Organ donations can save lives. Everybody knows this sentence and yet only 28 percent of citizens in Germany currently have an organ donor card. In the past, not only have new laws come into force to increase transparency in organ transplants, but also launched several campaigns designed to increase German donor readiness.
Just in time for the Organ Donation Day, the Federal Ministry of Health and the Federal Center for Health Education (BZgA) have launched a new campaign for more organ donations. This ties in with the actions of 2013. In the next few weeks, posters and advertisements under the motto “I decide” will be used to promote the completion of an organ donor card.
After a scandal broke out in the summer of 2012, the German government is trying to boost German confidence in organ donation. During the so-called Göttingen organ donation scandal, several doctors at the university hospitals in Göttingen and Regensburg have been manipulating medical records for years, so that their patients could receive a donor organ faster – although other people might have needed this much more urgently. The physicians are also suspected of having received money from their patients for this preferential treatment.
Doctors and clinics under pressure
In view of the numerous media reports, the trust of many people in the system of organ donation has been permanently shaken. However, it will take a long time before the Germans can unconditionally rely on organ donation, despite new laws and education campaigns. Above all, experts demand more transparency in the organ donation process. For this reason, finanzen.de would like to give you an overview of organ donation and has compiled the most important information for you.
- Organs save lives
- facts and figures
- Faith vs. Medicine – What are different religions for organ donation?
- Organ donation scandal and the consequences
- Criminal activities
Organs save lives
The donation of an organ is possible through organ transplantation. Nowadays, medicine is able to transfer not only the kidney and liver but also the heart, lungs, pancreas and small intestine from a donor to a transplant recipient. Tissue transplants such as corneas, bones, skin and blood vessels are also possible. According to the Transplantation Act, organs in Germany may only be removed under two conditions after the death of a human being: on the one hand, brain death must have been clearly established. On the other hand, a declaration of intent by the deceased or – if such is not known – the consent of the relatives must be present.
Organ donation in Europe
Thus, in Germany – unlike, for example, in France, Austria or Poland, where people have to clearly oppose an organ donation on request during his lifetime – the so-called approval scheme applies. The willingness to donate organs can be explained in this country with an organ donor card. This makes it possible that in case of own death in relation to the organ donation according to the personal desire can be acted.
According to a survey conducted by the Federal Center for Health Education in 2014, only around 68 percent of Germans would agree that they would take organs from them after their deaths in order to give other people the chance of life. There are currently about 11,000 patients nationwide waiting for a donor organ. Statistically, three of them die daily because there is no suitable organ available for them.
The organ donor card
According to official figures, only about 28 percent of Germans have an organ donor card. Anyone who does not possess such a card, leaves in the event of his death the decision of his relatives, whether organs or tissues may be removed from him. The possession of an organ donor card gives physicians and relatives in an already stressful situation certainty. Here, either the consent for organ and tissue donation can be explained in general or only for certain organs and tissues. However, ID card holders also have the opportunity to object to a donation after their death.
In 2010, according to a Forsa survey commissioned by Techniker Krankenkasse (TK) 82 percent of Germans had no organ donor card. The reasons for the non-ownership were manifold. After all, 36 percent of the respondents said they were not yet sufficiently informed. 10 percent did not consider an organ donor card due to health reasons. In principle, six percent of respondents were opposed to organ donation. Four percent of the respondents had no ID card for fear of being declared prematurely dead in an emergency. Three percent of the respondents refused a card at the time of the survey for religious or ethical reasons.
facts and figures
According to the German Foundation for Organ Transplantation (DSO) , 70,318 kidneys, 18,868 livers, 10,969 hearts, 3,865 lungs and 3,150 pancreas glands have been transplanted in Germany since 1963 (as of 2011).
In 2013 alone, a total of 4,059 organs were removed. Among them were:
- 2,272 kidneys
- 313 hearts
- 970 livers
- 371 lungs and
- 128 pancreases
- Currently around 11,000 people in Germany are looking for a donor organ – around 7,900 of them alone need a new kidney.
- Statistically, 20 patients die each week because a suitable donor organ is missing. On the condition that the risk of a transplant is not too high and a possible organ donation would be promising, those affected will be included in a waiting list.
- According to media reports, however, donor organs in Germany are being awarded the official waiting list more and more frequently, and the proportion of so-called accelerated mediation procedures has increased rapidly in recent years. Currently, every fourth heart, every third liver and every second pancreas is allocated directly from the transplantation centers to selected patients ,
Mediation via Eurotransplant
The data of the patients eligible for transplantation will be sent to the Eurotransplant (ET) agency in the Netherlands. Founded in 1967, this foundation organizes organ donations between the Benelux countries, Germany, Austria, Slovenia, Croatia and Hungary. Organ mediation to potential organ recipients in Germany is carried out in accordance with the guidelines of the German Medical Association, whereby the prospects of success and the urgency of a transplantation are the most important decision criteria in the awarding process.
According to media reports, however, donor organs in Germany are increasingly being awarded the official waiting lists, and the proportion of so-called accelerated mediation procedures has increased rapidly in recent years. While in 2002 the proportion of such heart, liver and pancreas procedures was still below ten percent, every fourth heart, every third liver and every second pancreas is currently being allocated directly to selected patients by transplant centers.
A board of examiners of the German Medical Association examines the transplants on a random basis. Currently, only one to five percent of the procedures are being investigated. In the course of the well-known organ donation scandal, the German Medical Association announced on August 27, 2012, that in the years 2000 to 2011 a total of 50,739 organ transplantations had been reported to Eurotransplant in Germany – of which 43,536 post mortem donations and 7,203 live organ donations. According to its own statements, in 119 cases the Commission examined reported allocations, with 31 cases of varying degrees of severity against the current Transplantation Act.
The pictured graphic shows that in Germany since 1963, especially kidney, liver and heart have been transplanted. Lung and pancreas transplants are still comparatively rare in Germany.
- According to the Central Association of Statutory Health Insurance, liver transplantation currently costs on average 84,000 euros.
- If there are complications during the procedure, the costs can quickly rise to over 100,000 euros.
- The hospitals are currently receiving a lump sum of about 3,100 euros for organ harvesting, according to the GKV umbrella organization, and about 3,900 euros for multiple organ removal. Interesting: Basically, the obligation to pay the health insurance ends with death. The Transplantation Act therefore stipulates that the costs of preparing an organ transplant for the potential organ donor are covered by the German Foundation for Organ Transplantation (DSO) .
Faith vs. Medicine – What are different religions for organ donation?
are in favor of organ donation
When the transplantation law was passed in Germany in 1997, both the Catholic and the Protestant churches in Germany welcomed this decision. Both churches see willingness to donate organs after death as a sign of charity and solidarity with the sick and the disabled. In a joint declaration on organ transplantation in 1990, the German Bishops’ Conference and the Council of the EKD advocated organ donation under certain conditions. Among other things, the will of a deceased special attention must be paid, so the Christian view. “Anyone who expresses his life during organ donation after his death, relieves his relatives of the sometimes painful burden of a decision and spares them the need for speculation about his will,” reads the declaration of the German Bishops’ Conference and the Council of the EKD .
Read here an interview on organ donation with the press secretary of the Evangelical Church in Germany, Mr. Reinhard Mawick.
According to the Central Council of Muslims in Germany , the German Transplantation Act is compatible with the Islamic principle. In Islam, a voluntary organ donation is considered a sign of compassion and charity. An opinion of the Central Council of Muslims on organ donation in Germany states that it is religiously admissible and praiseworthy to relieve the distress of another person. The condition for the organ donation in Islam is the consent of a donor, if he is of age and with a clear mind, or of his relatives. Living donations are allowed in most Muslim countries when the benefit to the recipient is greater than potential harm to the donor.
In Jewish belief, there are different views on organ donation. Orthodox Jews do not agree with an organ donation in brain death, since according to the Jewish religious law, the Halacha, death in humans occurs only when heartbeat and respiration come to a permanent standstill. From a Jewish point of view, God has only lent man his body and man must not deliberately violate his body. The integrity of a dead body must also be preserved in the Jewish religion. However, another commandment of Judaism also states that human life must be preserved and saved. Many liberal Jews today advocate organ donation for this reason. However, the voluntary donation is only allowed under the conditions that no profit is generated from the body and the corpse is treated respectfully.
Read here an interview on organ donation with the press secretary of the Jewish Community in Hamburg, Mr. Michel Rodzynek.
According to the Buddhist view, the human body and the soul constitute an inseparable unity. With the death of a human, this unity is dissolved in a process that continues beyond the standstill of perceptible bodily functions. For many Tibetan Buddhist followers, organ harvesting therefore interferes with dying. However, compassion, sharing, and solidarity play an important role in Buddhism. It also emphasizes that man should not cling to his body. Every Buddhist has to decide for himself if he agrees to an organ donation. If he has not made a clear statement of intent, then Buddhist supporters in Germany advise against relatives making a deputy decision.
Read here an interview on the subject of organ donation with the Buddhist teacher Mr. Öser Bünker.
In Hinduism, the body is considered a mortal shell, while the soul is considered immortal. Although the integrity of a corpse has a high priority, the religion does not prescribe a ban on organ donation. Most devout Hindus are positive about the donation and have no qualms about providing their organs for transplantation. Since suffering can be helped with such a step, the donation is considered an offering and can bring about good karma. In India, the country of origin of Hinduism, the brain death concept is officially recognized, although it contradicts the definition of death in Hinduism. Thus, a person is considered dead only when his body is cold. However, the principle of helping sufferers takes on a much higher priority.
Read an interview about organ donation with the Hindu monk Bhakti Raksaka Svami.
Currently in need of
12,000 people a donor organ
Organ donation scandal and the consequences
After the announcement of the donation scandal at the university hospitals in Göttingen and Regensburg in Bavaria invited Federal Minister of Health Daniel Bahr (FDP) on 27 August 2012 to a peak meeting between politicians, the Central Association of Health Insurance, the German Medical Association and the German Hospital Association, Eurotransplant, the German Transplantation Society , the German Foundation for Organ Transplantation and the Patient Commissioner of the Federal Government, to discuss possible measures after organ donation events.
“We need to improve control and supervision, and we need to improve transparency and consequences,” said the Federal Minister of Health at the summit meeting. Together with state representatives and specialists in organ donation, a catalog of measures has been developed that works towards these goals. One of the deliberations was whether the provincial authorities could increasingly control the hospitals in the future. Above all, independent experts should be allowed to control the transplant centers more strongly than before. The Examination Board announced spot checks in all centers.
Six eyes principle
When adding patients to a waiting list, a six-eye principle should apply in the future. At least three people – one of them who has no connection to transplantation medicine and is directly subordinate to the medical director of the clinic – will then have to decide on admission to the waiting lists. Even in urgent cases, organ transplants should be better documented in the future. It is also planned that rule violations against the provisions of the Transplantation Act have clear consequences. “Depending on the seriousness of the infringement, the spectrum ranges from sanctions to labor and professional measures to measures of misdemeanors …” , it said in the official statement to the top discussion.
Another major measure resulting from the donation scandal is the adaptation of doctors’ contracts in the transplant centers. The clinics had previously been criticized several times because they had entered into special agreements with doctors on bonus payments. For a certain amount of work, the responsible physicians received more money by contract, so that disincentives were set. The German Hospital Association expressed its support for the abolition of these financial incentives at the summit meeting and announced that it would make corresponding changes to the model contracts. Some hospital carriers have already terminated contracts with the special arrangements.
According to the President of the German Medical Association, Frank-Ulrich Montgomery, the incidents that have become known in Göttingen and Regensburg are isolated cases of German organ donation. “You can not talk about mafia or large-scale criminal behavior,” he said in an interview. Nevertheless, it seems that there are always criminal machinations in the area of organ donation all over the world. Probably above all, because it is possible to earn a lot of money with the chance of living illegally, cases of organ smuggling are becoming known again and again.
Organ trade – a global problem
Media reports about the banned trade in human organs can be found worldwide. In countries such as China, Moldova, Romania, South Africa or Turkey, paid organ donation has been a common occurrence in the past. Again and again, cases were known in which wealthy Europeans or Americans received organs from the poorer countries for money. At the initiative of the World Health Organization (WHO), 78 countries signed the Istanbul Declaration on Organ Trafficking and Transplantation Tourism in 2008.
With the Declaration of Istanbul, the signatories stated that both organ trafficking and transplantation tourism should violate the principles of equality, justice and respect for human dignity and should therefore be prohibited. In many countries, trade in human organs has now been defined as an explicit crime. Nevertheless, even after this statement, other cases of organ smuggling shocked the public, illegal transplants are repeatedly known and punished.
Particularly in developing and emerging countries, it continues to happen that organs are sold to wealthy beneficiaries. From a medical point of view, illegal trade poses a great danger to both living donors and recipients: donors are at high risk for their health, and inadequate medical care risks their own lives in order to earn money. The risk of the organ recipient rejecting the donor organ is also greater if the health status of the donor does not meet normal medical standards.
The chance of a new life through an organ transplant ultimately has a priceless value for all those people who urgently need a healthy organ. A shortage of organs in Germany alone causes more than 1,000 critically ill people in need to die each year. That’s what makes it so important that more Germans trust in organ donation. Anyone who carries an organ donor card with him, if he agrees to a donation, can give life after his death. And even if he decides against organ donation, he helps with the possession of an organ donor card to his family members, by taking them in an already onerous situation a serious decision.