Organ donation

Most of the recipients need a kidney, or multiple organs simultaneously. However, in 2019 only 932 people were organ donors. This means 11.2 organ donations for each million German citizens. Thus, Germany has one of the lowest rates of organ donation in Europe. Statistically speaking, every eight hours someone dies due to the lack of a donated organ.

How is the organ donation regulated in Germany? Citizens choose to fill-in an organ donor card , with the option to fully or partially agree, completely disagree and to delegate all decisions to another person (e.g. a family member or a close friend who`s contact-information is then required). Alternatives to carrying a completed organ donor card are to write a will referring to organ donation on a piece of paper, or to fill out a living-will . It is important to never make conflicting decisions such as agreeing to organ donation on the one hand and restricting intensive care measures like artificial respiration on the other hand, since that would be necessary to keep the organs functioning before preparing the donation.

Organs that can be donated post mortem – after death – are: kidney, liver, heart, lung, pancreas, small intestine and tissues such as bones and skin. There is no age limit for the donors; the oldest ever donor was 98 years old. The condition of the organ is paramount. It is crucial that no contraindications can be found. Contraindications can include infections such as tuberculosis or HIV. For cancer, it must be determined in each case whether the disease can be transmitted to the recipient via the organ or its adherent tissue.

Legally, organ donation is regulated by the „transplantation law“. This states that everyone is allowed to object to organ donation from the age of 14 and to agree to organ donation from the age of 16.

Worldwide, there are three common ways of regulating organ donation. The first is that everyone who doesn‘t explicitely object to organ donation is potentially an organ donor. This applies in Austria and Spain (amongst others). Secondly, only those people who actively agreed to organ donation become donors. The extended version of this also stipulates that the relatives can agree to the donation. This is so in Ireland and Denmark. Technically, the third option is a special, extended version of the second option. Here, the focus rests upon the personal decision, and requires the state to provide all the necessary information to make an informed decision. Nobody is forced to decide and if a person did not possess an organ donation card, the relatives are required to decide. This is how it has been regulated in Germany since 2012 with some adjustments: in the beginning of 2020 it became the responsibility of general practitioners to motivate their patients to make a decision.

How is organ donation organized? The central element is the waiting list. Patients can be added to the waiting list by transplantation committees (consisting of three people within local transplantation centres). Their decision is made on the basis of the most recent scientific information.

Patient data is then transmitted to the central distribution centre (located in Leiden, NL) called „Eurotransplant“. There the organs are allocated according to the waiting list.

The last requirement for post mortem organ donation is the determination of death. In Germany, death is defined by brain death. Brain death means the irreversible loss of all brain functions.

Why are there so few organ donations in Germany? A variety of reasons lead people to decide against organ donation. Some have a lack of confidence t in medicine, which was possibly exacerbated by the „transplantation scandal of 2012“ when several physicians were found to have manipulated the waiting lists. Others may have religious or moral concerns with donating their organs after death. Often, failing to agree either way is caused by the mere lack of knowledge or awareness.

Another serious issue is the organization of organ transplants within the clinics. More specifically, the number of professionals qualified for transplantation has been too low in German clinics. A law to improve cooperation and structures concerning organ donation (“Gesetz zur Verbesserung der Zusammenarbeit und der Strukturen bei der Organspende“ April 2019) now obligates clinics to commission one transplantation professional per intensive care unit, not just per clinic. Additionally, the clinics are fully compensated for their expense.

A possible explanation could also be that Germans have to actively agree if they want to donate („opt-in“) and not actively disagree („opt-out“).

Conclusion The numbers of organ donations are shockingly low. Enrolling for donation can be understood as an act of solidarity. Nonetheless, it is just as important that everyone has the freedom to decide what happens with their body after death. There is no single mechanism that would immediately increase organ donation. We need a combination of measures, and we should keep the public discussion alive. Ultimately, we need to stop thinking about numbers and to focus on personal stories.

EXERCISE: 1. Organs that can be donated post mortem are:

a) kidneys b) liver c) heart d) lung e) pancreas

2. There is no age limit for the donor.

a) true b) false

3. Contraindications für donations are tuberculosis or HIV.

a) true b) false

You’ll find the answer on the next page.

BIBLIOGRAPHY 1. www.bundesgesundheitsministerium.de/gzso.html. 2. http://dict.leo.org. 3. www.dict.cc. 4. www.dso.de/organspende/statistiken-berichte/organspende. 5. www.organspende-info.de/. 6. www.webster-dictionary.org.

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTA. Sie gründete 1998 in Berlin lobitz seminare, die unter anderem Englischseminare für Health Professionals anbieten. Kontakt: mail@lobitz-seminare.de www.lobitz-seminare.de

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Lösung für Exercise: 1. A–E 2. A 3. A

Organ donation

How is the organ donation regulated in Germany?

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Organ donation

How is the organ donation regulated in Germany?

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