The final item of business is a members’ business debate on motion S6M-18544, in the name of Christine Grahame, on organ donation week, 22 to 28 September 2025. The debate will be concluded without any question being put. I invite members who wish to participate to press their request-to-speak buttons.
Motion debated,
That the Parliament recognises Organ Donation Week, which runs from 22 to 28 September 2025, as what it sees as a vital moment to highlight the life-saving power of organ and tissue donation; understands that the opt-out system for organ and tissue donation in Scotland, which was implemented in 2021, still relies on family agreement; considers that many refusals happen because wishes are not discussed in advance; understands that in 2024-25, 274 people in Scotland benefited from a transplant compared with 390 in 2023-24, which, it believes, is a worrying trend; welcomes the Scottish Government’s “Don’t Leave Your Loved Ones in Doubt” campaign, which urges registration and open talks; notes the support for engaging young people and the view that colleges and universities should help educate through the use of QR codes; values the reported role of faith leaders in confirming that there are no religious barriers to donation and clearing up myths; understands that nearly 8,000 people in the UK, including people in Scotland, await transplants, and notes the encouragement for all eligible individuals to register, share their wishes and help to save lives.
17:10
I thank all of the members who signed the motion to allow the debate to proceed, the people who are manning the exhibition in the lobby this week and those who are attending in the public gallery, including members of the transplant team, health professionals and, in particular, Audrey Cameron, a donor’s mother, about whom I will say more later. I also thank those who have remained in the chamber after a very long week because of late sittings.
My contribution extends only to transplants following a death. Talking about death is always a difficult topic in any circumstance. One might say that it is grisly, and we in the western world prefer to avoid it. However, one death can save a life or allow a better life to someone else, and sometimes to many strangers.
Let me first set out the legislative background. The Human Tissue (Authorisation) (Scotland) Act 2019 was passed in July 2019. It provides for a deemed authorisation, or opt-out, system of organ donation for transplantation. It applies to most adults aged 16 and over who are resident in Scotland, but it does not apply to everyone.
There are exemptions: adults without capacity to understand the law, adults who have lived in Scotland for fewer than 12 months before their death and children under the age of 16. If a person in one of those groups dies in a way that means that they could donate, their closest family member will be asked whether they wish to authorise donation.
Otherwise, if a person dies in circumstances in which they could become a donor and have not recorded a donation decision—either to agree or to reject—it will be assumed that they are willing to donate their organs for transplantation. Even then, a person’s family will always be asked about their latest views on donation to ensure that it would not proceed if that was against their wishes.
I thank the member for giving way. Does she think that most of the public understand that? I have to say that I was a bit confused about it until I spoke to the folk today.
The reason for the debate is partly to highlight that.
That is where understandable difficulties arise. Specialist nurses must—without delay, for obvious reasons—raise the issue of consent to use some of the deceased’s organs in the most distressing of circumstances. If a person has registered their wishes one way or another, it makes that discussion much easier.
Therefore, although there is presumed consent, it is still better to register. Let me also stress that only 1 per cent of the population who die can be considered to become an organ donor—only those who are in intensive care and ventilated—so it is a niche set of circumstances.
The specialist nurse whom I referred to is one of a team of 23 who are based in intensive care units across Scotland. They support consultants and nurses who are having end-of-life discussions with families. They cover all aspects of the donation process, from the initial referral from the intensive care unit team, to building a patient’s profile—bloods, electrocardiogram, chest x-ray, medical notes—organ matching, offering and placement; organising theatre; and organising for the national organ retrieval service team to arrive at the donor hospital. Time is always of the essence.
Those nurses co-ordinate the retrieval operation to the very end, when they perform last offices with donors and ensure that organs are safely dispatched to their recipients. They also provide a bereavement follow-up service for donors’ families.
There are currently around 600 people waiting for an organ transplant in Scotland at any one time. Those patients are in urgent need of life-saving or life-enhancing organs, with the majority waiting for a kidney transplant. One donor can save up to nine lives.
Nothing illustrates the significance of organ transplant better than an example. Audrey Cameron is here in the Parliament today. Her son James Borland died in February 2024 at the young age of 25. Audrey chose to donate James’s organs, as she felt that that was fitting for him, as a kind and gentle young man. James went on to donate his heart, lungs and both kidneys, saving the lives of four people. His becoming an organ donor has given his family so much comfort amid their grief. James’s story has not ended, and he has changed so many people’s lives. He left behind his young son, who one day will know how brave his daddy was and how he is a true hero to so many. Audrey now works closely with the specialist nurse in the organ donation team, promoting and sharing her passion for organ donation, and I thank her for this permission to make public her experience. I thank all others who, in similar circumstances, have done that. Nothing can illustrate how important organ donation is more than that example. [Applause.]
17:16
My congratulations to Christine Grahame on bringing the motion to Parliament. I regret that the debate is being held on a Thursday evening, as it deserves a more prominent place in our schedule. Nevertheless, it is a highly appropriate debate. Everything that needed to be said was said in the story of James. Christine Grahame is right: he is a hero indeed.
I am pleased to speak in support of the motion, which rightly recognises organ donation week as a vital opportunity to highlight the life-saving power of organ and tissue donation. I agree with John Mason—who is not in his seat now—who is absolutely right that there is a lot of misunderstanding about the current situation in Scotland in relation to the opt-in/opt-out arrangements.
The motion reminds us of the striking and sobering truth that, in 2024-25, only 274 people in Scotland benefited from a transplant, as compared with 390 the year before. That downward trend is noteworthy and a concern, particularly as nearly 8,000 people across the United Kingdom, including many here in Scotland, continue to wait for a transplant that may be the difference between life and death.
The opt-out system was introduced in 2021 and has been a step forward. However, as the motion makes clear, and as Christine Grahame made clear in her speech, it relies on the agreement of families. Too often, transplants do not proceed because loved ones have never had a conversation. That is why I fully support the Scottish Government’s “Don’t leave your loved ones in doubt” campaign. It is so important, and it is why we should use this debate, and every opportunity that we have as elected members of the Scottish Parliament, to encourage people to register their wishes and speak openly with their families.
I am one of the people John Mason referred to, and he identified himself in the same way. When I first learned about the matter, because of organ donation week and this debate that Christine Grahame has brought to the chamber, and because I decided that I wanted to participate in the debate, I did not realise that I should register, go to the website and make clear my desire in the event of my own death. I am very grateful for the debate for that reason. I also communicated that to my family—to my wife and to our children—so that they would know exactly what I would desire. If any part of me could be useful to anyone else, that is what I would want. We need to make those decisions clear, but we also need to communicate them clearly.
An aspect of the motion that particularly intrigued me was the mention of the
“reported role of faith leaders in confirming that there are no religious barriers to donation and clearing up myths”.
I will talk about that from a personal point of view. Something that I have not done very much of in the past four-and-a-half years is speak about things from my perspective as a Christian and a member of the Church of Jesus Christ of Latter-day Saints. I take the opportunity to stress that organ donation is not only compatible with my faith, but I believe that it is one of the most selfless acts of love that a human being can perform. In my faith, the body is sacred, but so too is the command to love one another. For me, the act of donation is a profound way of following the example of Jesus Christ, whose life and sacrifice were the ultimate expressions of self-giving love.
The scriptures teach that Jesus said:
“Greater love hath no man than this, that a man lay down his life for his friends.”
Organ donation allows us, in a small but significant way, to reflect that same love by giving the gift of life to others, even after our own journey in mortality has ended. That is why I welcome the motion’s emphasis on the role of faith leaders. Across Scotland, religious communities have affirmed that there are no barriers in belief to donation. That clears away damaging myths and allows people of faith to see organ donation for what it is: a gift of compassion that is rooted in love and service.
I welcome the call to engage young people by using modern tools in colleges and universities, such as the QR codes that the motion mentions, to spark awareness. If we as parliamentarians need to be sparked into awareness, I am sure that the same applies to a wide range of people across all demographics. We need to be made aware of how we can make our desires about organ donation known.
The issue is not about compulsion or state control, but about responsibility, family dialogue and choosing to give. Therefore, I strongly support the motion and encourage all eligible Scots to register, share their wishes and help to save lives.
17:22
I congratulate my colleague Christine Grahame on securing this debate on organ donation week. I thank her not only for lodging the motion, but for her lack of fear in broaching subjects that need to be heard but which are difficult to discuss.
Most of us are aware of the advances that have been made in medical science and technology and the literally life-saving impact that they have had on folk who would otherwise not survive. If my understanding is correct—I will probably get told if it is not—the first transplant took place in the year that I was born: 1967. The technological leaps forward in the decades since have been astounding. However, such advances will count for very little if our medical professionals cannot find donors in the first instance.
The debate takes place in the middle of organ donation week, which is designed to raise awareness of organ donation and the incredible role that it can play in changing folks’ lives forever. It is bittersweet when someone receives a transplant from an organ donor, as everyone is very aware of the tragic death that has led to the much-needed donation.
The raw numbers have always been small in comparison to our population—a few hundred transplants a year—but the figures highlighted in Christine Grahame’s motion are deeply concerning. The numbers on the register have continued to grow over time, but there is an issue with those who make a positive decision to be on the register communicating their wishes to their loved ones. That is another difficult, but important, discussion. Indeed, these are difficult and sensitive discussions for anyone. For some folk, it feels a bit gruesome to talk to their next of kin, who often do not want to listen, about what will happen to their kidneys or liver after they have passed. However, it is because death is fundamental to the donor process that we need to have those chats now, before it is too late, and to ensure that our wishes are known.
As Christine Grahame has said, only 1 per cent of donor organs are fit for transplant. In 99 per cent of cases, despite the good will and good wishes of those on the register, that generosity cannot, for a variety of reasons, be taken up. The circumstances of death that present the opportunity for donation and transplant are incredibly specific, and they mean that our health professionals need to make the best possible use of every chance that they get to help another, because those chances are few and far between.
If we can increase the number of chances that our national health service professionals have, we can increase the chances for many more people across our country to lead healthy lives. I say to those watching at home that they should ensure that their families and their next of kin know their wishes.
I have been made aware of an art installation in recognition of organ donors that was unveiled very recently at Aberdeen royal infirmary. Shelagh Swanson, the artist, was commissioned to work with the relatives of donors as well as with young folk across north-east secondary schools to create glass pebbles, which have been placed on the walls of the foyer of the ARI’s emergency department, all the way up towards the Sandpiper sanctuary. The installation commemorates the ripples of organ donation, and it is hoped that it will act as a conversation starter.
If people see the ripples of organ donation as they are walking in the ARI, I ask them to remember to have that discussion with their loved ones and to tell them of their wishes. [Interruption.]
Thank you, Ms Dunbar. I give a gentle reminder to those in the public gallery that there should be no participation. Tempting though it is, that also includes applause.
Paul Sweeney is the final speaker in the open debate.
17:27
I extend my thanks and appreciation to Christine Grahame for presenting to Parliament a motion that I know will be close to the hearts of many people across the chamber and throughout Scotland.
Organ donation week is an important moment in the year for us to remember the lives saved by the incredibly generous donations of others, while also, I hope, stirring us to greater action so that we can live in a Scotland where everyone who needs a donated organ can receive one.
Organ donation, as has been mentioned by other members, including Mr Kerr, is the ultimate act of kindness and represents a selfless commitment to the wellbeing of others. It is a recognition that when our life has reached its end, others can be given the gift of life and vitality. It is an ending that becomes a beginning; the moment of death becomes, in a way, an act of love and a continuation or improvement of life. It is through such acts of giving and receiving that we build a society that is based on trust and recognition—one in which we care for the stranger and in which, at the end of life, we can leave with a generous spirit and a hand open to friendship, even to someone whom we have never met.
Like many in the Parliament, I was a registered organ donor under the old system. I am proud that the Parliament created an opt-out system in 2021, after the passing of the Human Tissue (Authorisation) (Scotland) Act 2019. That monumental act of Parliament still retains choice for those who wish, for whatever reason, to opt out of the system, but the more generous and giving option is now the default. The 2019 act was a profound moment of progress that we should all be proud of—it built a sense of solidarity and community.
That said, although Scotland should be proud of the opt-out system, the figures from Kidney Research Scotland paint a worrying picture of the state of organ donation in Scotland. Five hundred people are currently waiting for transplants in Scotland, but the numbers registering on the organ donor register have reduced dramatically each year, from 155,479 in 2021 to just 7,859. That is a worrying development.
Not registering on the organ donor register can create a lack of clarity for families regarding their loved ones’ final wishes. It can cause delays in organ retrieval, which means that organs that could have been saved to enhance or preserve life are no longer able to be used, often very urgently, in surgery.
I urge everyone listening to ensure that they are on the organ donor register so that their family, and medical professionals, can be in no doubt about their wishes, should they wish to donate organs. I admit that I did not fully appreciate that requirement to clarify my intentions and that I have just done so in the past five minutes. It does not take long at all—I just did it on the website.
I am ashamed to say that I, too, did not realise that. I have been carrying the old card and did not know that I had to register. I just thought that all would be well, because we now have presumed consent.
The figures that I mentioned might reflect some complacency since the law changed. People might think that it is a done deal unless they feel specifically motivated to rule themselves out, but clarifying which organs or tissue we wish to donate would avoid any ambiguity in the traumatic situation of dealing with the death of a loved one. It is good to address that matter, and I encourage members of the public and colleagues to do so.
I recently visited the anatomy school at the University of Glasgow, where staff raised similar concerns about the drop in the number of people donating their bodies to medical research. The five Scottish universities that teach medicine desperately need people who are willing to donate their bodies for research. It is still an opt-in system, and a generous one, and it is something else that people might want to consider this week.
We should use organ donation week to recognise that much more work is needed if we want organ donation to serve the people of Scotland as well as it can. We can no longer rest on our laurels; we must get people proactively registering, and we must reduce the stigma and silence by actually talking more about the end of life. We do that more in Scotland than we used to. We do talk about hospice and end-of-life palliative care, and people should be happy to discuss with their friends and family what they want to do at the end of their lives and whether they wish to donate their organs.
I reiterate my thanks to the member for lodging the motion, and I am happy to support it in the hope that today will be the start of a new Scotland-wide conversation about a vital topic.
I invite the minister, Jenni Minto, to respond to the debate.
17:32
I welcome the opportunity to participate in this debate. I thank members for their contributions, and I particularly thank Christine Grahame for lodging the motion. This week is crucial in raising awareness of the life-saving and life-changing opportunities that organ and tissue donation provides and today’s debate has made an important contribution towards that end.
I pass on my love and thanks to Audrey Cameron for the decision that she and her family made about James Borland, someone who Christine Grahame described as a kind and gentle man. He was inspiring, and I thank them so much for their decision. [Applause.]
Stephen Kerr spoke about comfort and selfless acts, and I thank him for being so personal in sharing his views, which can only help to ensure that we increase donor numbers. As Paul Sweeney said, we need a generous spirit, which Stephen Kerr showed, if we are to increase numbers and ensure that as many people as possible get the opportunity of a better life, or of life itself.
Paul Sweeney, and other members, also spoke about the importance of discussing end-of-life care. I was pleased to launch “Palliative Care Matters for All” 10 days ago. That framework recognises the importance of having those conversations.
During my time as minister, I have met people who have donated organs, the families of those who have, sadly, died and who took the decision to donate their organs, and people whose lives have been transformed by receiving transplants. I also observed a live kidney transplant operation at the Royal infirmary of Edinburgh. I pay huge tribute to everyone who has donated organs and to the clinicians and other NHS staff across Scotland who are involved in donation and transplantation.
The Scottish Government marketing campaign for this year’s organ and tissue donation week focuses on the key message, “Don’t leave your loved ones in doubt.” The national campaign is designed to encourage people who are aged 16 and over to record their donation decision on the NHS organ donor register and to tell their loved ones about their decision. I also think that the artwork that Jackie Dunbar described is hugely important, because it is sometimes easier to bring about a difficult conversation through art. I commend the work of Shelagh Swanson and Aberdeen royal infirmary.
Scotland has a good record on the number of people who register their decision on the organ donor register, which I am pleased about. However, we have to do more. Working with stakeholders and using a variety of social media platforms, video on demand and digital and radio platforms, we will be emphasising the message that, if family and friends know about someone’s donation decision in advance, it will make it easier for them to ensure that that is honoured. I thank Erin and Bushra for the conversation that I had with them on that specific issue at their stand in Parliament earlier today. I also thank them for our conversation about death and the importance of sharing our wishes with our loved ones.
I am grateful for the publicity on organ and tissue donation, but members who are sitting here in the Parliament did not know that it is preferable to register one way or the other. I know that we are sometimes not the brightest of the bright, but even though there is a campaign, the message is not even getting through to us. How do we step up the campaign so that it becomes common knowledge that people should help by registering one way or the other?
I thank Christine Grahame for that very important intervention. My conversation at lunch time was about that issue and how we can make that more clear. We need to disseminate the message widely, including when people apply for certain things such as driving licences, so that as many people know as possible. I have taken that on board, I have listened to that conversation and I will be discussing it with officials after this debate.
I will draw attention to three key areas of Scottish Government work that supports organ and tissue donation. First, we are working with NHS Blood and Transplant to address concerns about a decline in the pool of eligible donors, as Christine Grahame just mentioned. That is not just across Scotland but in the United Kingdom and internationally. There has also been a decline in family authorisation rates and changes in the perception of the NHS post pandemic.
With the aim of seeking to explore how opportunities can be maximised to increase the number of organ donations, we created the organ donation joint working group. That has taken advice from international experts and I look forward to receiving the group’s report in due course. Inputs from tonight’s debate will clearly also be part of my thought process and evidence gathering.
We are aware that some families find the donation process difficult. I welcome that the NHSBT, as part of its work, will review the donor family authorisation form to seek to improve the experience of donor families and specialist nurses and help to reduce the length of the donation process. I also look forward to receiving next year’s five-year evaluation of the opt-out system, which was introduced in 2021. I am sure that there will be more learning from that.
The second area that I draw attention to is that, earlier this year, we worked to promote living kidney donation as an excellent option for those who face the need for transplantation. That work is supported by the renal education and choices @ home programme, which is being funded by the Scottish Government. REACH, which was established in late 2022, is focused on timely education—a key component of the treatment pathway choice for all patients.
The network of REACH nurse specialists in Scotland provides home visits to people with end-stage kidney disease and their key family members to give them more information on living kidney donation. That approach drives improvement in education and increases the uptake of patients who access pre-emptive living donor kidney transplantation. Meeting a family that benefited from that is one memory that will never leave me.
Thirdly, I thank Kidney Research UK, which the Scottish Government grant funds to increase awareness of living kidney donation among minority groups in Scotland, which might otherwise face challenges in equitable access to transplantation. The work of our peer educators, whom I met here in the Parliament, provides a vital service informing, educating and helping people to make choices about organ donation.
Again, I thank members for their support and for their speeches, and I once more urge people across Scotland to record their donation decision on the organ donor register and to discuss their decision with their family and friends.
Meeting closed at 17:40.Air ais
Decision Time