What is organ donation?
Organ donation is the transfer of an organ or parts of an organ from an organ donor to a recipient. The aim is either to enable a sick person to survive or to improve his or her quality of life. If you want to become an organ donor, all you have to do is document your decision in writing, for example in an organ donor card. Also discuss your wishes with your relatives.
Further information: Organ donor card
You can read why it makes sense to fill out an organ donor card and where you can get one in the article Organ Donor Card.
A distinction is made between post-mortem organ donation and living donation: Postmortem organ donation refers to the donation of organs after death. The prerequisite is the clear determination of brain death in the donor. In addition, there must be consent from the deceased himself or his relatives.
- Spouse, fiancées, registered partners
- First or second degree relatives
- other persons close to the donor
In addition, living donation must be voluntary and may only be offered by persons of legal age.
Which organs can be donated?
Basically, the following organs can be used as donor organs:
Apart from organ donations, patients can also benefit from tissue donations. These include:
- Cornea of the eyes
- Heart valves
- @ Skin
- Blood vessels
- Bone, cartilage and soft tissue
Organ donation: Age limit
To be allowed to donate organs, only the condition of the organs is decisive, not the biological age. Of course, the health of younger people is often better than that of seniors, but even the functioning organ of a 70-year-old can be successfully transplanted. This is especially true when the organ goes to an older recipient.
Organ donation: Criticism
There is a rather skeptical attitude towards organ donation among the population. Criticism has been triggered in recent years primarily by organ donation scandals in which patients were given preference in organ allocation by manipulating the waiting list. In the course of this, the Transplantation Act was revised in 1997 with the aim of increasing transparency in organ allocation. In particular, the penalties for physicians who deliberately violate the guidelines were also increased: such physicians can now be prosecuted with a fine or imprisonment of up to two years.
Organ allocation via the Eurotransplant Foundation is based on the urgency and likelihood of success of a transplant. The financial situation of the recipient plays no role. The Transplantation Act also prohibits organ trafficking and makes both the sale of an organ and the receipt of a purchased organ punishable.
Organ removal always takes place with the same surgical care as an operation on a living patient. After the procedure, the surgeon reseals the cadaver and the body is handed over to the relatives without disfiguring injuries.
Organ donation: Ethics
The issue of organ donation raises many ethical issues, including in particular whether a person’s brain death justifies the removal of his or her organs. In 2015 (last amendment 2021), the German Ethics Council issued a statement on this matter in which it considers organ removal for transplantation purposes to be acceptable – provided consent is given by the donor or the donor’s relatives.
Organ donation: Pros and cons
The motivations for deciding for or against organ donation are manifold. Common reasons for refusal are a lack of trust in the allocation system or – in the case of living donations – fears of disfigurement or health disadvantages. Spiritual or religious reasons usually do not play a role, since none of the larger religious communities in Germany has so far spoken out against organ donation.
For many relatives of dead organ donors, the knowledge that they have helped a sick person with the donor organs helps them cope with the grief of losing a loved one.
Organs of a deceased person may only be removed if the person concerned has expressly permitted this during his or her lifetime or if the surviving relatives explicitly consent to organ donation. Apart from Germany, this regulation also applies in Northern Ireland. An extended consent regulation, in which the next of kin or authorized representatives decide if there is no documentation of the deceased person, exists in Denmark, Ireland, Iceland, Lithuania, Romania, Switzerland, and the United Kingdom.
Many other countries (e.g. Spain, Italy, Austria, Hungary, England with Wales and Scotland) follow the objection rule: here, every deceased person becomes an organ donor if he or she has not expressly decided against it during his or her lifetime and also documented this in writing. The relatives have no say in the matter.
When do you need an organ donation?
Organ donation is often the only life-saving treatment for chronic or sudden organ failure. Organ donation may be considered in some circumstances for the following medical conditions:
- End-stage liver cirrhosis
- Liver cancer
- severe organ damage due to iron storage disease (hemochromatosis) or copper storage disease (Wilson’s disease)
- current liver failure (mushroom poisoning, diseases and malformations of the bile ducts)
- diabetes mellitus (type I or type II) with kidney damage
- polycystic kidney disease
- chronic nephritic syndrome (a disease of the kidneys)
- congenital heart defects
- valvular heart disease
- coronary heart disease (CHD)
- heart muscle disease (cardiomyopathy)
- cardiac insufficiency (heart failure)
- functional disorders of the intestine
- chronic obstructive pulmonary disease (COPD)
- pulmonary fibrosis
- cystic fibrosis
- sarcoidosis
- “pulmonary hypertension” (pulmonary hypertension)
What do you do when you donate an organ?
Procedure for post-mortem organ donation
Before a patient can be considered as a donor, brain death must be clearly established. For this purpose, the physician informs the German Foundation for Organ Donation (DSO), which then refers independent neurologists to determine brain death. According to the Transplantation Act, two doctors must independently determine brain death in the patient. This is done according to a fixed three-stage scheme:
- Evidence of severe, incurable and irreversible damage to the brain.
- Determination of unconsciousness, the ability to breathe on one’s own, and the failure of reflexes controlled by the brain stem
- Verification of irreversible brain damage by examinations after prescribed waiting periods
The doctors record the course of the examinations and their results in a protocol sheet, which can also be viewed by the relatives of the deceased.
If consent to organ donation has been given (by the patient or his or her relatives), DSO arranges for various laboratory tests to be carried out on the deceased. These serve to rule out infectious diseases that could be transmitted to a donor. Blood group, tissue characteristics and the functionality of the organ to be donated are also tested. In addition, the DSO informs Eurotransplant, which searches for a suitable recipient according to medical criteria such as the likelihood of success and the urgency of the transplant.
Procedure of living donation
Are you thinking about donating an organ to a loved one? Then you should first contact the doctors in charge at the transplantation or dialysis center. In an initial discussion, it can be clarified whether a living donation is actually possible in the case in question. The final authority in this examination is the Living Donation Commission, which is usually affiliated with the state medical association.
First, the surgeon begins with the removal of the donor organ. Shortly before the end of the procedure, the recipient’s operation begins in parallel so that the donor organ can be implanted directly with the least possible loss of time.
What are the risks of organ donation?
The removal of an organ or part of an organ involves general risks for a living donor, as they can occur in any operation:
- Wound healing problems
- @ Scarring with unaesthetic results
- Bleeding @
- Injury to nerves
- Wound infection
- Anesthetic incidents
It has not yet been clarified whether patients increase their risk of suffering from high blood pressure or an increasing loss of protein in the urine (proteinuria) as a result of kidney donation.
What do I have to consider after organ donation?
The transplant center is a central point of contact for living donors and family members before and after organ donation.
After post-mortem organ donation
After living donation
If no complications arise, as a donor you may go home after ten to 14 days. After a kidney or liver donation, you must expect to be unable to work for about one to three months – depending on the physical strain of your job.
The organ recipient must stay in the hospital longer so that it can be monitored and checked whether the new organ is resuming its work.
As a donor, you do not usually have to expect long-term health problems. Regular examinations ensure that any late effects of organ removal can be detected and treated in time. Ask at the transplant center for advice on the intervals at which you should go for follow-up care after organ donation.
