In the transplantation of a heart and/or lungs a non-treatable, diseased organ is replaced by one from a brain-dead donor. Brain death has to be diagnosed by two specially trained doctors, independently of each other.

In Germany organ donation is regulated by the Transplantation Law. This law strictly divides the areas of organ donation, organ allocation and organ replacement, to avoid conflicts of interest. The Deutsche Stiftung Organtransplantation (DSO, German Foundation for Organ Transplantation) coordinates and supports the processes of brain-death diagnosis of the donor and organ procurement. The Eurotransplant Foundation in The Netherlands is responsible for allocating all donor organs in eight European countries, including Germany. The transplantation is carried out by specialized transplant centers. The German Heart Institute Berlin is one of the 25 centers for heart transplantation and 16 centers for lung transplantation in Germany.

The condition for organ transplantation is that no other treatment of the diseased organ is possible. Whether a patient is eligible for transplantation is decided by the doctors in accordance with guidelines applicable worldwide. Patients who have a malignant tumor, for example, are excluded from heart transplantation.

If a patient is eligible for transplantation he or she can be actively listed with Eurotransplant. Eurotransplant allocates organs using these criteria: matching of the blood group, similar height and weight of donor and recipient (+/- 15 percent). Further, the urgency of need, corresponding to the seriousness of the patient’s illness, is taken into account. The waiting time can differ strongly from one patient to another and may last several years.
Patients with an acute life-threatening and incurable heart weakness who cannot receive a donor organ in time therefore often receive an implanted mechanical circulatory support system. These systems are known as ventricular assist devices (VADs) and consist of a small pump, which is implanted directly at the patient’s heart. Thanks to improvements in the technology and in surgical procedures VADs are increasingly becoming a long-term alternative to transplantation.

Once brain-death and the willingness of the deceased to donate organs have been established by the DSO, Eurotransplant (ET) is informed that an organ is available.
ET establishes which patient on the waiting list is most suitable to receive the organ and informs the transplantation center treating this patient. A surgeon there checks the medical data for the donor organ. If he or she decides to accept the organ, an organ explantation team is dispatched to the hospital of the donor. As soon as they arrive, they explant the organ. Now the so-called ischemic time has started; this is the time in which the organ is not supplied with blood. This time must be kept as short as possible to avoid damage to the organ.

At the same time the organ recipient is prepared for the transplant in the operating room. When the explantation team starts the journey back, the operation begins. This is so that the ischemic time can be kept as short as possible.

Normally the new organ would be recognized as foreign tissue by the body’s defense system and be attached – similar to the incompatibility of different blood groups. For this reason, after the transplant the patient has to take medication lifelong that regulates the immune system, so-called immunosuppressants. In this way the organ can be accepted by the body and function as it should. In the first months after the transplantation the individual selection and dose of this medication is established.

The Berlin self-help group "transplantiert e.V" (formerly IOP) has for many years helped patients waiting for or living with a donor organ, and their relatives. The voluntary helpers are themselves people who have received organ transplants and can offer support on the basis of their own experience. On the website transplantiert e.V. you will find information on many aspects of organ transplantation and how to contact the organization.