Germany seeks Spanish help on organ transplants

According to Wikipedia, the laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The frequency of donations varies among countries. For example, Germany (16 donors/million) has an opt-in system whereas under Spain's opt-out system it has the highest organ donation rate in the world (34 effective donors per million inhabitants). German officials are to be congratulated for making this effort to help improve their system.

By Steve Tallantyre, The Local, Spain

Top officials and doctors from Germany are in Spain to get help on how to improve the performance and transparency of their organ donation and transplantation system.

The delegation of government officials and doctors from Germany's DSO transplant organization arrive in the wake of a series of scandals involving data manipulation to alter waiting lists in that country, according to online daily Lasprovincias.

The head of Spain's National Transplant Organization (ONT), Rafael Matesanz, explained that when the German government ordered a leading lawyer to review and overhaul organ donation systems, he had contacted Spain to analyze the Spanish model to see which aspects of it could be successfully transplanted.

"They can't change their system overnight but they can adapt many of the concepts that we've developed and try to modify them to help them improve," he said.

"It's important for a country like Germany, which has always operated its transplant system independently, to come to Spain because we are a leader in this area."

The German system is very different to the Spanish because it depends on the cooperation of the various German federal states, the procurement of organs through the DSO and their distribution via a company called Eurotransplant.

In Spain, the ONT is responsible for both the procurement and transplantation of not just organs but also other tissues and cells whereas in Germany these are handled separately by "many different private companies".

The German Ministry of Health is not involved in the process.

"We have urged them to change in this regard," said Matesanz.

He added: "Spain was the first country where the department of health got involved with transplants and, after 25 years of working well it has proven to be effective."

The German delegation have invited Matesanz to visit Berlin to explain the Spanish transplant model to the federal parliament and how it could be adapted to the German healthcare system.

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Three die a day in Germany waiting for an organ transplant

Around 12,000 people are on the waiting list for an organ transplant in Germany as only 15 percent of Germans carry an organ donor card. Some politicians think the system needs to change so that consent is assumed.

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If you're told that you need a liver transplant, or a new kidney, the sad truth is that the wait for that new organ is often longer than the time you have left.

"The waiting time for a kidney transplant is around seven years, and even worse for heart and liver transplants," said Günter Kirste, medical director for the German Foundation for Organ Transplantation (DSO).

Of the 12,000 people waiting for a new organ in Germany, three people die every day before they get the chance of a new organ.

Shortfall of donors

There is a huge shortfall between the high demand for transplants and the small number of registered organ donors.

In Germany you can register as a donor and select on your donor card what organs you are happy to donate after your death. However, only around 15 percent of the public have a card.

"Around 80 percent are actually in favor of being a donor, but most of them have no card nor have [they] spoken to their family about their wishes," Kirste said.

The DSO together with other national transplant associations organizes special days when they offer information to the public to help boost the number of donors.

At one such day in Frankfurt, the leader of the Social Democrats in the German parliament, Frank-Walter Steinmeier called on the public to "take a moment to consider those battling for life." The issue is personally pertinent for Steinmeier as only last year he donated a kidney to his wife when she was taken ill.

"They're battling, waiting, hoping for that phone call from the clinic saying their organ donor has finally arrived," Steinmeier said.

Even with big visible events like the one in Frankfurt, the number of donors has actually decreased slightly in 2011 compared to 2010.

A new system needed?

The system in Germany is completely voluntary, as you only have to register for a donor card if it interests you. Even then, you can tick a box on the card saying you do not wish for any of your organs to be used after your death.

However some think this system lets too many potential donors slip through the net. Instead of requiring people to choose to be a donor, it should be assumed that they would do so, said Stefan Grüttner, Minister for Social Affairs in the state of Hesse.

"Lots of people are ready to donate their organs after their death but simply don't have a donor card," Grüttner told Deutsche Welle. "Under an opt-out system people can still object, or their relatives can object, but the number of potential organ donors would dramatically increase."

Grüttner argued that Germany is lagging behind countries like Spain where consent is presumed. Indeed Germany has 15 donors for every million inhabitants, compared to 34 donors per million in Spain. Grüttner, who currently chairs the meetings of Germany's state health ministers, plans to put his ideas to them at the end of June.

Importance of decision-making

However Grüttner's critics say an opt-out system removes an important element of free choice.

Egbert Trowe was the recipient of a new liver in 2002 after hepatitis B developed into cirrhosis and he needed a new organ to live.

He does not know if his donor had a card, or whether it was the next of kin who decided, but he said the important thing was that the decision was not forced.

"Everyone should make the decision freely, and I believe the law in Germany is based on that democratic principle," Trowe said. He thinks the way to improve the system is to improve relations and communication between hospitals and transplant organizations.

Dr Kirste from the DSO is also not totally sure an opt-out system is the way forward, but suggests there is a "middle ground." He thinks people should be asked about organ donation every time they do things like apply for a passport or driving license, or buy health insurance.

"People need to be confronted with this topic and make up their minds," Kirste said.

Author: Catherine Bolsover
Editor: Michael Lawton

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