those adults who lack the capacity to understand deemed authorization and for adults who are resident in Scotland for less than 12 months who will not be subject to deemed authorization. Evidence suggests that there is no one answer to increasing organ and tissue donation and there is no silver bullet. However, there is evidence that opt-out systems can make a difference as part of a package along with other measures. Scotland has already taken forward many improvements. With our partners in the NHS, work has progressed over the past 10 years to improve the infrastructure and systems that support donation. That includes learning from other countries such as Spain and responding to major reviews such as the Organ Donation Task Force report in 2008. Improvements have also been realised through the Scottish Donation and Transplantation Plan to 2020. David Stewart rightly identifies that Spain has been top of the league table for organ donation, but the minister will know that the success there has been because they have had a high level of intensive care beds rather than about consent. Could the minister answer that point? The point is that we should look to write across the world to learn lessons, but we have to recognise that there are differences in systems. While we look at other systems to see what we can adapt to our system, we need to be mindful of differences in culture and differences in the way forward. I was pleased that the committee in its review of evidence agreed and specifically made that point in relation to the differences from the Spanish system to the UK system. Improvements have also been realised through the Scottish Donation and Transplantation Plan to 2020, such as the appointment of a Scottish regional manager for specialist nurses for organ donation and the publication of secondary schools education pack, which has contributed to the highest awareness among young people. The work continues. For example, we recently confirmed to NHS BT that we will provide funding to support new technology to help to improve outcomes for patients receiving liver transplants and increase the proportion of livers that are suitable for transplantation. A duty on ministers in the 2006 act to promote donation through regular publicity and awareness raising has resulted in Scotland having the highest proportion of its population on the NHS organ donor register of any of the UK countries at 52 per cent. However, as support and awareness for organ donation has grown in recent years, so has interest in a move to opt-out. The member's bill, introduced by Anne McTager in the last session, was significant. Although the approach in that bill was not supported either by Parliament nor Government, but both Parliament and Government recognised that there was an appetite to move towards a different form of authorisation. The bill before us is the product of that appetite and of the great deal of work that we have undertaken over the last few years following those discussions. We have worked with a lot of people, including NHS professionals and people affected by donation and transplantation, to consider how best to introduce a system of opt-out in a way that contains appropriate safeguards and in a way that will not compromise the already complex and lengthy donation pathway. We place a particular importance on making those changes in a way that is transparent and open to the public. Organ and tissue donation enjoys and depends on a high degree of public support, and we do not want to do anything that puts that support at risk. I want to now turn to some of the specific sections of the bill. The bill sets out a framework for pre-death procedures. That is medical procedures that may be carried out for the purposes of transplantation. The sorts of medical procedures that we are talking about here are, for example, blood tests or urine samples to help to ensure that donated organs are more likely to be transplanted successfully and that the donor's wishes can be fulfilled. The bill also sets out that the authorisation for some procedures can be deemed in certain circumstances. I was pleased that the committee accepts the proposals in the bill, but I recognise that that is a complex area. I want to reassure members that this sort of clinical practice is not new and that it is already an important part of the donation and transplantation pathway. We also recognise that clinical procedures will continue to change. We want to ensure that there is a clear framework in place and that that will set out when pre-death procedures can be used and what safeguards must be in place to ensure future developments in clinical practice can be introduced where appropriate. We agree with the committee that the use of such procedures should be kept under review. The bill provides that the procedures and proposed changes to those procedures will require consultation with the appropriate clinical bodies and the scrutiny of this Parliament. As with the positions around optite, our approach is to be transparent and to maintain a high degree of trust in donation. The bill also includes a new duty to inquire. In practice, that ensures that the NHS understands the wishes of the donor before further steps are taken. The aim of the bill is to ensure that the interests and views of the donor are safeguarded at all times but that there is a clear and effective mechanism in place for relatives and others who are entitled to provide information to exercise their rights. To meet those aims, while reflecting current good practice, the bill includes a duty to make inquiries in respect of authorisation given by the donor or whether an optite decision is in place. For example, the specialist nurse for organ donation or the tissue donor co-ordinator will undertake a check to the information held on the organ donor register. Inquiries will also be made of the nearest relatives or other person of the most recent views of the donor or whether the donor falls into an accepted category. To be clear, as with the law as it currently stands, families do not have a right to overrule the wishes of a loved one, but they have an important role to play to provide information on whether the donor has expressed any wish or whether they had changed their mind. The bill would change the laws at hand at the moment. At the moment, it says that the relative can only provide knowledge of the intended wishes of the donor, but the bill in front of us says that it has to provide evidence to a health worker that would convince a reasonable person. There is quite a different level of bar that the relative has to jump over now. The standard of evidence in respect of a donor's view was given a great deal of consideration during the bill's development. The view on those working in the system was that requiring written evidence was impractical, as it is almost never provided. The consultation included reference to written evidence, but the bill does not. Those are discussions that take place with families, and they are rarely written down. We have the level of evidence that is required at an appropriate level. Maurice Corry We talk about families having been consulted, but have you considered powers of attorney and deputies of the court of protection? The aim here is to make sure that we are identifying the views of the potential donor. In many cases, that might be the family. In some cases, it might be somebody else. That is part of the process that stands just now, is that the specialist nurses make sure that they are speaking to the best possible person to identify the wishes of the donor. It is a crucial part of the legislation that is our aim. Good public awareness will be crucial in achieving the aim of increasing support for donation. The bill builds on the support in the 2006 act for ministers to support and raise awareness of donation by introducing a requirement to raise awareness specifically around the new authorisation processes that the bill introduces. We need to ensure that the public are aware of the opt-out system and are able to exercise their choice to opt-out of donation, and we encourage to tell their family. In addition to the duties in 2006 act and those in the bill, the Scottish Government is committed to a high-profile raising awareness campaign during the 12 months lead-up to the introduction of the opt-out system. Awareness activity will be designed to reach a wide range of people, including hard-to-reach groups, minority groups and those with special needs. We also recognise the importance of raising awareness of young people as they approach the age of 16, so they are aware of the implications for them, and we are exploring ways of achieving that. A great deal of work has gone into developing the bill over the past 18 months. I am grateful to the expertise, dedication and experience of the NHS, clinicians, professional organisations and individuals who have helped to shape the bill. I want to particularly acknowledge the Scottish Donations and Transplant group, which advises the Government on those matters. Our long-term aim is to increase donation and transplantation rates, and I hope that the bill will contribute to that. I welcome the committee's support for the general principles of the bill, and I thank them for their thorough and constructive consideration at stage 1. In conclusion, I move that the Parliament agrees to the general principles of the Human Tissue Authorisation Scotland Bill. Thank you very much, minister. I now call Lewis MacDonald on behalf of the Health and Sport Committee, convener, please. Thank you very much, Presiding Officer. Lung transplant recipient Gillian Hollis gave the Health and Sport Committee a neat summary of the general principles of this bill. Tell us if you want to donate, tell us if you don't want to donate and if you don't tell us anything, we'll presume you have authorised donation. She was one of several people with direct personal experience from whom we heard formally or informally and who helped shape the committee's report on stage 1 of the Human Tissue Authorisation Scotland Bill. I thank all who assisted with our scrutiny by responding to our call for views or to our survey or by giving oral evidence. I would particularly like to thank those like Gillian Hollis who gave evidence from their own experience, including people who had benefited from donated organs, patients who were still waiting for a transplant, and relatives who had authorised the donation of an organ from a deceased family member. I would also like to thank the clerks to the committee and the Parliament's external engagement and media teams. As with the current law on organ donation, the Human Tissue Scotland Act 2006, the fundamental purpose of this bill is clearly to enable an increase in rates of organ donation in order to save lives. The evidence that we heard at stage 1 was that donation rates have benefited from the changes to law and practice, which followed the 2006 act, but they have not yet ended the tragedy of people dying while on the waiting list for an organ transplant. Despite all the good work that has been done since 2006, there are over 500 people waiting for a transplant at any one time in Scotland and there are simply not enough organ donations to enable them all to survive. The 2006 act boosted donor rates in Scotland to be the highest in the UK, as the minister said, although we are now challenged by Wales since the passing of new legislation there in 2013. However, in Scotland around half the population have opted in, but that is still not enough. We know from survey work that 90 per cent of Scots say that they would like their organs to be available for transplantation after death. That means that up to 2 million people in Scotland would like to be organ donors, but have not registered their wishes. The bill deems those who have expressed no view on the matter to be potential donors, bringing the share of the population who can donate closer to the proportion of the population who want to. Although, of course, in the terms that Joe FitzPatrick laid out in opening, in practical terms, only 1 per cent of deaths can be appropriate for transplantation. People need to be able to make an informed choice about adopting and erupting out and also to understand the implications of deemed authorisation. The language around organ donation can be confusing, so we also need a robust and continual engagement strategy to explain what it all means. The committee was keen to learn from the experience of other countries. The legislation passed in Wales in 2013, introduced a system of deemed authorisation similar to that proposed here. An evaluation of the impact of the Welsh act confirmed that the new law did not at first lead to a major increase in donor rates, but that that has begun to happen in the last year or so. The evidence is that increasing donation follows increasing awareness, not simply from a change of the law on its own. Likewise, as we have heard, the evidence from Spain did not prove a direct link between an up-to-out system of deemed authorisation and an increase in transplantation rates. High numbers of intensive care beds and hospitals able to retrieve organs have been at least as important to the high organ donation rate in Spain, as David Stewart pointed out. When we asked the minister to review the issue of intensive care beds, he indicated that the 2020 strategic forecast did not anticipate an increase in donation rates above increasing capacity as a result of the bill. We therefore recommended a review of infrastructure across the country for organ donation, and I therefore very much welcome the minister's commitment today to discuss with stakeholders whether further improvements can be made. The committee's online survey on the bill attracted 747 responses. The most widely held concerns related to the rights of the individual who has not expressed a view, but his body could be treated as some felt as if in some way it belonged to the state. While we did recognise the ethical and legal issues raised, the committee accepted the minister's view that, in the final analysis, the right to authorisation rests with the donor, and by the same token, so does the right to withhold consent. The idea that deemed authorisation could undermine the sense of a gift from donor to recipient was also highlighted in our survey. However, patients awaiting transplant, on the other hand, were insistent that any organ would be welcomed as a gift whether it was enabled by registration as a donor or by deemed authorisation. Clearly, it would be useful for the Scottish Government to revisit this in a number of years, as Mr Fitzpatrick has indicated that is intended in his contribution this afternoon, to see if there is any change in public attitudes and any impact on donor rates. We would also like to see a review after the same sort of period, perhaps five years, of the bill's provisions for medical procedures prior to death to help successful transplantation. The minister again mentioned this. This is critical to ensure that such procedures are conducted with the necessary sensitivity. The committee had a very valuable session with the specialist nurses organ donation, or SNOTS, who showed us how they work with the families of potential donors. It became clear that families have a dual role in providing the essential medical and social history of the prospective donor and in enabling donation to go ahead. We were struck by the many and sometimes difficult questions that SNOTS have to ask at what is already a distressing time. Those questions are standardised across the UK in order to maximise the opportunities for donations and transplants between jurisdictions. We suggested that this would be a good time to review those to ensure that every question that is asked continues to be one of clinical importance, so we welcome the minister's commitment to take that forward. The law already says that the wishes of the donor are paramount rather than the views of family members, but, as we heard in committee from Dr Stephen Cole, consultant in intensive care medicine at Ninewells, doctors would find it difficult to override the wishes that are expressed by patient relatives. We accept that in practical terms. It would not be possible for the medical profession to proceed with donation against the wishes of the family. Therefore, the role of SNOTS in working with families is clearly critical. We heard from patients on the transplant waiting list who told us about the emotional and financial distress that is caused by waiting for an organ to become available. Even when an organ is found, 40 per cent of transplants do not proceed for a variety of reasons. That is really tough for those on waiting lists whose hopes can be dashed time and again. We know that specialist post-transplant support is provided to recipients of blood stem cell or bone marrow donations, and we see no reason for any difference in approach. We welcome the assurance from Government that psychological support across all those services is under review, including for people affected by organ donation. Having had that assurance from the minister, we look forward to the findings of that review later this year. For the bill to achieve its aim to increase donation rates, a high-profile public information campaign is required, running for at least 12 months before commencement of the new rules. We are pleased that the Government has accepted our recommendations that they review the engagement strategy in Wales and undertake outreach sessions with ethnic minority groups. We also welcome the commitment to building the existing collaboration between the Scottish Fire and Rescue Service and the Anthony Nolan Trust, who work together to promote awareness of stem cell donation in secondary schools and colleges. The committee supports the general principles of the bill, but we stress that the bill alone will not achieve the desired effect. Scotland, like Wales, must use the change in the law as a vehicle for promoting greater awareness of the benefits and requirements of organ donation. Ministers will therefore ensure that the necessary infrastructure is in place in good time to support the increased number of transplants that we all want to see in Scotland in the 2020s. Deputy Presiding Officer, when I attended university in Aberdeen, all students at the time in the Granite City became very aware and concerned about our fellow student, Millie Forbes. Millie needed a vital bone marrow in stem cell transplant and, after significant work to try to find a donor, it had led to no suitable match. As a young man who had just escaped rural Persia for the city life of Aberdeen, I can say that registering for any donation list was the last thing on my mind, but for so many students in Aberdeen it was the need to do something and wanting to help that made students, the student population, sign up en masse to the Anthony Nolan register and to hopefully be the match that Millie needed underneath blood stem cells. Millie sadly lost her fight at age just 21, surrounded by members of her family at the anchor unit at Aberdeen Royal Infirmary in 2004, eight months after she'd successfully undergone a stem cell transplant operation, her only real hope of survival against my lord leukemia. Millie was a real inspiration and 15 years after she lost her life through leukemia, it's remarkable how Millie's campaign has brought fresh hope and saved lives of others with leukemia across Britain today and since. For me personally, it's this experience that's made me think about these issues and to decide during my time at university to sign up the Anthony Nolan register and the organ donation register. But sadly for so many of our fellow Scots, taking this step or even having a conversation with loved ones is just not something that is happening today and why so many people's wishes on organ donation are simply not registered or known by family members and it's this that clearly needs to be improved in Scotland today. In Wales, the most recent figures since they changed organ donation legislation showed that from November of 2018, the rate of family consent is now at its highest ever level at 80 per cent. That compares with Scotland at 63 per cent, England at 66 per cent and Northern Ireland at 66.7 per cent. I'd like to thank all those organisations and groups who have provided briefings ahead of the debate today and for the contribution that they have given to the work of the Health and Sport Committee. I'd like to also put on record my thanks to the committee team and for the work that they've undertaken during the inquiry and also recognise the work of Mark Griffin in bringing forward his private member's bill on this. In the time that I have, though, I wanted to touch on some of the important aspects of the bill, which we need to get right as the bill progresses through Parliament. The wishes of the donor's family has already been raised and this is something that I think we need to make sure is at the heart of the bill and throughout our inquiry it was clear that the role of the donor family is fundamental to the success of any donation going forward and will be central to the success of this bill. Keith Brown Can I thank the member for taking intervention and just to clarify a point? Is it the member's view that the wishes of the donor's family should supersede those of the donor themselves? I think that this is where we found difficulty and specifically in the sense of if someone's not known to have a wish expressed then actually they already have that opportunity in not taking forward the questionnaire, which still stays part of the bill, so in theory that will still be the case if they're not willing to go forward with the donation questionnaire and that's something which I know the SNOT team have always found difficult. During the inquiry, as when the member was still a member of the Health and Sport Committee, I think it was that work which was done with the specialist nurse for organ donation team, which was so important. I have to say personally listening to the conversations they take forward and facilitate with families at the most distressing time any of us can imagine is incredibly professional and also demonstrates our NHS at its very best. The professionalism of the SNOT team is critical and the sensitive assistance and support they provide to potential donor families and the open communication and transparency around this is also vital to the process. I'd like to pay tribute to the work that they do in supporting families at this unimaginable time of distress and also the work that they are doing to actually highlight the benefits and keep informed families post organ donation. It was clear that families have always and always will be at the heart of facilitating donor selection through the donor questionnaire process and in taking forward the wishes of a donor and this was demonstrated by the conversations that the committee, as Lewis MacDonald has already highlighted, had with families. I want to thank the families again who gave their time so generously to the work of the committee and I think I speak for all members when I say that we learnt much from them. For those families though who have decided not to go ahead with donation, it was understandable and I hope that we've been able to take forward improvements on what they outlined had influenced their decision making at the time and how we improved the organ donation system and the family experience further in the future. Family refusal accounts for 50 per cent of non donations. In countries where they've adopted a system of opt-out, this has now reduced to around 25 per cent. There's clearly much work to be done to help improve family consent rates and I believe the work that we've done in this bill can help to very much improve that. I don't have time today to highlight the amazing work and lasting connections made through the family donor network and other organisations such as the British Transplant Games, but I also wanted, in terms of the work that we undertook, to highlight the work of those organisations and thank them. Infrastructure, as has already been highlighted, is an issue that has been raised with the committee and which I believe we need to see significant commitments from ministers. Intensive care beds, as David Stewart has already outlined, are a key area in which the committee had highlighted. It's clear that if the bill is going to achieve the outcomes of increasing organ donation, we will need to see progress on improving transplantational infrastructure. I welcome the minister's response to the committee, but it is also important that we see further clarity on capacity issues to support the bill in the future, especially around staffing and intensive care beds. The useful briefing provided ahead of the debate by the Royal College of Physicians in Edinburgh specifically makes key recommendations and points around that, which I think are important as we progress to stage 2. Celebrating organ donation is something that I hope we will achieve within the bill. We need to change the culture in Scotland to publicly recognise and celebrate organ donation more, and to see the life-saving and life-changing difference that donors and their families do in the majority of cases is total strangers and giving the gift of life is incredible. The committee has recommended a communications programme, as I outlined, and I believe that if the bill passes, we need to make sure that this is one of the best and most innovative public information campaigns that the Scottish Government has undertaken. Deputy Presiding Officer, to conclude, Scottish Conservatives welcome the publication of the Human Tissue Authorisation Scotland Bill. The debate today is very important as we move forward with the bill in Parliament. We believe that all options should be considered to increase organ donation and will engage in the legislation progress before the final vote at stage 3. The Scottish National Party Government must also ensure that the comprehensive information and adequate infrastructure that we will need is in place, so donors and families are fully informed and organs that are donated are able to be transplanted successfully in the future. Someone in the UK dies every day waiting for an organ transplant. We have the opportunity, I believe, to change that. I am pleased to speak in this stage 1 debate on the human tissue authorisation Scotland Bill. Like other colleagues, I also want to thank the health and sport committee for its diligent work and reports, which were summerised by Lewis MacDonald a few minutes ago. I am grateful to the British Heart Foundation, the Royal College of Physicians of Edinburgh, the Royal College of Nursing, the Antinolan Trust and Kidneycare UK for their briefings ahead of the debate. Scottish Labour supports the general principles of the bill and its overarching aim to increase the organ and tissue donation rate and, consequently, the number of transplants that can be carried out. Scottish Labour has long been supportive of a soft opt-out system, and I would also like to thank my colleague Mark Griffin for his influence on this agenda through his members' bill in 2016, and prior to that, Anne McTaggart's work on her members' bill in 2015. I look forward to hearing from Mark Griffin and other colleagues this afternoon. With 500 people on the organ transplant list at any one time in Scotland and up to 60 people each year dying while on this list, there certainly is a need to increase the number of donated organs. I am pleased that there is public support for a soft opt-out system that is demonstrated in the Scottish Government's consultation and the committee's survey. That said, I think that we are all alive to some concerns that have been raised about the move to a soft opt-out. Some people express their worry that people have organs removed against their wishes. However, it is important to highlight that people can still opt in and opt out of the system, as we have always been able to do so. For people who have not declared, consent would be presumed, but there are safeguards in place. For example, next of kin can provide information if that was known to be getting to their family's wishes. I will take a brief intervention. Mike Rumbles. As I said earlier to the minister, that is the law as it stands. The law stands now in the 2006 act as it might provide knowledge of the deceased person's intent. However, the bill in section 7 says that it must provide evidence to a health worker that would convince the reasonable person. It is quite a different step change in providing evidence in legal terms. I have been reassured by the committee's scrutiny and the reassurance that we have had from the Government that there are appropriate and robust safeguards. I will come on to talk about the public education aspect, which is so important. Fundamentally, it is crucial that we get those things right, because people who are on the transplant waiting list urgently need help. Organ transplants do save lives and can make a transformational change to a person's quality of life. For example, Kidneycare UK described dialysis as distressing, extremely painful, and it can be hugely disruptive to daily life with five-hour dialysis sessions three times a week, challenging for people in rural areas—I am sure that Mike Rumbles knows that—so that a kidney transplant can really give a person their life back. The committee heard that the wait for a transplant can be a lonely experience, and it can take a huge toll on someone's mental health. It must be anxious waiting to find a suitable organ, and then there is disappointment where delays and complications arise, even on the day of surgery. Returning to the transplant waiting list can be a source of disappointment and anxiety. Will people on the waiting list recognise the committee's recommendation to improve the experience for people where possible, for example, by having specialists who are there to provide support? It is crucial that the bill is backed by clear and consistent messaging throughout Scotland so that people understand the system, and it is crucial to spark conversations about organ donation. The BMA has said that, whilst half of the population has opted into organ donation, their experience is that when asked, nine out of 10 people say that they would donate their organs, so deemed consent will help to close this gap. I hope that we can all agree that a person desperately waiting on an organ transplant, which could be the difference between life and death, should not miss out simply because many of us never got round to opting in to be an organ donor. The convener touched briefly on the work of the Antony Nolan Trust of the Scottish Fire and Rescue Service. It is an excellent partnership, especially working with young people in our schools. Since 2009, 13,000 people in Scotland have registered on the stem cell donor and, potentially, that is 42 lives. That is fantastic work that I hope that the Government can help those organisations to build on. Importance of public awareness and frank conversations is brought into sharp focus when we consider that family refusal results in the loss of around 100 donors in Scotland per year, which could make a huge difference to people on the transplant waiting lists. It might not be an easy conversation to have and it might feel morbid to discuss it, but it is important that we overcome this stigma and make our wishes known to our loved ones. I was moved by the stories from families where organ donation has been a positive experience and even helped them to come to terms with their loss. Just recently, I was walking our dog in Shatlarow Country Park in Hamilton, and there is a bench that I have passed a number of times, but I knew that this debate would be coming up. It is a tribute to Lanarkshire's organ donors, and it is very poignant. There are flowers, as you expect, and little plaques on the bench, but it simply says to remember those who gave the gift of a lifetime. I am pleased to hear about the measures that are currently in place for the families of the deceased, where they get a certificate. That must be hugely important and meaningful, because it is a very extraordinary gift. An additional benefit of good public awareness is that everything suggests that it will help to drive up donation rates. Although the soft opt-out system is important, the BMA and others have highlighted that a change in legislation is not a panacea and must be accompanied by investment in the infrastructure and support delivery, and others have touched on that in terms of intensive care capacity. In conclusion, Scottish Labour supports the general principles of the bill and looks forward to working with others to bring forward amendments. Organization is one of the greatest gifts that a person can give, and it is life-changing to receive. It is important that the bill maintains a special nature in which it is viewed, and that the surrounding measures must be implemented to help to ensure its success. Before I call Alison Johnson, I remind members that if you intervene, your request-to-speak button is switched off, so check that you have switched it back on again. It is just the way that this wonderful technology works in Parliament. I will call Alison Johnson to open for the Greens, please. Thank you, Presiding Officer. I, too, would like to thank the Health and Sport Committee, all involved in getting the bill to this point at stage 1, the expert groups and all who have been witnesses and given their time. I would also like to note as well the contribution of Fann McTaggart and Mark Griffin in this on-going debate. Right now, about 4,300 people in Scotland are living with a denated organ because someone made active choice to register as a potential donor. Thousands of people have a second chance at life. We are all aware of some of the heartfelt letters that recipients have sent to families of donors to get a sense of what this has meant to them. Scotland is doing well when it comes to getting people to register to be a donor. Around 50 per cent of Scots have registered, as we have heard, compared to 38 per cent across the UK. As a result, the number of successful donors has increased significantly over the past decade, with waiting lists reduced by more than 100 in that same period. However, as we know, that still is not enough. 500 or so people in Scotland are on the waiting list for an organ transplant, and sadly, some 40 to 60 people will pass away while they are waiting. Despite having that high proportion of people registered, our level of donation here in Scotland is the lowest in the UK. That is why it is vital, among other measures, to increase the total number of potential donors. Clearly, there is scope to do that, because there is a persistent gap between the number of people who state in surveys that they would wish to donate organs and the number who go on to join the organ donation register. The question before us today is whether an opt-out system, if the kind proposed in the bill, is likely to increase the number of organs that are available for donation. The evidence on that, as we have heard and as the policy memorandum rightly notes, is mixed. We have to be very clear—and I think that it seems across the chamber that we are—that an opt-out system is not an instant solution on its own. Some countries have experienced increased donation rates after adoption of such systems, and in some there have been decreases. However, the evidence presented to the Health and Sport Committee and in many of the briefings that we have received suggests that an opt-out deemed authorisation system, as part of a broader strategy to increase donations, may well have a positive impact. Figures released by the Welsh Government show a significant increase in families consenting to donation after the new system was established, standing at 80 per cent compared to 63 per cent in Scotland. An NHS blood and transplants audit of potential donors in 2016-17 showed that 177 families across the UK said no to donation because they were not sure whether their relative would have agreed. Based on last year's average number of 2.6 transplants for each deceased donor, those refusals could instead have led to around 460 life-saving or life-transforming transplants. If, as the bill intends, the Scottish Government is able to reduce the high number of refusals by families in Scotland, then it will have a very positive impact indeed. The ideal, however, is clearly still to have as many people actively opting in as possible. Family consent is always highest where the person who has died opted in, and in that situation the intent of the person is the clearest. That is one of the many reasons why section 2 of the bill is particularly important. It places a duty on ministers to promote awareness about how transplantation may be authorised, and it would be useful if the minister could give some more details on how that awareness will be raised when he has an opportunity in closing. Deamed authorisation really depends significantly on people being well informed about their options, and so this awareness-raising must continue over time. As we have heard, anyone who is resident in Scotland for more than 12 months can be subject to deemed authorisation, so the logical conclusion of that is that we must have a continual year-on-year campaign of raising awareness. NHS blood and transplant surveys show that more than 80 per cent of people support organ donation, but only around 49 per cent of people have ever talked about it, so we need to have a wider and more effective national conversation about organ donation, and I would be interested to hear from the minister how he thinks that that can best be achieved. Before closing, I would like to focus on the role of specialist nurses for organ donation. The whole system really does hinge on the incredible work that the specialist nurses do. They lead the discussion about the patient's decision for donation with the family, where a decision to donate is established, the nurses ensure that the relevant medical tests are carried out and they discuss the patient's medical history with the family. The new system potentially changes quite significantly their role. For example, the new duty to inquire established by the bill will, in practice, likely lie with the specialist nurses, and there will be, for example, retraining needs related to that. The evaluation of the Welsh system has drawn attention to the pressure that some specialist nurses felt to make the policy work. Some nurses were concerned that they might be blamed if consent and donation rates did not improve, so clearly that is something that we can learn from and something that I am sure will seek to avoid. It is also important that the guidance for specialist nurses and other professionals is clear, particularly in relation to some of the challenging situations that they might face, such as when the family objects, even though relatives have no formal entitlement to refuse a donation. As part of a broader strategy to increase donation rates, the bill is welcome. Clearly, though, this is a sensitive issue and the bill will need to be implemented with care, appropriate safeguards and respect paid to the very difficult situations that families face, having lost a loved one. However, if there is a chance that it could lead to more people getting the gift of life, it should be welcomed. Green supports the general principles of the bill and will vote accordingly at decision time. I am delighted to stand here today to offer my full throat of support for this piece of legislation. When I was out losing elections as an aspirant Liberal Democrat candidate, I was often asked at hostings and party meetings, as I am sure each of you were. If you make it to Parliament, what would be your private member's bill? It is a hypothetical question, but I always gave the same answer. Deputy Presiding Officer, this bill was my answer. I always supported legislation to bring forward a soft opt-out system and presumed consent for organ donation, and I will tell you why. When I was 14 years old, I met a guy called Anders Gibson. Anders was 12 at the time, and he and I soon became friends. I was told by adults around Anders that I had to be prepared for the fact that he might not see 20, and that was because Anders had CF cystic fibrosis. However, happily enough, Anders rode the wave of medical advancement and benefited from new treatments that emerged in his late teens. He went on to become a fierce campaigner for cystic fibrosis, issues an ardent footballer and a brilliant stand-up comic. Very sadly, we lost Anders in 2014 in his mid-30s, but I speak in his memory today. I am grateful for his impact on my life and the lives of everybody with cystic fibrosis in this country. It is for that reason that I understand entirely the personal motivation behind Anne McTaggart and Mark Griffin for bringing private member's bills of that kind to this chamber. I thank them for their work. They have paved the way for change in this country that might not have happened were it not for their efforts. Rightly so, because we are pushing on an open door here, we have heard that we have a very high rate of registration on the organ donation register and 70 per cent of our fellow country people do support change in this regard. However, there is always a disconnect. It has been alluded to by several speakers who have spoken already between those who do not mind the idea of having their organs give life to others in the event of their passing and those who sign up to the register. We know the human cost of that disconnect, because on any given day in Scotland there are 500 people waiting for an organ in this country, some of whom may wait in vain and ultimately pay the ultimate price to that. It may not be a huge uplift in the number of organs that are made available, but it is a vital step that we need to take. It is important to recognise that if we bring in a soft-out system, it does not mean that everybody's organs will automatically be donated at the event of their death. You need to die in very specific conditions for that to happen, but nevertheless it will give hope to those 500 people where none existed previously. I would also like to state at this point that we do not need to wait for people to die to benefit from organ donation. In the middle of next month, in mid-March, I will be hosting a photo call after FMQs for a Giver Kidney UK, which is a philanthropic organisation of philanthropic organ donors who I think do not have enough publicity and I urge you all to learn about them because they are truly heaven sent. This process around this bill has been a very enjoyable one. It has been touching and indeed inspiring and I want to pay tribute to the outstanding work of the specialist transplant nurses. They are a credit to their profession. I had no idea about the pre-death procedures in advance of transplant, but they are onerous. There are hundreds of questions that have to be asked of families at the most vulnerable point in their journey through grief. Often, prior to somebody's actual death, they have to take time away from the bedside to answer some of those questions, but those transplant nurses do it in a way that makes it a cathartic experience. They almost get to unpack that person's life and their likes and dislikes and who they were as a person. It was really touching to see how they would make a bureaucratic exercise intensely cathartic for the families around them. However, it is vital that that process does not become part of a barrier. Although I understand the duty to inquire, I support the suggestion from my friend and colleague Mike Rumbles that we need to have some amendment around the need for evidence that would reasonably convince a reasonable person in ascertaining the views. Nevertheless, by retaining opt-in, that is important. We need to engender those conversations and make them continue to feel like a gift and to have a gift-giving element where people can proactively make that statement. Those who receive those organs do absolutely regard that as a gift. Again, one of the most touching moments of that consideration was when we had a breakfast session with half a dozen recipients of organ donations, and they were inspiring people. They talked of their gratitude and such goodwill that they exhibited to their donors and particularly felt the impact of that gift on their life. It is so important to recognise, though, that each of those people have been through a roller coaster of emotions on that journey. We need to do something in the periphery around that bill to do more for them. Anders, whom I mentioned at the start of my remarks, had four abortive attempts to go to Newcastle to get a lung transplant. That had a profound effect on his mental health, waiting by the phone, being turned around and having to restart that whole process again—the guilt that he felt of waiting for somebody to die. At the moment, we do nothing for people who are on that transplant register. I really hope that the minister will address that in his remarks and agree to meet with me about how we can do more. In essence, in its brass tax, I absolutely support the principles of the bill. It will give hope to those 500 people and it will do more to make sure that people like Anders have a fighting chance at survival. Thank you very much. Open debate. I call Emma Harper to follow by Maurice Corry, Ms Harper. Thank you, Presiding Officer. I am pleased to be speaking in today's debate on stage 1 of the Human Tissue Authorisation Scotland Bill as deputy convener of the Health and Sport Committee. The committee took a large volume of evidence and I would like to thank the clerks for their hard-working diligence. I want to thank all who provided evidence to the committee. That includes the healthcare professionals, including Leslie Logan and her team, who provided us with insight and their medical expertise so that we could be better informed about the whole process of organ and tissue retrieval and donation, as well as the transplant process. I would also like to thank the organisations who provided briefings ahead of this stage 1 debate, as Monica Lennon has pointed out. That includes the Antony Nolan Trust, who currently supports education with the Scottish Fire and Rescue Service, and I know that they have previously worked with my colleague Bill Kidd MSP. As a former member of the trauma and liver transplant teams in Los Angeles, I was especially grateful to hear from the people who were waiting on an organ. The personal voices of recipients and people waiting for organs and tissues is vitally important in informing this debate, as around 500 people in Scotland are waiting on a transplant at any given time. Presiding Officer, the primary aim of the Human Tissue Authorisation Bill is to increase the organ and tissue donation rate. Organ transplant is a complicated process, and it normally requires two teams of healthcare professionals and two surgeries to engage and coordinate obtaining organ and then transplantation into a new recipient. I have participated in the process of retrieval of organs, as well as the transplantation of solid organs into a recipient, a patient. On one occasion, I even carried a heart in a sterile ice-filled bowl from one surgical team up three floors in the elevator to the waiting transplant team. It was awesome in the true sense of the word awesome. It was an awesome experience to be able to see the gift of one organ being transplanted into a recipient. The biggest challenge for me while working on this bill was deemed authorisation or presumed consent. One of the key arguments in favour of authorisation is that many people in Scotland support donation but have not yet recorded their wishes on the organ donor register. We heard in evidence to the committee from Dr Sue Robertson, deputy chair of the British Medical Association in Scotland. Sue told us that about 50 per cent of the Scottish population have already opted in, so they are already registered to be donors. In the committee evidence that we heard, 68 per cent of people in Scotland support to being organ and tissue donors, but they have not registered. They have just not got round to it. It is worth highlighting that when talking about donation, we are referring to heart, lungs, liver, pancreas, kidney and even small bowel, and that is before we even start on potential tissue availability. My personal thoughts are that we really need to encourage people to make an informed choice on donation. We need to encourage families, friends and colleagues to have conversations about donation. If everyone has a conversation with their family members when they are meeting, chatting or engaged, that conversation is easier to have than at the most stressful, tragic and traumatic time when a family member is in the intensive care unit. The specialist nurses who are having difficult conversations with patients relatives who have registered their wishes to donate put the specialist nurses in organ transplantation in a better position when they know what the wishes of the donor are stated. I encourage that. For me, the conversation and education is the key. I surveyed my own family and my team during this whole process of considering the evidence here at stage 1. All of my family are on the organ donor register. I am a staff too. I was actually quite chuffed to hear that, because no coercion was needed. My dad, who is 77, proudly pulled out his organ donor card to show me his evidence. He was absolutely happy to support people if his heart, liver, lungs, kidneys or pancreas or anything else—even his eyes—could save the life of someone or support their vision, someone whose life depended on this. Absolutely grateful gift of a person who, through some terrible, tragic or traumatic circumstances, would gift their organs and other tissue to save someone's lives. Donors could be called superheroes because they have the power to save so many lives—heart, liver, lungs, kidneys times two, pancreas again. We can all be superheroes, so I am on the donor register myself. It would be interesting to know how many other superheroes are in the chamber today. What is a bit disconcerting, though, is the conversation that I had with my nephews, 1-14 and 1-16, and that neither have had any conversation with any educator about organ donation. The Royal College of Physicians briefing suggests that it is particularly important that we provide education in tandem. One of my big asks is to make sure that any education for the schools and ethnic minorities is that we engage and we need to make sure that engagement is sustained as this bill progresses so that we can save lives in Scotland. For me, we need to make sure that we opt in, opt out and are able to provide deemed authorisation also to save lives. Thank you very much. I call Maurice Corry to be followed by Sandra White. Thank you, Deputy Presiding Officer. It is indeed my pleasure to speak on this bill in this debate today, and it is certainly a challenging subject, most certainly for all of us today. In the midst of grief over the loss of a loved one, organ donation is one of the most positive and life-changing acts that we can make. Playing a part in giving someone a second chance at life is a privilege. With that in mind, any legislation that alters how this process works needs to be carefully considered and fully informative for those who it affects. We have seen the rise in the number of organ donations to Scotland over the last 10 years, and for those living in kidney failure or with congenital heart defect, we can only imagine what those donations mean for them and their families. It gives them a renewed outlook on what is possible, but, as we have heard today, while organ donations may be increasing in Scotland, there are still many living in need of those transplants. The necessity of having more organ donors on the register is clear, and, over the past year, 27 people in the UK died while awaiting a heart transplant. That is where the proposed legislation seeks to bring about change by creating three options—opt-in, opt-out or deemed authorisation. The bill aims to encourage an all-important increase in organ donations in Scotland. I thank John Mason for his email, which I found very helpful with his Christian angle on the matter, and it was certainly very thought-progressing, as I did spend a little time in church today before I came to this debate. Deemed authorisation in essence, presumed consent, has been successfully adopted by a number of countries. Indeed, of the top 10 countries in the world for organ donation rates, nine have adopted a similar presumed consent model. We see that, in the right circumstances, that can work. Today, many people support organ donations but often never get round to actually signing themselves up as donors despite the best of intentions. Public support often does not translate into actual donations. Deemed authorisation would help to tackle that problem and, for many, it gives the intended outcome that people may have supported but not acted on in their lifetime. The third option of deemed authorisation of presumed consent also means that there is a higher chance of medical suitability, with a larger pool of potential donors. The likelihood of identifying a match is much greater. Of course, we all want to see a rise in organ donations, and so, in principle, the objective of this bill is right and well meant. It has the potential to be effective in leading to more successful donations. I am pleased to see that there will be safeguards surrounding this change. For example, it is perfectly right that those under 16 who are incapable of understanding the implications of deemed authorisation will not be automatically opted in to organ donations upon their death. For those who have been residents of Scotland for under a year, they too will be excluded from the pathway. Those measures go some way to ensure that this is not a blanket change in legislation with no thought for potentially sensitive cases. Having a soft opt-in system solves the issue in cases where the wishes of a deceased person were not made known before their death. In those circumstances and situations, it maximises the use of potential donors. However, while those three options opt in, opt out and deemed authorisation may be the right step forward, changes in the law alone will not work. The bill should not be implemented without proper investment in organ donation awareness, and there must be active engagement alongside this change in legislation. First and foremost, I hope that there will be engagement with families of deceased. As I said earlier to the minister, including the executives of deceased estates and those with powers of attorney and deputies in the court of protection, the way in which families are approached and handled by organ donor professionals in the hours after the death of a loved one is so important. A sensitive donor liaison team can make all the difference to their experience with generally exemplary training that those teams can help to guide their decision. However, Scotland has the lowest family authorisation rate in the whole of the UK. For this reason, the proposed changes will not work unless families are consulted as part of the process. If loved ones are fully informed of what those changes mean, the move is to deem authorisation in a much smoother transition. I hope that the bill will be considerate and mindful of holding the rights of the deceased as well as the rights of the family. The ethical concerns that can spring up from this balance need to be taken into proper consideration by the Scottish Government. Secondly, there must be engagement with the wider public. Surely, this can only be done with a strong emphasis on communication and awareness, and we cannot take it for granted how important it is to have public discussion on those changes on such a subject. Without it, how can we expect to see a noticeable rise in organ donation? Already, we have seen the benefits of the partner visits that are conducted by the Scottish Fire and Rescue Service and the Antonine and Oland to Scottish secondary schools. Through visits such as these, teenagers have been equipped to understand what organ donation really means and how they can sign up. Awareness campaigns like this can be the spark that encourages families to talk about their issues. I, like Emma Harper, discussed only last night with my daughters and son on this very subject, and I asked them their views. Their views were very clearly the opt-in-opt-out approach. I am glad to say that half of them had donor cards, which I had not realised, and one of them was on the Antonine and Oland register, which I commend that for. Organisation and awareness and communication needs to be embedded at the root of our communities, and for that is how people can understand how they can choose to express their wishes and the implications that this can have for their families. I need to add at this point, and the reason why my children had that is because they had been told about it at their secondary schools, so it is working there, and that was in Argyll and Bute Council. Coordinating those efforts to make the process as efficiently handled as possible and with the utmost consideration is of everyone's interests. Even so, I agree with Mike Rumbles, as I too have concerned about the written proof of the deceased wishes being necessary to support the family's wishes at such a difficult time, although I am advised that the questionnaire that is required is the safety mechanism that will be in place. To conclude, I welcome the debate today. We all want to see a rise in the nation rates in Scotland, but, for that to be possible, all sides must be listened to and taken into consideration. If legislating a soft option approach as a way forward, then the Scottish Government must ensure that it is done sensitively and with an effective and supportive infrastructure. The proposed legislation just finishing cannot stand alone, it needs to be connected with the increased awareness communication co-ordination. Sandra White, followed by Mark Griffin. I also would like to take the opportunity to thank all the organisations, individuals and professionals who took part in the evidence sessions, meetings and surveys, which prove so invaluable to our report. I also want to thank Mark Griffiths and previous MSP and McTaggart for introducing the member's bill in the previous session. Although the committee of the time could not support the general principles of the bill, I believe that it has led to a much more comprehensive bill that we are looking at at stage 1. I will be perfectly honest that, having supported the previous bill, I thought that I had learned a great deal about transplantation and organisation, but I was very much wrong having heard the evidence in regards to the particular bill. I realised that the human tissue authorisation bill was much more complicated and comprehensive than I thought. I read through the contents of some of the evidence that we took for the bill. We looked at mandated choice, rights of the individual, gift element, authorisation process, rights of the family, their consent, post-transplant care, mental health and others. It was hugely comprehensive. That is why I felt as I was going through the committee that I was learning all the time. One of the areas that I knew nothing about whatsoever, I really took special attention to this particular one, was the pre-death procedures. I had never heard of that before. That is one of the areas that I would like to concentrate on, Presiding Officer. During the course of the evidence taking, I was really intrigued by the pre-death procedures. I had asked various questions, too. It has already been mentioned by the convener of the 2006 act. I will take my glasses off, if I do not seem to need them today. There have been many highlighted points in regard to the bill. The bill creates two types of procedures, type A and B, with further details that are contained in regulations. It is anticipated that type A procedures would be more routine. The minister mentioned that in his opening remarks, blood enduring tests, and that would be allowed to proceed under deemed authorisation, or when the person is opted in. You have type B procedures, and they are anticipated to be less routine, including the administration of medication or more invasive tests. Regulations could also specify what requirements would apply to type B procedures, and how they would be authorized and deemed authorisation would not automatically apply to type B procedures. I know that everybody is intrigued by that. I know that I certainly was. In the policy memorandum for the bill states, in all cases where pre-death procedures may be undertaken, a decision will have been taken that the person is likely to die imminently, and that if the person is receiving life-sustaining treatment, that will be withdrawn. All very complicated, but all very necessary. I found it really intriguing that those things were going forward. During our informal meeting with the families who have authorised the nation, we asked their opinion on pre-death procedures, and they expressed their discomfort of any invasive tests on relatives, but they accepted the notion of blood tests and other routine tests. It is really a very sensitive subject, but it is very important. We asked various experts, and one of them was Dr Emson. He confirmed that health professionals would not go through specifics with families for every blood test taken. Families would be involved with tests that helped to certify death by neurological criteria, for example, to observe brainstem death taking place. She explained that when a potential donor is proceeding with donation, appropriate information—I think that may answer some questions that have already been asked—appropriate information is shared sensitively and compassionately with families, and certainly the families there did say to us. In fact, one lady who gave evidence took part in understanding and seeing the process go through, very brave of her, but she felt it helped her in knowing that her relatives did not suffer at that particular time, and they had donated their organs. It is very complicated. There were other areas with pre-death procedures to do with the law and doctors. The law society highlighted one of the issues that doctors should be concerned with prolonging life rather than viewing them as a source of organs. I am not saying that from some of the evidence that was given. The law society mentioned the fact about the Hippocratic Oath, where the first consideration for health and wellbeing of the patient was raised in it. I must thank the minister as well. When he gave evidence to the committee, he reiterated the need for transparency to maintain a high degree of trust in donation. It is really important—I know that the minister has accepted the recommendation from the committee—to inform the families and pre-death procedures, accepting the proposal that we will look at the procedures being reviewed in five years' time. That is really important, because medical science moves on, so it might not be appropriate at that particular time. I am very supportive of the bill—certainly we will support it—but I must thank everyone who gave evidence. It is a very comprehensive bill, and I certainly learned a lot during the passage of that bill. The Human Tissue Authorisation Bill is an important piece of legislation, and the Government has my support for bringing it forward. I lodged a proposal for a member's bill to introduce the same system as the Government intends and was grateful to the Health and Sport Committee for giving me permission to take that forward without any need for consultation, given the extensive work that it has already carried out. I said at my appearance at committee that I would only take forward my proposal on the event of the Government deciding not to, so I very much welcome that bill today. At committee and in previous debates, I have spoken about my own personal experience of the present organ donation system. I would like to talk about the huge impact that increasing the number of organs available for transplant could have on the lives of those on the transplant waiting lists and on their families. Almost 12 years ago, a man received the phone call that he had been waiting for for more than 10 years. He was told that a transplant heart was available and that he should come into hospital to prepare for his operation. He had taken ill 10 years before and had been struggling with the diagnosed heart condition ever since, with his health gradually deteriorating all the time. Regular hospital admissions was in the ability to work in his job as a welder or to take part in any physical activity at all. That man in his family made the trip to the hospital and said their goodbyes that day, full of hope that the operation would lead to a much better quality of life. Unfortunately, that was not the case. After the operation, he was placed in intensive care as expected, but the hope for recovery just did not happen. That was not as a result of a failing in the care that he received from the NHS consultants who carried out the operation or the intensive care nurses who sat vigilantly by his bedside 24-7 during the recovery period. The reason that he did not recover was because his liver, kidneys and other organs failed as a result of having to work harder in the previous 10 years to compensate for that heart condition. They just weren't strong enough to cope with the operation. The matter of days after the surgery, he died at the age of just 47, a young man giving life expectancy in this country. He left behind a wife and a family of four children, two boys, two girls, the oldest was 22, and the youngest lost her dad at the age of 13. Today he would have been 59. He missed the university graduations and weddings of his children, significant birthdays, anniversaries and the birth of all his grandchildren. So many family members was missed and still to be missed. Of course it is naive to expect everyone to survive a major operation such as a heart transplant, but it is common sense that for the person to be given the best chance of survival, they should have the operation as soon as possible after they have been placed on that transplant waiting list. That is where the legislation becomes significant. If we can follow the lead of other countries around the world and implement a system of presumed consent alongside that high-profile publicity campaign, I believe that we can boost the number of organs that are available for transplant so that people will get access to operations sooner and we can help to save lives. If we remember that even just one more organ donor means so many more saved lives just by that one tragic incident, I would also like to pay tribute to the Evening Times, the British Heart Foundation and Anne McTaggart for the fantastic work that they have done in working towards an opt-out system. Also, the early adopters and drivers of this policy in the Government Benches 2, Kenny Gibson, has been notable in his hard work in pushing for this change. During the various campaigns, research has repeatedly shown, as others have said today, that although 90 per cent of people are in favour of organ donation, just over half of the population are on the organ donation register. If you are willing to receive a donated organ, then, similarly, you should be willing to donate. The only thing that prevented me from registering as a donor years ago was probably my unwillingness as a young man to confront my own mortality. That is a silly reason when you think about it. We could overcome that barrier by having a system of presumed consent. Some members will know who I was speaking about earlier, others most of you will probably have guessed that the reason I was able to speak so personally about organ donation is that the man I described as my dad, who was lost to me, my mum, my brother and sister at such a young age. That is why I feel so strongly about the subject, why I support the bill, why I am speaking today and why I support the Government wholeheartedly and its ambition to introduce a system of presumed consent in Scotland. Mike Rumbles, followed by Kenneth Gibson. I have been on the organ donor register for the last 20 years. I was on the health committee when we passed the human tissue act in 2006. In the stage 3 debate on the bill, I said, this bill is perhaps one of the best bills that the Scottish Parliament will ever pass. It is good news for the families who are waiting for a transplant for their loved ones. I hope that, at a decision time, the bill will be passed unanimously. Well, it almost was, with the exception of four Scottish Socialist members, but I also noted in that debate that we had achieved more than 25 per cent of people in Scotland on the organ donor register. I see now, 13 years later, we have over 50 per cent of the population of Scotland on the register. The 2006 act has been a real success. I understand now that the Scottish Government wishes to go further. However, we now have a bill before us which changes opt in to opt out in order to achieve even more successful organ donations. The committee in its report says, and I quote, the overarching aim of the bill is to increase the organ and tissue donation rate. I couldn't agree more with this aim. That is what I want to concentrate on because I don't believe that, as the bill is written in section 7, it will do this. The Minister for Public Health at the committee meeting on 27 November said that the current legislation and the proposed legislation are clear that the right to authorisation rests with a potential donor. Unfortunately, that is not what the bill before us actually says in section 7. It says that the deemed authorisation in section 7 does not apply if a person provides evidence to a health worker that would convince a reasonable person that the adult was unwilling for the transplant to take place. Why have those words been used instead of the current wording of the legislation, which states that the nearest relative, and I quote, has actual knowledge that the adult was unwilling for any part of the adult's body to be used for transplantation? There is a real difference between those two approaches. In the bill before us, the evidential bar for the family of the deceased to confirm the wishes of the deceased is being raised and raised unnecessarily. The family of the deceased now has to provide evidence that would convince about the wishes of the deceased. What sort of evidence that would convince does the new wording in the bill require? Well, it is silent on that. I acknowledge that the public health minister has said that this bill does not change the fact that the right to donation rests with a potential donor. However, that right has to be a real right. Again, I focus on the problems that the family would have in meeting the new evidential test about the wishes of the deceased if those wishes particularly had only been expressed to them in oral terms. In the summing up of the stage 3 debate in 2006, the then health minister, a certain Lewis MacDonald, said, "...our new system of authorisation, which is founded on honouring people's wishes, will mean that the person's own wishes are paramount. I couldn't agree with him more, and I continue to believe, and I hope Lewis MacDonald does also, that if we are to get the uptake and organ donations we need, we have to get the wording in this bill at section 7 right." I will, if I have time. Keith Brown I thank the member for taking a time to be brief. I am just trying to get a sense of whether the member is saying that, as I think he just said, the rights of the donor—somebody in full possession of their faculties—is decided to donate should be superseded by whatever evidential bar by the family or not. Mike Rumbles It certainly shouldn't be superseded by the family, absolutely not. What we did in the 2006 act was to say that we have to have a system where the rights of the individual donor are paramount, and that's the important thing. The reason why I'm so exercised about these words in section 7 of the bill is that, if they remain in it, I am fearful that it could end up being counterproductive to what we all in this chamber want to see an increase in organ donations. In 2006, all the members of the then health committee were concerned about the issues that had arisen at Alder Hayes Children's Hospital, the Bristol Royal Infirmary and other hospitals, which I know the previous minister would acknowledge. They were resulted in a loss of public trust. Indeed, we only have to look at more recent incidents, such as the baby ashes scandal, to see that public trust is a precious thing that we mustn't put at risk. I want to vote for this bill. That will make it absolutely clear at decision time tonight. I'm pleased to see that, in paragraph 35 of the report, the health committee agrees with me, and I quote it, if the nearest relative, next of kin or a long-standing friend is in possession of information regarding the deceased wishes on donation, it could be taken into account. That's marvellous, but the problem here is that this is not what the bill in section 7 actually says. It replaces that wording about knowledge of the wishes of the deceased by replacing it with a requirement to write evidence that will convince a health worker of those wishes. Why this unnecessary change? If the minister in a summing up would confirm a willingness to return at stage 2 to the language used in the 2006 act in section 7, then I'll happily vote for this bill. If the new words about evidence that will convince rather than the current words about knowledge are going to remain in the bill, then I believe that this strikes out one of the fundamental principles of the bill. I am with the committee on this. They say that, in paragraph 10 of their report, deemed authorisation would apply when someone dies without making the decision on donation known, with their consent to donation being presumed, unless their next of kin provided information to confirm that this was against their wishes. That is what the committee has said, and that's what I support. Knowledge is knowledge, and evidence is evidence. It's a clear difference. I urge the minister to commit to using knowledge in the bill and not evidence. I want to vote for this bill, but I need to hear a commitment from the minister in his summing up whether he will commit to looking at changing the wording in section 7 before I can vote for it at decision time. Thank you, Presiding Officer. Well, this may be a stage 1 debate. It's actually the culmination of decades of concerted campaigning by patients, medical professionals and third sector organisations. Newspapers such as Glasgow's Evening Times and, of course, many of my colleagues in the chamber today, and indeed on 1 November 2012, I myself led a member's debate on this very issue. I'm therefore delighted to contribute this afternoon and unequivocably support the principles of the Human Tissue Authorisation Scotland Bill. I would also like to recognise the excellent work that's been done by the Health and Sports Committee and thank the British Heart Foundation in particular for their excellent briefing circulated to members ahead of this afternoon's debate. It provided illuminating data on organ donation in Scotland and, more importantly, acknowledged their dogged and proactive support for soft uptout over many years. We should, of course, remember the sterling work of Anne McTaggart in the last Parliament and, indeed, in this Parliament, the work of Mark Griffin, who gave a very moving speech just a few minutes ago. As we know, there's already been a significant shift in attitudes towards organ donation in Scotland over the years, and it's incredibly happening that more than half of Scots are already registered to donate their organs or tissue after death, with 50.4 per cent of the Scottish population far higher than the UK average of 38 per cent registered donors. That has yielded positive results, with a 22 per cent drop when people are waiting transplants between 2008 and 2018. However, sadly, I'm sure that many of us know someone who waited too long for an organ or, indeed, may still be waiting today. We've heard of that in this chamber earlier this afternoon. At the end of 2018, 577 people in Scotland were waiting. Any reduction, no matter how small, on that number will be life-saving and life-changing. Having campaigned on this issue over many years, I was delighted when the commitment to introducing a soft uptout system was included in the Scottish National Party Government's 2017-18 programme for government. Indeed, we could have passed a member's bill to legislate on this issue last session. I voted for it. However, the majority of colleagues disagreed with me and deemed it not robust enough to prevent unintended negative consequences. The Scottish Government has fully consulted with those working in donation and transplantation to ensure that the proposed system will work not only in paper but in practice. The consultation shows that there's not only expert clinical backing for the bill, there's widespread public support for the principle of organ donation, which needs to be translated into donor numbers, as there is a clear gap between the number of people who state, who they'd wish to donate organs, and the number who joined the organ donor register. By creating a soft uptout system, we can more easily capture the estimated 80 to 90 per cent of Scots who support organ donation. Unfortunately, family authorisation for organ donation in Scotland at only 57 per cent is the lowest in the UK. As Dr Sue Robertson, the Deputy Chair of the British Medical Association Scotland, said, if you ask people 9 and 10, we'll say that they would wish their organs to be donated. We're looking for that 40 per cent who have not opted in but who actually want their organs to be donated. Those are the people who we want to have that conversation with their families because we know that they actually want their organs to be donated. I heard earlier what was said by Alison Johnstone in terms of specialist nurses and I think that that is very important. Of course, there is a soft uptout system, meaning that it incorporates safeguards and conditions that might include seeking authorisation from the person's nearest relative for certain groups of people or in certain circumstances. That is not about the wishes of family, overriding the wishes of donors and, as the Minister for Public Health, Sport and Well-being, Joe FitzPatrick clarified in relation to deemed authorisation. I'm going to quote you here, Mr FitzPatrick. When the family are asked about donation, they will not be asked for their views, they will be asked about what they believe were the views of their deceased relative who is the potential donor. There is strong evidence to suggest that a soft uptout system can improve levels of family authorisation with those living in countries with uptout legislation between 27 per cent and 56 per cent more likely to authorise donation of their relative's organs. Indeed, that has absolutely been the case in Wales where consent rates have risen by almost half from 49 per cent in 2014-15 to current levels of 72 per cent. Of course, medical suitability is key with only 1 per cent of people dying circumstances which leave their organs suitable for medical use. Unfortunately, we cannot legislate for medical suitability of organs and must concentrate our efforts on areas when we can make real change, increase in the number of potential donors and maximising family consent. In doing so, we will increase the pool from which medically suitable donors can be found and increase the likelihood of patients being matched and getting off waiting lists. It is also worth noting that the system is very brief because I am struggling for time. David Stewart, thank you for giving way. The member is quite right about the 1 per cent and he is totally correct on that. We would not share my view if we increased amount of intensive care beds, that would allow the medical service stand so that more organs are available for transportation. I listen to your speech with Kair earlier at our own, Mr Stewart. I have to say to you that this is not a magic bullet and other circumstances have to be taken into account. Indeed, increased intensive care beds have been shown in places like Spain. I do think that they actually make a difference. Presiding Officer, it is vital that this legislation is accompanied by a co-ordinated campaign, as many members have stated, to raise public awareness and we have a concerted effort to make all diverse sections of Scottish society with their rights. That is also a key feature in the health and sports committee's report into the bill, which recommended a high-profile public information campaign, including outreach sessions to be held with minority groups and awareness with regard to children through appropriate methods, and Lewis MacDonald covered that in great detail. I agree wholeheartedly with the recommendation and encourage the Scottish Government to take it forward. The bill is simply the latest step towards driving a long-term change in attitudes towards organ and tissue donation in Scotland, but it is an important step, and I wish we could have made many years ago. In supporting the bill, we are voting to increase the pool of viable organs and improve and indeed save lives of people in Scotland waiting on an organ today. We are not stripping away individual choice, but empowering the majority of people who support organ donation may not have had time and knowledge to form a register. In death, our body would normally give the world little, but in donation, our bodies can give life and happiness to others for many years to come. I am going to have to cut the last two speeches. Five and a half minutes, please. Tom Mason followed by Keith Brown. The issue for us today is one of unmistakable importance. Organ donation is a life-saving procedure for thousands of people every year. As more than 500 people in Scotland are waiting for a transplant, we need to find ways to increase the pool of available donors and speed up the process of donation for more people. With that in mind, I support the general principles of the bill and the incorporation of deemed authorisation into the current system. I believe that the proposals to great such a soft option system would be welcomed by a majority of people in Scotland. As consultation is conducted by the Scottish Government, the Royal College of Nursing and the Bridget Hart Foundation confirm. One of the fundamental reasons for bringing this legislation forward is to put in place a system that would increase the pool of donors, and thus the chances of someone on the transplant list getting a suitable organ in a shorter period. The Health and Sports Committee consultation on this raised some concerns on the ability of the bill to deliver this. However, I also know that it is by no means an unanimous opinion. I do think that the bill should be given the chance to move forward, and if such concerns are addressed again, measures should be introduced to make sure that it achieves stated goals. Another issue that I hope will be addressed at the future stages is the information available to wider public about organ donation programme. The Royal College of Nursing has asked for a public awareness campaign of no less than a year for any changes coming into effect. Whilst the Royal College of Physicians has asked for a parallel process of public education about organ donation and the infrastructure that is available to support families. That is particularly important, given that 80 per cent of Scots support organ donation, only 52 per cent have signed up to the organ donation register. Getting people to support donation is an important first step, but it is vital to capitalise on this support and make sure that they put themselves forward and expand the number of potential donors. As a law study notes, donations proceeding against the wishes of the family concerned would be extremely difficult. However, allowing families and an effective veto over the previously expressed wishes of the potential donor would be contrary to the fundamental aims of the bill. The committee will have to consider how to balance these competing ideals at stage 2 in order to ensure that this legislation has legitimacy in the eyes of both families and the wider public. Presiding Officer, we must never lose sight of the human side of this issue, and why it is so important. In 2014, one of my constituents was taken into hospital with extreme nosebleed and was diagnosed with high blood pressure. By the end of the year, he was diagnosed with total renal failure. Fortunately, he was suitable for pre-inertial dialysis, and even that involved liquid transfer treatment up to four times a day, and carrying around two litres of chemical fluid all of the time attached to his stomach. It is not easy to say but not to cope with rentancy on a day after day with no end in sight. The only escape was a kidney transplant. In October 2015, the process came available, only to find that it was not suitable. Again, in 2016, another prospect, but no successful match. Deep clinical depression threatened, mitigated only by dedication of his family members. At last, at the end of 2016, a successful match was attained, allowing life to get back to normal. So far, the kidney transplant has been successful, but there are signs of a viral infection, which is again slowly destroying the kidney. Once again, donors will need to be found. For my constituent and for the countless others in the similar situation, we obliged to do all that we can to maintain a good supply of organ donors. During 2017-18, more than 400 people across the UK died waiting for a transplant. We have the clinical skills and the expertise that is necessary, and we just need to expand the pool of potential donors so that organs can be made available sooner. The public word supports such moves, so let's move forward. Urgency is important, but so is getting this legislation right. It is within mine that I look forward to the bill receiving further consideration in committee and returning to the chamber for a stage 3 in due course. Thank you, Mr Mason, for giving me some time back. You can have six minutes. Mr Brown is the last of the open debate speeches. Thank you, Presiding Officer. I was about to say that I was delighted tonight to have a minute of my time to the rest of the members, but I'm grateful for getting it back. I think that it's been a very good debate, even if it's been almost entirely consensual. I'm very grateful to the members of the Health and Sports Committee. I was on the committee for a short time, and I know from that time they went about their business extremely diligently through quite a number of lengthy evidence sessions. I was also, like other members, very impressed by the specialist nurses, especially in one instance where they did a role play with family members going through the questionnaire. That's obviously a very difficult time, but it was done extremely professionally, thoughtfully and with kindness. I also thank the families of those whose relatives had donated. They gave evidence and talked about the obviously very difficult circumstances. Even within that evidence session, there was some concern. I remember one family member who had said that when she heard the questionnaire that's gone through, she said that she'd rather not have been part of that process. I can't remember to be honest whether she said that she'd rather was an opt-out so that she wasn't having to be put in that situation or that the rights of the donors were just evident and accepted. There was one woman who preferred, as I say, not to have been part of that process and would have liked to have taken out of her hands. It is extremely intrusive, it's exhausting. It happens at a very difficult time. Sometimes, as one member said, when the family member is still alive and the members of the family are being questioned about this. I wonder whether it's possible that the process could have some further scrutiny. Not least, would it be possible, for example, to ask the potential donor at an earlier stage some of those questions? Asking a son or a daughter or a mother about the sexual history of their relatives is a very difficult thing to do. Both that and whether it's possible through more medical work being done in terms of tests, either on the person concerned at that point or at an earlier point, if we can find some way to reduce the intrusiveness of the questionnaire, I think that that would be something that would help donor figures. Other concerns, the soft opt-out, I think that all members of the committee heard some instances of people who said that, if there was to be a soft opt-out, they, as people who were currently registered, would come off that register. They felt so strongly about what they felt was a diminution of their rights—the right that the state can go in and take organs from your body without having taken any action to prevent it. So, there was that concern that's out there, and that does worry me somewhat. However, my main concern is the relative discount that we heard placed time and time again on the wishes of the donor. The central person in all this, we heard instances where people did not want to donate and they did donate. We had many instances where people wanted to donate and a family veto, and the family veto exists. Whatever has been said by some members here, we heard time and time again. I think that some other members said 100 cases of family refusals. So, somebody in full possession of their senses, knowing what they're doing, taking a legally competent decision to donate, is then frustrated subsequently by some people who might not even be very close family members for their reasons, and they might be understandable. I think that that should be a real concern to all of us. We can imagine a situation in which somebody might benefit from that donation, say, waiting on a heart, and somebody who has, in all conscience, taken the decision that they want to donate their hearts, and possibly other organs. Then it's frustrated by family members, and that person waiting on the heart doesn't get the heart. I think that Kenny Gibson said that every single one of those cases is absolutely crucial. If we can increase it by one, then that will be a tremendous achievement. It's also true to say that we heard a lot of evidence about the feelings and the wishes of the medical staff. I think that the convener, and he's quite right that this was said. I don't agree with it, but it was said that medical staff cannot be expected to proceed with a donation procedure when the families are expressly against that position, or worse to that effect. I don't want to put words in the convener's mouth. I don't agree with that. There are jurisdictions where the rights of the donor to donate are what is respected. If the family members understand that well in advance and support all the work that has been suggested to ensure that there is a campaign to ensure that people are much more aware of that, then there shouldn't be that veto. It should be the case that the donor's rights are respected. Of course, it's the case that the relatives, especially in that horrible set of circumstances, will have very strong feelings. It's my view that the person who is, at least at that stage in possession of those organs, should have the ultimate right. I think that there are a number of things that I would be grateful if the committee could look at. I think that I've highlighted some of those. I also might take some evidence from or look at some of the evidence from some of those jurisdictions where they follow this path. There's also a brief issue about the age. I think that what's being proposed in the bill is from the age of 16, 16 and 17-year-olds, which has no counterpart in England and Wales. Some of the issues might throw up in terms of donation. Obviously, organs can go across boundaries within the UK as well. We haven't heard much of that. Those are some of my concerns, Presiding Officer. I just hope that they will be further listened to. I would ask that both the Health and Sport Committee have done a tremendous job and the Government will listen to some of those concerns as the bill progresses. However, at this stage, I agree that the right intentions of the bill are good intentions. They try to achieve what we all want to see, which is more viable organs going to more people than need them. For that reason, as things stand and at this stage, I am willing to support the general principles of the bill. We now move to the closing speeches. David Stewart, six minutes please. Thank you, Presiding Officer. I think that this has been an excellent debate with well-informed and thoughtful contributions from across the chamber. As we have heard from all members, of course, this is crucial legislation. How do we raise the level of organ donations in Scotland to match the needs of those desperately awaiting transplantation? As we have heard from many speakers, tragically 426 patients died in the UK, while on the transplant list, or within one year of removal last year. Again, we have heard that Scotland has the highest percentage of people on the organ donation register in the UK, but the lowest actual organ donation in terms of rates per million. The key issue is the gap between those who wish to donate organs and the number who actually go on to join the organ donation register. Around 80 per cent support donation, but only 52 per cent have signed up the donation register. In simplistic terms, the purpose of the bill is to bridge the divide, to encourage those who support organ donation, but have not registered in ORD to have their wishes respected. Let me tell you about my friend Gary. He is in his mid 50s, and he lives in Glenrothes in Fife. Nearly two years ago, he was given the gift of life by a crucially needed heart transplant. Prior to that, he was on the transplant list for 12 months and had a pacemaker, but he was slowly deteriorating and without the transplant he would have died. I spoke to Gary at the weekend and he said that he cannot praise enough the dedicated support of the medical and nursing staff at the Golden Ghibli. He said to me that it was a matter of life or death. So we know that international evidence and best practice are crucial elements in the principles underlying the bill. We know from background research by the British Heart Foundation that people living in countries with soft opt-out were 17 to 29 per cent more willing to donate their organs. In general terms, soft opt-out means that unless the deceased has expressed a wish in life, not to be an organ donor, consent will be assumed. As we've heard from a number of speakers of the top 10 countries in terms of donors per million, nine have an opt-out system. That brings us to Spain, and I made a couple of interventions earlier on that. Spain leads the world league table for organ donations. We took evidence at the health and sport committee on that point. Why are they so successful? There are three main reasons. They have a comprehensive network of transplant coordinators, a donor detection programme and greater provision of intensive care beds. Even if the UK refusal rate was reduced to similar levels with Spain, that's 40 per cent to 15 per cent, but the donation rate would still only be half of that, which is currently enjoyed in Spain. Could the Ministers wind up commenting on this? Bearing in mind, of course, this is not a zero sum game. We must also be concentrating on increasing the number of intensive care beds to allow for the increased number of organ donation care. Of course, whilst Labour will support the bill, there are some issues that are worth further discussion around adults within capacity, as we have heard from Keith Brown on that issue, and the variable age of children to consent, 16 in Scotland and 18 in Wales, which is referred to by many members. There are also some issues around rights and obligations of decision making and organisation in the bill. As we have heard in simple terms again, the three routes to decision making are an opt-in, an opt-out or deemed authorization, which is a passive decision. However, as the minister will know, the law society and others have raised legal questions around that, which the minister may wish to look at. Firstly, it is deemed authorization consistent with the Montgomery ruling, which was Montgomery vs NHS Lancer, which was a Supreme Court case around informed consent. Secondly, and perhaps more importantly, and I am sure that the minister has already had some information from his advisers on that, is the bill consistent with the European Convention on Human Rights, specifically the case of Albert vs Latvia of 2015? For those members that are not intimately familiar with the case, Mrs Albert's husband tragically died in a car with no recorded wishes on organ donation. His tissues were used and the court later ruled that that was a violation of article 8 of the ECHR, which, of course, as the minister knows, the bill has to be consistent with the ECHR before it can get approval from the Presiding Officer. In practice in the future, what assessment has been made that medical professionals will, in fact, take into account the wishes of the family irrespective of the terms of the bill? Should the law reflect that and will transport units, as I said, have capacity to deal with the increase in donations? In conclusion, Labour supports the general principles of the bill. However, we have also highlighted areas in which the bill can be strengthened. I agree with Andrew Tickler of Glasgow Caledonian University when he said, and I quote, The failure to put the rights of family members and duties of doctors on a statutory footing appears even more problematic. I would strongly suggest that the Scottish Government look again at the question marks around the bill's compliance with article 8 of the European Convention on Human Rights. Notwithstanding the above, that is a vitally important piece of legislation that will improve Scotland's position in the international league of organ donation and will literally be a matter of life and death for many Scots like my friend Gary, who is desperate in need of life-saving organ donation. As Gahail Gibran once said, you give little when you give of your possessions, it's when you give of yourself that you truly give. Thank you, Deputy Presiding Officer. I'm pleased to have the opportunity to close this debate on behalf of the Conservatives. As has already been mentioned in here, it's been a very consensual debate and that's hardly surprising given that the topic is how we all want to increase organ donation and that, but a number of things raise within that. Again, it's been able to demonstrate, but some of the contributions from across the chamber this bill has instigated much thought and deliberation. On the face of it, you might imagine that the bill should be straightforward and it should pass quite smoothly, as I've said after the aim of the bill, is to increase organ and tissue donation. It's one that most of us would commend, as Scottish Conservatives will be supporting this bill at stage 1. However, in supporting the bill, we have to recognise the level of investigation undertaken and evidence taken by the Health and Sport Committee. The subsequent discussion that it initiated in the committee and some of the things that have been thrown up and thrown up today in this chamber. To start with, my fellow committee members would agree with me that the evidence taken was as comprehensive as it was uncomfortable to hear in some cases. Many members have mentioned Miles Briggs, Alison Johnstone and Alasgo Hamilton. I've mentioned the specialist nurses and their staff and their demonstration of how they do their incredible work acting out that intervention in that role-play. I think that none of us will fail to be moved in that particular session. Learning that there could be up to 300 questions asked of family members in those incredibly difficult circumstances when they have just lost a loved one. The minister highlighted why it is so important to increase organ donation, given that only about 1 per cent of donors are available in the way that they meet their end. Maurice Corry reminded us that the people on organ waiting lists actually do die while they are waiting for organ donation, so it is an incredibly important bill. I want to mention Keith Brown in this one, because in his time in the health and sport committee and in this particular bill, he was very exercised by the rights of the donors themselves, and he is very consistent in that. Again, he has brought it into the chamber today. I agree with Mr Brown that if he decides that he is going to donate his organs, his wishes should be the ones that are paramount. However, as Miles Briggs highlighted, the wishes of the family will be taken into account here, and healthcare professionals will not go against the wishes of the family. In essence, because it is required that, before organs can be donated, the questionnaire is fulfilled by the family, if they do not want to take part in that questionnaire. They supersede the wishes of the individual, so it is a conundrum there. I recognise Keith Brown's campaign to highlight the rights of the deceased. How we get round that, Mr Brown, I think that we will continue to have that discussion. One of the things that we can do is encourage that discussion among family members, long before we get to that stage, so that the wishes of the donor are understood completely by the family. When Dave Stewart first raised the issue with Spain and tried to do that comparison between Spain and Scotland, we have to be careful here, because we are not comparing apples with apples here. As quite rightly we have said, we have a different system to us, intensive care beds in every hospital, and we therefore have a capacity that we currently do not have. In conjunction with the bill, it is important that we have a look at the capacity that we have in Scotland. Can we take how many more donors can we particularly take in that? The idea of presumed consent being the silver bullet, as everybody talks about, will not necessarily increase the organisation in the way that we would like it to do. I think that there is a clear and significant difference between actual consent and deemed consent. I think that this exercise might be quite a lot on this, or perhaps even stated opt-out for that matter. My own personal view is that we should be ensuring that the opportunities to take a stated position be made widely available. Ensuring that that awareness of the bill is crucial. I was one of the 40 per cent deputy brilliant officer who would donate organs, but it was not until I was in the Health and Sport Committee that I was actually made aware that I was one of the 40 per cent. It was only because I happened to move house and had to change my driving licence that I got the opportunity to sign up. It is very simple. It only took seconds and I was signed up. That is something that we need to be cognisant of. We need to make sure that that opportunity is available as much as possible. I want to mention at this point Mark Griffin's personal contribution to this debate and to the cause of Anne McTager. Both have been so influential in bringing this debate to the stage that it is now. I believe that the bill, in and of itself, will not necessarily lead to the increase of organ donation. However, I believe that the scrutiny of the bill by the Health and Sport Committee and the subsequent awareness, while by its own very definition, will potentially create an environment where individuals can speak about the bill and consider their own situation. Is the Scottish Conservatives view that a continuing awareness campaign that encourages a clear decision for those 40 per cent of the population, yet to make the views clear, is essential to go along with the bill? They say that 50 per cent of marketing works, but they are just not sure which 50 per cent. If, by bringing the bill forward, we raise awareness and encourage those conversations and encourage taking a position that is ultimately leading to that increase in organ donation with all the lives that could possibly save, then I think that the bill will be worth it. Now, Colin Jofits Patrick, nine minutes or so will take us up to decisions. Thank you, Presiding Officer. I want to thank members for what has been a very interesting debate on what is a complex and sensitive subject. Obviously, there are some different views on how we get to there, but I think that everyone in the chamber is of the view that we want to increase donations. The evidence suggests that there is no one solution to increasing organ donations and tissue donations, but I am sure that we all agree that it is important that we do what we can and take the initiatives that we can to increase donations. It is hoped that, over the long term, deemed authorisation will continue to change the culture towards support for organ and tissue donations. I want to put on record my thanks to the delegated powers and law reform committee, the finance committee and, in particular, to the health and sports committee for their work to inform the Parliament's consideration of the bill. I will probably add to others in thanking the many organisations that have provided briefings, which I think that we all found helpful. I will use my time to pick up on as many of the issues that members have raised during the debate as time permits and I will follow up others in writing if I do not quite get there. First, I want to thank those members who raised personal experiences today, because I think that that is always particularly helpful. Miles Briggs is talking about Miley. Mark Griffin has a very moving speech about his father. Emma Harper is talking about her experience as a nurse. That is all important because, for all of us, it is important that we understand why the bill is so important and what it means to so many people. Lewis MacDonald talked about the on-going process of culture change and awareness raising around organ and tissue donation, because I think that that is so important in encouraging more people to support donation. Many members have already said that opt-out alone is not the answer to make the change. It has to be one measure of a package of measures that we are already having to make a real impact. Maurice Corry and Emma Harper—I think that Brian Whittle just at the end—talked about one of the very important points that I think will make a big difference. It is about people making a decision but also about discussing that decision with their family. I think that that is so important. I hope that the process of the bill—I know that for some members in the chamber it has taken longer than they would have liked—but I hope that the process of the bill has got more people talking about donation and talking to their family, because I think that that will make the whole process easier. Before I touch on some of the points that I need to respond to, I want to just recognise the point that Alex Cole-Hamilton made an important point in relation to living donors. If I can also echo the point that he and Keith Brown and probably others made in praise of our specialist nurses who, along with others in the donation and transplantation community, do a fantastic job. Moving on to the topics that were raised, a number of members—Miles Briggs, Alison Johnstone, Keith Brown in particular—talked about the role of families. Families will remain critical to the process in communicating the views of the potential donor and providing information about them to ensure the safety of organs and tissues for transplantation. Families will also continue to perform an authorisation role in certain circumstances. Any potential donor's family's members would be fully involved in the process. David Stewart. I am very grateful for the minister giving way. I could just reinforce that the minister knows that I support this legislation, but I do think that there are real issues around the European Court of Human Rights, particularly article 8. I would stress again, in case he has forgotten, that the Latvia versus Albert case is really relevant here. I am sure that you have the lawyers working in this test case. Joe FitzPatrick. Thank you very much. I need to make progress, but that was one of the points that I was going to cover. We are absolutely content that the bill is compliant. The issue specifically in Latvia in relation to Albert, the outcome of the Albert case, turned on its own particular facts and circumstances. The issue was the quality of the Latvian organ donation legislation, which gave family members a right to object to donation, but provided no mechanism for that right to be given effect to. A very different set of processes. If we have learned anything from that, it is about making clear that the bill is about the rights and views of the person who would be making donations. It is an important point that we learn lessons from others, but I am very confident that the bill team has learned those lessons. Keith Brown, in particular, spent some time talking about his concern that, in some cases, there is a family veto in effect. To be clear, authorisation is something that is for the person who is making the donation, but we need to remember that it is always a very difficult time for families when they have just lost a loved one. The current system deals with those issues in a sensitive way, and that will continue under the new system. The principle behind the proposed system, as with the current system, is to give effect to the donation decision that a person made in life. We also need to be mindful that donation happens at a distressing time for families, so it is right that clinicians are able to respond to that. Sandra White talks about pre-death procedures, and we have talked in committee at some point, but is there a better word for them? Of course, the whole part of our transplant system is that we need to be transparent and pre-death procedures describe what they are about. By including those provisions, the bill is not only setting out a framework for the carrying out of those procedures that will be able to respond to change, but it is also bringing transparency to the whole of the donation process, letting people know what they are agreed to. Of course, we have made it very clear that, if there are changes to those processes, they will come back to this Parliament to be approved by the affirmative process, so I think that that is also important. A large number of members, Lewis MacDonald, Alison Johnstone, Emma Harper, Kenneth Gibson and I am sure that others talked about the need, and the committee talked about the need for awareness raising, and the Government is very clear that that is a very important part of taking this forward. It is essential for a soft opt-out system to work, and as set out in the consultation, it is the intention to have a high-profile awareness-raising campaign over at least 12 months before the introduction of the new system and on a regular basis after the implementation to maintain awareness. It is a crucial part of the safeguards that will underpin the system that will ensure that people will not become donors if that is not what they want or become donors if that is what they want. Specifically, we will work with a range of groups, including disability groups and faith groups, to research, develop and test clear and accessible information that will always be available in a range of languages. Alex Cole-Hamilton talked about support for families. I think that that is a very important point that he has raised. NHS national services division is currently reviewing the provision of psychological support across all of our national commission specialist services, including organ transplantation, to ensure appropriate provision that is in place. The Scottish Government understands that the review will be completed later this year. I apologise, but I have to make progress to respect other members who have taken part in the debate. Miles Briggs and David Stewart talked about infrastructure and the 2008 UK organ donation task force report, which is considered the introduction of an optite system but prioritised improvements in infrastructure, as it was considered that those who would have the greatest impact on donation at that time. Throughout the task force and the subsequent Scottish plan, we have seen significant developments around the donation and transplantation infrastructure over those decades. However, I recognise and I recognise in my response to the committee that there is an on-going commitment to supporting measures, including infrastructure, to increase donation. To the point that Mr Rumbles raised in particular, I think that Maurice Corry also said that we are satisfied that the wording in the bill is not overly burdensome, but I would be happy to discuss that more with the member just to make sure that I am understanding him fully and, hopefully, I will be able, along with officials, to allay his concerns. However, I think that I am offering a serious discussion to make sure that we can understand what the bill is actually trying to do and trying to say. The approach in the bill is broadly similar to that that is in the Welsh legislation, and we are not aware of the issues that the member is concerned about. Our specialist nurses are, as we have heard, highly skilled at having conversations with families and provisions that largely mirror the current practice around the conversations that are explored with family members and what their loved ones' views are. Obviously, taking that forward, there will be guidance produced by NHS BT and SNBTS, but I will be keen to have that discussion with the member. In conclusion, I would like to acknowledge again and thank the Scottish Donation and Transplant Group, which advises the Government on donation and transplantation matters for their assistance in developing the bill. I again want to pay tribute to everyone who has contributed in the debate today and everyone who has donated in the past and every family who has supported those donations. Through such selfless acts, lives are saved and improved. I hope that the bill will lead to further increases in donation, to save further lives and to offer any such progress as a tribute to all those who have donated in the past. Members have raised several issues during the debate. If members feel that I will respond to those who have not managed to cover in writing, if other members feel that they want to discuss their particular issue to make sure that we have the most robust bill going through stage 2 and into stage 3, I would be very much happy to do that. I again thank all colleagues for taking part in what I think is a very important debate. That concludes this afternoon's debate. The next item of business is consideration of motion 1-5594 on the financial resolution for the Human Tissue Authorisation Scotland Bill. I call Derek Mackay to move the motion. We are going to turn straight to decision time. The first question is that motion 1-6001, in the name of Joe Fitzpatrick, on the Human Tissue Authorisation Scotland Bill, be agreed. Are we all agreed? We are not agreed. We will move to division. Members may cast their votes now. The result of the vote on motion 1-6001, in the name of Joe Fitzpatrick, is yes, 107, no, one. There were two abstentions and the motion is therefore agreed. The final question is the motion 1-5594, in the name of Derek Mackay, on the Human Tissue Authorisation Scotland Bill, financial resolution be agreed. Are we all agreed? We are agreed. That concludes decision time. We are going to move on now to members' business in the name of Jenny Gilruth on LGBT History Month, but we will just take a few moments for members and the minister to change seats. We will just take a few moments to change seats.