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Germany

Germany rethinks organ donation after Steinmeier gives kidney

Around 12,000 Germans are waiting for an organ donation. Some politicians think that a model where everyone is presumed to be a donor unless they have said otherwise could give a much-needed boost to organ donation.

A doctor holds in his hands a diseased heart which has just been removed from a patient during a heart transplant operation

Some 12,000 Germans are waiting for an organ right now

When German opposition leader Frank-Walter Steinmeier donated his kidney to his sick wife last week, he put organ donation in the spotlight. But most transplants don't come from living donors like Steinmeier, but rather from people who have died but whose organs are still in good shape.

Frank-Walter Steinmeier of the Social Democratic Party and his wife, Elke Buedenbender

Steinmeier's kidney transplant is an example of live donation

In an interview with the Welt am Sonntag newspaper, Rolf Koschorrek, who heads the Christian Democrats' parliamentary health committee, said he was ready to fight for a system that presumed consent rather than asked for it.

He told the paper that he sees the "opting out" model as "an opportunity to significantly improve the supply of donor organs."

A common approach in Europe

Many other European Union countries take the approach championed by Koschorrek, including Austria, France and Spain, where more than one out of every six of the EU's organ donations in 2009 took place.

Dr. Guenter Kirste, the medical director of the German Organ Procurement Organization, told Deutsche Welle that he thinks assuming everyone is a potential donor would change the conversation for the better.

"I would prefer a kind of presumed consent," he said, "because it makes it easier to talk to the people and say, well look, your brother, your sister died for this and that reason. Now we are going to talk about organ donation, which we will do if you have no objections."

A kidney bound for transplant

Could a presumed consent model lead to more organ donation in Germany?

Presumed donors

Professor Hans Lilie of the German Medical Association said he worries that discussions of a presumed consent could actually have the opposite of the desired effect.

"I worry that such a debate will spark fears in the public," he said, "and that it could actually reduce organ donation numbers."

Lilie, who heads an interdisciplinary research center on medicine, ethics and law at the Martin Luther University of Halle-Wittenberg, said that by forcing people to choose one way or another, many who are unsure may simply decide to say no - a decision it would be difficult for relatives to reverse. He's also concerned about the rights of those people that such an opting-out model would automatically make donors.

Doctors ask permission regardless of model

Spain's health ministry recently released a statement crediting its system with its high organ donation numbers. Spain oversaw 4,028 organ transplantations in Spain in 2009 compared with just 1,297 in Germany. But the press release didn't mention the country's presumed consent model. Instead it cited its centralized national authority for organ donation and the presence of transplant coordinators in Spanish hospitals as the reasons behind the country's success.

Both Kirste and Lilie agree that what would most benefit organ donation numbers in Germany is better organization and someone in each hospital who is specially trained to identify and recruit potential donors.

"That's exactly how Spain has done it," said Lilie, "with well-paid doctors who are responsible for recruitment. And that's what we want to reproduce in Germany."

According to Kirste's statistics, in only about 10 percent of donation cases do doctors find a consent card on a person who has died in Germany. The majority of organ donations are decided upon by the family.

Kirste, who likes the idea of presumed consent, said studies show that doctors approach the families of the deceased the same way, even if the country's has presumed consent. They ask their permission to use their loved one's organs in a transplant.

Author: Holly Fox
Editor: Chuck Penfold

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