Organ donation

Current German law requires people to declare their willingness to donate some time during their lives. If a patient pronounced brain dead by doctors has not made this decision, it is up to immediate family members to decide. 

But with 12,000 patients in Germany waiting for an organ donation, and a great number of potential donors never during their lives deciding on whether or not they would donate their organs, a new law intends to push Germans more actively to make this decision. In the future, health insurers will make it a point to ask members to declare their willingness to donate organs.

No compulsion

The new law scheduled to be passed this summer will allow insurers to ask each adult regularly about his or her willingness to donate organs. This year, residents will receive a letter from their insurers informing them about organ donation and asking them if they would be prepared to donate. Reminders by mail will follow in a cycle stipulated by law. Additionally, federal offices that issue passports and driver's licenses will distribute information about organ donation.

There is no legal obligation to issue a declaration, so the decision to accept or ignore requests to become an organ donor remains up to the individual. There is a clear consensus among politicians of all political parties that the wishes of those who do not want to donate will be respect.

Many willing, few donors

The key difference in the new legislation is the leverage it allows for targeting citizens directly rather than issuing general appeals. A further goal is to allow potential donors to declare their willingness right on their health insurance chip cards rather than on a separate donor badge.

The legislation follows years of discussion about how to increase the number of Germans who are both willing and registered to donate. Surveys show around 75 percent of the population would offer organs, but only 20 percent have a donor card that documents their consent.

Following Spain's example

Medicine has made enormous strides when it comes to transplanting organs, but every day, three people die in Germany who are in urgent need of an organ donor. Only patients who suffer brain death before cardiac arrest occurs are eligible to provide organs for a transplant. Of those circa 400,000 people who die each year in German hospitals, around one percent suffer brain death before cardiac arrest.

In Germany, the number of organ donors per every million residents is 15, while in Spain, it's 35. The policy in Spain and many of Germany's other European neighbors requires those who do not want to donate organs to issue a specific objection. Those who do not are automatically eligible to donate.

But Poland offers an example that legislation requiring an objection can bring its own problems. Despite having laws that require a written objection from non-donors, just eight out of every million residents have donated organs - well below the German average. That's because the family members of a potential donor can claim that he was against donating and prevent the procedure, which occurs in around half of all cases.

Training and support are key

But the new law doesn't do nearly enough, says Günter Kirste, head of the German Organ Transplantation Foundation (DSO) that advocates donation. Kirste believes that one aspect of the new law has gone almost unnoticed. Health Minister Daniel Bahr would like for every hospital to have someone who oversees the transplant process - a point of decisive importance, according to Kirste, who pointed again to the example of Spain, where such overseers have long been in place.

"Of course such a position would have to be sufficiently funded and occupied by someone with the right expertise," Kirste told DW.

That expertise includes drawing attention to potential organ donors and leading conversations with those closest to the donors. The role involves not just administration but also sensitivity to people's feelings and the ability to train staff accordingly. Until now, many possible donors were simply overlooked, Kirste said.

Kirste isn't the only one to advocate funding such a position. The German Bishops' Conference also recently pointed to the problem of insufficient support for donation in many clinics.

Bishop Anton Losinger said the reasons include "insufficient funding in hospitals, too heavy workloads, the unusual work procedures donation requires and the shyness and uncertainty that results from deficient training when it comes to talking with family members about organ donation."

Citing solidarity

The practice of removing organs from patients who have suffered a brain death and transplanting them to the severely ill still has its share of critics. Many argue that if the organs of a person are still alive, then the person as a whole cannot be dead.

Günter Kirste sees that as a backward view of things from a medical point of view. He agrees, though, that it is legitimate to reject donation based on moral or ethical grounds.

But objections to organ donation don't always come from church representatives.

Ineed, the church has produced a number of well-known supporters, including Pope John Paul II, who called organ donation "a noble deed."

Friedrich Weber, chair of the Association of Christian Churches in Germany, said organ donation corresponds with Christian teachings, adding, "coming to a decision about whether or not to donate organs is something that can rightfully be expected of every person."

For Günter Kirste, social solidarity is the most convincing argument: "In Germany as a social community, everyone should give consideration to organ donation and essentially also be prepared to take part," Kirste said.

Author: Günther Birkenstock / gsw
Editor: Andrea Rönsberg