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Organ Donation: "There is a long waiting list for donated organs“
Professor Elisabeth Pott; © private
Death is an unpopular subject that is often not talked about. Many people have an especially tough time to confront the issue of their own death while they are still in the midst of their life. Particularly when it comes to the question of whether to donate their organs, people are at a loss. Reservations about organ donation are still very strong, because often there is not enough knowledge on what requirements need to be met before an organ can actually be accepted.
MEDICA.de spoke with Professor Pott, Director of the German Federal Center for Health Education (BZgA) about the new awareness campaign “Become an ORGANPATE (ORGAN DONOR)”, which started in October of this year.
MEDICA.de: Professor Pott, what is the current status on the number of organ donations and organ transplants in Germany?
Elisabeth Pott: In Germany currently 12,000 people are waiting for an organ, of which about 8.000 need a kidney. There are about three times as many people waiting for a kidney than we are able to procure organs. Each day three people die, because they did not receive an organ in time. In the year 2009, 1217 people donated their organs after their death, which were unfortunately not many more people than in the previous year 2008. At least nine organ donors were added. The number of postmortem donated organs which could also be transplanted is just under 4000. This means, we took on average of about three organs from each organ donor.
MEDICA.de: Do “public“ donations, like for instance when SPD Chairman Frank-Walter Steinmeier donated a kidney to his wife, help in winning people over for this topic?
Pott: Apparently, through these types of public decisions that also experience a positive media response, people are more encouraged to increasingly look into the subject. They discuss this topic for instance with their family and friends. We noticed, that the news coverage about the “public“ organ donation by Frank-Walter Steinmeier to his wife has lead to a definite increase in attention towards the topic of organ donation. We can hinge this particularly on the number of hits at the BZgA Internet page for organ donation. During that time, the use of our pages increased tenfold. We are hoping of course that those who get more information on the Internet, potentially also fill out an organ donor card. However, we don’t have any measurable numbers for that.
Such an event of course cannot be repeated all the time. It does not happen very often that a publicly well-known person decides to do a living organ donation for a loved one. This draws attention to the topic for a limited amount of time. The rest of the time, we of course also need to increasingly educate people, inform them, encourage conversations and discussion in families and with friends, so people continue to feel motivated to deal with this topic and complete an organ donor card.
MEDICA.de: Can you briefly describe what the most important steps are to be able to carry out an organ donation after death?
First of all, someone who completed an organ donor card needs to be in a position to actually become an organ donor. Currently we have a situation where 400,000 patients die in German hospitals each year and roughly one percent, about 4000 people, dies of brain death. And only those patients can be considered for harvesting organs, because brain death is the medical prerequisite for someone to become a donor. If such a situation arises, two physicians have to independently of each other diagnose brain death, so the greatest possible amount of objectiveness is being warranted. These physicians cannot have anything to do with the transplant themselves.
MEDICA.de: What job do the individual physicians at the hospital have?
Pott: At first physicians need to identify the patient as a potential donor. If it is suspected that the patient might be brain dead, a diagnosis of brain death needs to promptly be initiated. In the case of a positive diagnosis, the doctors in the hospitals send a message to the German Foundation of Organ Transplantation, which then notifies the European coordinating center Eurotransplant.
Unfortunately, they do not always take a close look at whether the patient can be considered for an organ donation, meaning whether he suffered brain death. That’s a shame, because many patients that die this way, cannot be considered for an organ transplant. Additionally, few people have documented their approvals for organ donation on a card. If a diagnosis of brain death occurs, physicians need to check whether there actually is a decision for an organ donation available. If that is not the case, they talk to the relatives. The closest surviving members of the family need to be asked if they know the probable wishes of the person that just passed away. And physicians also ask whether the patient was ready to agree to an organ donation.
MEDICA.de: The BZgA just started its new campaign ”Become an ORGANPATEN (ORGAN DONOR)“. Why is it so important to continue to sensitize the population about organ-and tissue donation?
Pott: We have a long waiting list of people that are waiting for an organ transplant. And then there are many people, who don’t have a completed organ donor car and also have not talked with their family and relatives on how they stand on the issue of organ donation. We would like to sensitize as many people as possible, so they consider this topic. That’s why the campaign addresses all questions about organ donation and all worries and fears. There are several offers. There are experts who are available to talk for the “ORGAN DONOR” campaign about the issue. There is an Internet offer, where you can play a part as an organ donor on the appropriate platform. We offer a multifaceted range of information, which includes all types of media.
The factors that influence the willingness to donate organs vary; ©panthermedia.net/Sven Weber
MEDICA.de: For many people, dying just like organ donation is an extremely personal subject. According to a BZgA sample survey, 75 percent of the general population do not have an organ donor card yet, and they cannot or don’t want to make a decision yet either. 47 percent of those that do not have an organ donor card yet, say they are worried about a potential misuse through organ trafficking. What kind of measures for instance do you use to reach those target groups that cannot reach a decision just yet?
Pott: Generally we know that people who are well informed, are more likely to complete an organ donor card and are less afraid of misuse through organ trafficking or have less fears that in the event of their death, not everything medically possible is being done for them.
We are counting on providing good information and education. Those are important prerequisites so people talk about the topic and if applicable then agree to an organ donation. And so we hope to reach many different people.
MEDICA.de: In some European countries there is the presumed consent model, for instance in Spain, Portugal and Austria. Does this create higher rates in organ donations?
Pott: A brief explanation about this – presumed consent is a regulation which by law regulates that everybody can become an organ donor, unless they explicitly decided against it. Depending on the country’s regulations, you need to carry this objection in writing with you or need to record it at a central registry for conflict resolution.
The factors that influence the willingness to donate organs vary. In some cases it is linked to the level of information, the knowledge, the availability of the organ donor card and the trust in the country-specific regulations. Above all, the structural situation in hospitals has an influence on the rate of organ donation. Based on our knowledge it is not so much a question of whether there is express or presumed consent. Physicians will inform relatives in any case and also ask them. If there is a situation of presumed consent and relatives object, you are faced with the same problem. So it is not just a deciding factor whether we have presumed consent, but rather how brain death diagnoses, the communication with the relatives, organ harvesting and the entire course of organ donation at a hospital is organized. That’s important.
Spain registers a particularly large number of organ donors. In the local hospitals there are specific in-house coordinators, who are exclusively in charge of organ donations. This means, there are specialists, who make this their principal task and thus make the topic of organ donation routine in Spanish hospitals. This is also due to the fact that there are a much larger number of coordinators working in Spain than in Germany. And these original in-house coordinators relieve the other hospital employees. The physicians and the nursing staff, who are already overburdened, do not have to deal with this topic. This task is taken on by the special employees, who are engaged in organ donation at the hospitals.
To add to this – and once again we know this from other countries, like for instance the United States – public campaigns can boost the population’s willingness to donate organs.
MEDICA.de: Currently it is being discussed whether it makes sense to record the willingness to donate in your ID card, driver’s license or the future electronic health card. What is your opinion on this subject?
Pott: We recommend trying to keep the organ donor card directly with your ID card. In the case of an accident or a critical situation, the organ donor card is then immediately available. It gets difficult if the ID card is at home in your drawer and a patient gets to the hospital and does not carry the card with him. It’s at first unclear, whether an organ donation can even be considered.
Since the new ID cards have been available since November 1st, it presents a great opportunity to inform about the topic of organ donation while handing out the ID cards. The corresponding passport offices therefore can order a certain allotment of organ donor cards and small information brochures.
MEDICA.de: What is the best argument to decide in favor of organ donation?
Pott: There only is one powerful argument: You can save lives by donating organs. If you are irretrievably dead and your organ can save somebody that otherwise has no chance to live, it is a very valid reason to donate an organ.
The interview was conducted by Diana Posth and translated by Elena O’Meara