Organ donation: what you need to know | Politics & Society | '
What is this debate about?
The numbers of organ donors in Germany have been falling for years. According to the German Foundation for Organ Transplantation, the number of organ donors in 2017 reached a low of 797. Although the number in 2018 rose to 955 – but that's still not enough: In Germany, about 9,400 seriously ill people continue to hope for the transplantation of an organ.
If it goes to Federal Health Minister Jens Spahn (CDU), every German who has not explicitly contradicted, should be considered a potential donor. Spahn intends to combine the contradiction rule he proposed for organ donation with a broad-based information campaign. Every citizen should be contacted three times. Anyone who rejects organ donation can register it in a register – but who does not contradict or make no decision should be registered as a potential donor. However, there should be the opportunity to revise the decision at any time.
SPD parliamentary group vice-president Karl Lauterbach, who supports the bill, emphasized that in Germany every year about 2,000 people "die on the waiting list". The abstract willingness to donate was much higher than the number of people currently carrying an organ donor card. However, it is uncertain whether the draft of Spahn is passed in the Bundestag.
There is also an alternative design supported by, among others, Annalena Baerbock and Katja Kipping. The Green Leader and the Left Chairperson want to maintain the current approval scheme, but all citizens should be contacted at least once every ten years to collect an ID card on organ donation.
What criticism is there?
The chairman of the German Foundation for Patient Protection is against the introduction of the Opposition Regulation. The proposal of Baerbock and Kipping interfere less in the fundamental rights, so Eugen Brysch on Deutschlandfunk.
But Brysch does not go far enough with both bills. The editorial network Germany, he said that both proposals would "completely ignore the question of justice". Brysch referred to surveys, according to which half of the Germans feel that the distribution of organs in Germany is unfair. He calls for a reorganization of the transplant system. Both the control and the organ allocation would like to see his foundation in state responsibility.
The Catholic Church has also expressed disapproval of Spahn's proposal. For example, the German Bishops' Conference said that there were considerable ethical concerns about the contradictory solution. In addition, other countries show that switching to the opposition solution alone does not lead to more organ transplants.
What further measures does the Ministry of Health envisage with regard to organ donation?
The Ministry of Health has already drafted a bill last year to increase the number of organ donations by improving the remuneration of hospitals. In addition, a strengthening of the transplantation commissioner introduced a few years ago is planned. Since 2012, every hospital in which an organ donation is physically and personally possible must appoint such a representative.
In addition, smaller collection clinics should be supported by qualified doctors. Above all, potential organ donors should be better recognized and reported. According to the Federal Ministry of Health, a nationwide reporting system will be introduced. "Clinics are required to submit anonymised data to the coordinating office, which will allow an analysis of all deaths from primary and secondary brain damage," the ministry said on its website. The German Foundation for Organ Transplantation is to act as coordination office and also advise on the improvement of in-hospital procedures. Also a better care of the relatives is planned.
Which legal regulations exist in Europe?
Organ donation is organized differently in Europe. The legal regulations determine when and under what circumstances the organs may be taken from a deceased person.
In Germany, the decision-making solution has been in effect since 2012. This means that an organ removal is only permissible if the person concerned has consented. Every insured person receives information from their health insurance or insurance at the age of 16 to discuss the issue and make a decision.
In the case of the narrow consent solution, the deceased must have already consented to organ removal during his lifetime. In the case of the extended consent solution, the relatives decide on behalf of the deceased person if they have not made a decision during their lifetime and documented it. It applies for example in Greece, Great Britain, Denmark, Romania, Lithuania and Switzerland.
The opposition is available in countries such as Bulgaria, France, Ireland, Italy, Latvia, Liechtenstein, Luxembourg, Austria, Poland, Portugal, Slovakia, Slovenia, Spain, the Czech Republic, Turkey, Hungary and Cyprus. If the deceased person has not expressly objected to organ donation during his lifetime, for example in an opposition register, organs can be removed for transplantation. If there is no deceased person's decision, the relatives may object to organ donation in some countries. The opposition system with the right of appeal of the relatives applies in Belgium, Estonia, Finland, Lithuania and Norway.
At the beginning of 2018, the Netherlands amended its Organ Donation Act and declared every full-year person an organ donor. This regulation will enter into force in 2020.
If someone dies abroad, the regulations of the respective country apply.
What are the requirements for an organ donation?
In addition to the consent of the deceased or his relatives, medical aspects must also be considered. Only people with brain death can donate organs. So only when the total function of the cerebrum, the cerebellum and the brainstem has been irrevocably canceled and this was determined by two doctors. The cardiovascular system is artificially maintained so that the organs and tissues are further supplied with blood. In most deaths, a cardiac arrest occurs first, which is why the organ donation in any case only for a few deceased in question. In contrast to organ donation, a donation of tissue can be made up to three days after the cardiac arrest, the so-called clinical death.
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