When donors are not forthcoming

Organs in short supply in Germany

Expectations ran high when the German Transplant Law (TPG) was introduced in 1997. The government felt it had done its part to ensure more legal certainty for the donation, removal and transplantation of organs: the population could feel encouraged to sign up for organ donation and was supposed to follow suit. However, this did not occur.

Dr Margret Engelhard
Dr Margret Engelhard

The figures for post-mortem donations, as well as live organ donations, have remained constant, whereas the need for donor organs relentlessly increases. Germany’s situation would be even worse if it was not part of the Eurotransplant network, and therefore received more organs than it can donate to other countries. In a study* by the Europäische Akademie GmbH (European academy for the study of consequences of scientific and technological advances), biologist Margret Engelhard, PhD, project manager at the academy in Bad Neuenahr-Ahrweiler, examined the manifold reasons for organ shortage and also identified potential approaches to solve the problem.
There are many reasons why organ transplants in Germany lag behind the statistics for other countries, she told EH reporter Meike Lerner. ‘Over the years, the Federal Centre for Health Education has run repeated campaigns to raise public awareness of the need for organ donation. However, the number of people carrying donor cards has not increased significantly. The TPG stipulates an extended consent solution, which means: The wish, expressed by the deceased, prior to death, takes precedence. If this wish is not documented, or known, the closest relatives make a decision based on the likely wish of the deceased. In only 6% of the cases the decision is based on a written statement of the deceased – for example on a donor card – and, thus  in most cases, falls to the relatives, which is obviously awkward for the bereaved and cause of much uncertainty. Most people aren’t actually aware of the wishes of the deceased and do not want to be confronted with the issue of organ donation when in mourning. This is one of the reasons why we think that a presumed consent law, as practised in Austria or Spain, makes sense. Everyone would automatically be considered for organ donation unless they had specifically objected to this in their lifetime.’
The role of hospitals in promoting organ transplants is another issue. ‘Unfortunately, about 50% of all potential organ donations are not even reported,’ Dr Engelhard explained. ‘This is a big problem, mainly caused by our reporting hospitals not receiving enough funding for preparatory work for organ removal. This means they take an economic as well as an ethical and legal risk if they become involved with transplant medicine. However, if they do not actively participate in this, there are currently no negative implications. Moreover, there is a lack of staff responsible for the identification and notification of potential organ donors. By comparison, Spain has 15 transplant co-ordinators per million inhabitants, whereas in Germany there are only 0.8, which means there are 60 transplant co-ordinators in Germany who are not even based in hospitals. In some German Federal States there are additional transplant representatives, but they carry out this work alongside their main duties and are accordingly overstretched.’
How could the organ transplant situation be improved? ‘Apart from the mentioned call for a presumed consent solution and the removal of the financial obstacles for the reporting hospitals, the creation of a national central organ donor register, as per § 2, Paragraph 3 of the TPG, is absolutely essential. This would allow for more reliable organisation of donor identification, i.e. establishing the consent to, or objection against, organ donation. Moreover, it would be desirable to improve the insurance law for live organ donors. Unfortunately, the reality currently means that live donors often have disadvantages if they want to take out a life insurance or change medical insurers following an organ donation. In rare cases, a kidney donor may even end up as a dialysis patient. However, they will not receive preferential treatment in terms of the waitlist. This is unacceptable.’
* Publication on shortage of donor organs: “Organmangel. Ist der Tod auf der Warteliste unvermeidbar?” by Breyer, F., van den Daele, W., Engelhard, M., Gubernatis, G., Kliemt, H., Kopetzki, C., Schlitt, H.J., Taupitz, J., Springer, Berlin 2006


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