For more than 9000 people in germany, waiting is a matter of life and death. You are in urgent need of an organ donation because your body is no longer functioning one hundred percent. Every year, the health of more than 1,000 of the patients on the waiting lists deteriorates to such an extent that either a transplant is no longer possible – or they even die.
The major scandals about manipulated waiting lists were a few years ago, and according to surveys, the attitude of germans is more positive than ever. Only: there is a shortage of suitable donors.
932 organ donors last year
Last year, the number of organ donors fell slightly from 955 to 932. "Statistically, these are fluctuations, not a gross change", says axel rahmel, medical director of the german foundation for organ transplantation (DSO). It is important to note that the significant increase in 2018 was not an aberration. In 2019, the number of organs donated fell from 3113 to 2995. According to preliminary data from monday, 1524 kidneys, 726 livers, 329 lungs, 324 hearts, 87 pancreas and 5 small intestines have been removed. On average, each donor has given more than three seriously ill patients a new chance at life.
Politicians are aware of the problem. In the past year, the law was changed: transplantation officers were given a higher status in hospitals, and their work is better remunerated. Training on how to deal with patient confessions and better analysis of death traps in hospitals should also help to increase the number of organ donations. In addition, care for relatives was included for the first time – a value that should not be underestimated from rahmel’s point of view.
All the experts agree that all this can help. How much it will help remains to be seen, as does the pace at which the improvements will occur. DSO has at least seen an increase in requests from hospitals in recent months.
Vote for no objection
Most people expect a lot from a vote that will take place this thursday (16. January 2020) is coming up in the bundestag: then it will also be a matter of the so-called "no objection". Two cross-factional bills are on the table: a group of delegates led by health minister jens spahn (CDU) is proposing a "double no objection" proposed.
According to this, all burgers should automatically be considered organ donors. However, one should be able to say no to this later, otherwise it would also be necessary to inquire with relatives. This is rejected by a group around grunen leader annalena baerbock. She proposes that citizens be asked about the issue at least every ten years when they pick up their ID cards.
Rahmel says the no-refusal rule has meant that everyone has had to deal with the issue. "Today, more than 40 percent of negative decisions are made by relatives who do not know what the deceased wanted." However, he also warns: "the lack of contradiction is only one building block. This will not double the numbers from one day to the next."
Until now, organ removal has only been permitted in the case of an explicit yes. Philosopher dieter birnbacher, a member of the central ethics committee at the federal medical association, believes that the rate of refusals by patients is related to the respective attitudes in the countries. "In germany, a culture of mistrust still prevails with regard to high-tech medicine", says birnbacher. "It would be a good thing if more potential donors were to donate their organs while they were still alive."
Death must be beyond doubt
A second point is important: the death of the human being must be unequivocally established by proof of the irreversible loss of the total function of the cerebrum, the cerebellum and the brain stem. Two physicians review this independently of each other. For example, organ donation after cardiac arrest is possible in spain, but not permitted in germany. "This is a relatively thick board and has its own ethical challenges", says rahmel.
Once a suitable recipient has been found, time is of the essence: "some organs can only be preserved for a short time, a heart, for example, for only four hours, DSO offers training courses. In the case of a kidney, more than 20 hours could pass before the transplant is performed.
Too many hospitalized patients
There are around 1300 so-called collection hospitals in germany. Birnbacher also sees a problem here, because the rough number leads to too few transplants per intensive care unit and too little expertise. Concentration and specialization, as has been achieved in denmark, is therefore desirable. "However, local interests stand in the way", so birnbacher. "However, I believe that concentration is inevitable, not only in the interest of patients, but also because of the problems of financial viability of the existing system."
The german hospital association (DKG) refers to a study published in 2018 for saxony, saxony-anhalt and thuringia. It shows that the collection hospitals identify almost all potential organ donors. However, the study’s authors also found that, for example, brain failure was not diagnosed in all cases in accordance with the guidelines of the german medical association (bundesarztekammer). However, the DKG is convinced that the changes to the transplantation law in spring 2019 have adjusted important parameters in order to further strengthen organ donation in germany.