Organspende in Deutschland@@@Organ donation in Germany?current situation and future perspectives

As a rule, organ transplantation is currently the better, or only, therapeutic option for patients with chronic or acute organ failure. About eleven transplantations are performed in Germany every day, but during the sameperiod three patients die due to the shortage of donor organs. For years the number of organ donors has stagnated. The success in transplantation has led to extended indication criteria and to an ever growing waiting list with presently more than 11,500 patients. International comparison shows Germany, with 12-13 organ donors per million inhabitants, to be in the lower third. However, the fact that there are 20 donors per million inhabitants in some regions indicates that the donor rate can be increased across Germany. Results of a poll (by forsa) suggest that the amount of information on the subject correlates with the readiness for organ donation. This is the reason why intensified public relations measures targeting special groups are thought to provide a way to improve the state of organ donation. A further decisive method is to achieve greater participation in organ donation by about 1,400 hospitals with intensive care units, to be projected as a joint task in implementing the transplantation law. Under this law, hospitals are obliged to inform the German Organ Transplantation Foundation (Deutsche Stiftung Organtransplantation: DSO; coordinating authority for organ donation) of any potential organ donor. However, only about 40% of hospitals actively participated in organ donation in 2002. According to the DSO, the major obstacle to hospitals playing a more active role in organ donation are deficits in the recognition of possible organ donors, in the adequate assessment of the suitability of the donor, and in the essential and consistent intensive therapy before and after brain death has been diagnosed. This is also clear from investigations of the organ donation region of Central Germany (States of Hesse, Rheinland-Pfalz, Saarland): in 38% of patients who died due to acute brain damage organ donation was excluded because of circulatory arrest or multi-organ failure. To counter this situation and increase the number of organ donations, the DSO provides 24-hour consultation service and extensive support in the donation process. This includes clarifying the suitability of the donor, and help with diagnosing brain death, approaching the family, examining the donor and maintaining the organ protective therapy, as well as comprehensive logistic and organizational support. With respect to this, the appointment of transplant representatives in hospitals as the persons responsible for implementing the procedures for organ donation and for co-operating with the DSO has proven successful. Further-education programs by the DSO not only promote the donation process, but also the self-assurance of medical and nursing personnel in the acute situation, as well as dealing with mourning relatives and asking for organ donation. Assured handling is especially important in view of results of the most recent studies showing that intensive care personnel greatly value organ donation (83.8%), but about 61% of those questioned felt inadequately prepared to deal with an acute situation. This uncertainty is particularly obvious when it comes to dealing with the relatives of potential donors: about 47% of those questioned felt inadequate for this task. Organ donation is an interdisciplinary process which also depends on decisions at the level of hospital management and health policy, as well as the climate of opinion within the population and medical personnel. Thus, organ donation can only be promoted by concerted action in close co-operation between the responsible groups and individuals.