November 2009:
For and Against New Transplantation Laws
Congress: European and International Day of Organ Donation
In Europe there is a glaring shortage of donor organs. At present around 63,000 people are waiting for an organ, about 12,000 of them in Germany. Every day about 12 people on the organ waiting list die.
Participants from over 60 countries attended the 5th international and 11th European day of organ donation, which was followed by the congress of the International Society for Organ Donation and Procurement (ISODP), held in Germany for the first time. The central topic was the shortage of donor organs and its effects. Other topics discussed were, in addition to questions of transplantation medicine, legal, ethical, religious and logistical (donor management) problems.
Dr. Axel Rahmel of the Eurotransplant Foundation, Leiden, which coordinates organ donation in seven countries, presented an analysis of the transplantation results for the year 2008. There were 11,000 patients on the waiting list for a kidney, 2442 for a liver, 361 for a pancreas, 1007 for a heart and 859 for a lung. In 2009 it is expected that the figures will rise by 2-3 percent (for the liver by 80%). Germany remains an "import country" as regards organ donation (100 organs from abroad). With 14.6 donors per 1 million of the population, the level is below the European average of 16.1 donors (by comparison: Spain 34.2, Portugal 26.7 and USA 26.3 percent).
To solve the problem of the shortage of organs, Prof. Axel Kirste (chairman of the German Foundation for Organ Transplantation, DSO) is of the opinion that there is no need for a change in the transplantation law from the extended acquiescence solution to a system whereby organ donation is allowed unless the potential donor has expressly forbidden it. He hopes that the competence of the DSO will be extended, with hospitals employing their own trained transplant coordinators. They could provide logistic support for the often overburdened intensive care unit personnel and help to increase awareness of questions of organ donation. It is also important that physicians are informed that even elderly patients are suitable donors of living organs. However, he sees great difficulties in the realization of these ideals, since transplantation provisions are a matter of national law, whereas the actual organ donation takes place in hospitals that come under the jurisdiction of the federal states.
The chairman of the Deutsches Herzzentrum Berlin, Prof. Roland Hetzerm explained the view of the transplanting hospitals: In the 1990s, before the transplantation law, there were more than twice as many hearts and lungs available as donor organs. Now he implants more mechanical circulatory assist devices and total artificial hearts to keep his severely ill patients alive during the waiting time, which often lasts for a year or longer. The trend is now even to implant “artificial hearts” for permanent support. These devices are the only means of reacting to the serious mismatch between the number of organs needed and the number on offer. The new, very effective support systems offer, like dialysis for kidney patients, a thoroughly acceptable perspective. Unlike Prof. Kirste, he argued in favor of a change in the transplantation laws in Germany and adoption of the "declared opposition" solution, in line with the recommendations of the German Ethics Council, which unfortunately have been rejected. At the same time he reported the problem, caused by the donor organ shortage, that today certain compromises have to be made regarding the quality of donor organs that are accepted, so that patients may receive an organ at all. He also spoke of a new system (Organ Care System, Transmedics) that enables organs to be continuously perfused during transport, which preserves the tissue quality of the donor organ and makes transport times of 7 to 9 hours possible, twice as long as before.
Dr. Lothar Färber of Novartis Pharma drew attention to the global Novartis initiative "Transplantation Tree of Life Academy." This new academy supports scientific projects associated with transplantation, further training for doctors and improvements in the management of organ donation. As a symbol the first tree of life has been planted on the Mitte campus of the Charité to honor people who, by donating their organs, have given a second chance to seriously ill patients.
