The back of a completed organ donor card © Marie Reichenbach
Probably this year, the Bundestag will decide on a change of system for organ donation. A hearing on the ie will be held in Parliament this Wednesday. Some key points of the debate.
Why is this debate taking place?
For years, Germany has been at the bottom of the league in Europe in terms of organ donations; the annual number of donors is in the basement. To reverse the trend, the Bundestag passed a law in April to improve structures in transplant medicine. But for some politicians and health experts, that's not enough. They want to place a stronger obligation on citizens to consider organ donation and to document their position on it.
How many organ donations there were in 2018?
For the first time since 2010, the number of organ donations in Germany rose again in 2018. 955 people donated their organs after their death, 20 percent more than a year earlier. 3.113 organs could thus be mediated by the international mediation agency Eurotransplant to patients of the eight European countries belonging to the network. That's 519 organs more than in 2017.
How is organ donation regulated?
In Germany, the Transplantation Act passed in 1997 regulates this area. To prevent abuse or organ trafficking, the law provides for strict organizational and personnel separation of the areas of organ donation, procurement and transplantation. The German Foundation for Organ Transplantation (DSO) is responsible for coordinating the donation process.
Where are the organs removed?
There are currently around 1.350 hospitals with intensive care units allowed to harvest organs. Since 2012, they have been required to appoint transplant officers to identify and report potential organ donors and accompany relatives. Organs are transferred at about 50 transplant centers nationwide.
What does the current consent solution say?
Since 1997, an extended consent solution has been in effect in Germany: only if the deceased expressly consented to the removal of organs during his or her lifetime may the organs be removed. Expanding on the rule, relatives or those designated by the deceased to do so also have the right to decide whether a removal should take place. In 2012, the Bundestag passed another amendment. The so-called information solution provides for every citizen to be asked at least once in their lifetime about their willingness for or against organ donation. Health insurance companies were obliged to inform all citizens about organ donation at regular intervals. The decision should be documented.
Prominent politicians are now calling for a system change to an objection solution. Why?
Health Minister Jens Spahn (CDU), SPD health expert Karl Lauterbach and the German Medical Association are calling for the introduction of an objection solution in view of the low numbers of organ donations. If the deceased has not explicitly objected to organ removal during his or her lifetime, organs can be removed for transplantation. According to the draft law, in the case where there is no expression of will on the part of the potential donor, relatives can also file an objection. However, they are not allowed to assert their own opinion, but must prove that the potential donor would have rejected it.
What speaks for an objection solution?
It widens the circle of potential donors. The state ames a basic willingness to donate organs. Advocates point out that countries with an objection solution have higher transplantation rates. Critics doubt this connection: Spain, for example, which has the highest donor rates in the world, already introduced the contradiction solution in 1979 — without any results. Only measures to build trust and involve relatives would then have ensured the high donor numbers. This also applies to Sweden.
What are the arguments against the objection solution??
An objection solution has also been discussed in Germany for decades — and repeatedly rejected. Critics say it is unwarranted and counterproductive because it could increase distrust in transplant medicine. They point out that in Germany even the smallest medical intervention requires the patient's consent. The Catholic Church in Germany also finds the objection solution unacceptable: in its view, organ donation must remain a conscious and voluntary decision.
The decision solution is also up for debate. What does it mean?
A group of delegates around the party leader of the Greens, Annalena Baerbock, Katja Kipping (left) as well as the CDU health expert Karin Maag, Stephan Pilsinger (CSU), Hilde Mattheis (SPD) as well as Christine Aschenberg-Dugnus (FDP) want that the organ donation remains further a voluntary and conscious decision. According to her draft law, citizens should be regularly asked about their willingness to donate organs, for example, when they renew their identity cards. Family physicians should counsel their patients about possible donation at least every two years. The answers should then be registered in a central database.
Are there other models?
Health economists and philosophers have proposed a model based on reciprocity: if you register as a potential donor, you will receive a preferred organ in the event of illness. This rule, already in place in Israel, would provide more incentive to donate and more justice by preventing freeloading.
How is organ donation regulated in other European countries??
A look at the European countries reveals a colorful patchwork. However, the opposition solution prevails. An extended consent solution exists in Denmark, Iceland, Lithuania, Romania, Switzerland, England, Northern Ireland and Scotland.
In the Netherlands, too, the consent solution still applies. However, the Dutch parliament has passed an objection solution that will take effect next year.
An objection solution applies in Austria, Belgium, Bulgaria, Croatia, the Czech Republic, Estonia, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Liechtenstein, Luxembourg, Malta, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Turkey and Wales. There are differences in how these states regulate the appeal rights of relatives.