Analysis: Mr Burke's case raised many issues over the treatment of Irish patients in need of lung transplants, writes Martin Wall
The case of the 29-year-old cystic fibrosis patient, Mr Billy Burke, raised many issues over the treatment of Irish patients in need of life-saving lung transplant operations.
It generated controversy over how patients are selected by doctors for such surgery, posed questions as to whether it was appropriate for politicians to intervene in this process, and highlighted that the Irish lung transplant programme - a project originally promised for 2001, but which was beset for years by in-fighting between the Department of Health and the Department of Finance - has still not got underway.
However, perhaps above all, the death of Mr Burke places the spotlight on the acute shortage of suitable donor organs for transplantation both here and in the UK.
When he died yesterday, Mr Burke, from Killorglin in Co Kerry, was on a waiting list for a double lung transplant at the Wythenshawe Hospital in Manchester.
Last night the hospital's transplant co-ordinator, Ms Helen Newton, in a statement of condolence, revealed that one-third of patients awaiting a transplant there die while on the waiting list. The UK Transplant Authority, told The Irish Times that 443 people died there last year while on waiting lists.
In Ireland, the country's first lung transplant unit was officially opened at the Mater hospital earlier this year.
At present there are around five patients on the waiting list. However, no suitable donor organs have so far been obtained. And The Irish Times understands that a further State investment of nearly €9 million will be required if the target of 15 lung transplants per year is to be achieved.
Mr Burke was originally placed on a waiting list for a double lung transplant at the Freeman Hospital in Newcastle four years ago. The Department of Health had a contract with the Newcastle centre to carry out such operations on Irish patients as there were no such facilities available here.
However, last year Mr Burke was removed from the waiting list after he contracted an infection. Doctors there felt that he was too high-risk to undergo the operation.
Mr Burke sought a second opinion, and in June last year the Wythenshawe Hospital deemed him suitable for a transplant. This Manchester hospital asked the UK Transplant Authority for priority access for suitable organs originating from a donor in Ireland.
However, this was refused on the grounds that it was contrary to organ allocation rules, would cause inequity and might disadvantage other patients on the same waiting lists.
The Kerryman was subsequently placed on the general waiting list.
Mr Burke appealed publicly to the Taoiseach and to the then minister for health, Mr Martin to intervene.
His supporters complained of doctors "playing God" and urged that the Government should consider insisting that Irish organs should be reserved for Irish patients, even if the transplant took place in the UK.
Mr Martin spoke to the UK Health Secretary Mr John Reid about the case, but the Government was adamant that it could not interfere in medical decisions regarding who should receive transplants, or where donated organs should go.
The Department of Health here maintained that "political intervention in such a clinical area would jeopardise public confidence in an ethically-run transplant service".
The Department, following consultation with "relevant authorities" also maintained that seeking to reserve Irish-donated lungs for Irish people could ultimately worsen the prospects of patients from here securing a transplant. Senior Department figures maintained that under the agreement with the UK, Irish patients were on a common waiting list, and had equitable access to the entire pool of organs donated and not just those from Ireland.
The transplant surgeon, Mr Maurice Neligan said last night that there would always be more people requiring organs than there were donors.
He said that in the area of transplantation, doctors had to make difficult decisions based on clinical grounds.
Since the official opening of the new unit at the Mater hospital, it is given first call on lungs donated by Irish patients. To date, and despite the strong objections of the Department of Finance, the Government has spent almost €10.5 million on the programme, which now has a staff of 80.
However, the Mater has maintained that nearly €9 million more for new theatres and equipment will be needed before the target of 15 lung transplants per year can be achieved.