More than 10,000 seriously ill people, including many children, are currently waiting for a donor organ. For these, it is often the only possible life-saving measure. About one third of patients whose heart, liver or lungs fail will not win the race against time and succumb to their disease before a suitable donor organ is available. A successful transplant can save lives, but in other cases it can also improve the quality of life of those suffering from the disease to an otherwise unachievable degree. Anyone who knows the ordeal of a sufferer can imagine what a transplant means to them – it is felt like a new life.
More patients than available donor organs
The gap between available donor organs and patients in urgent need of a transplant is widening as more patients face a stagnating number of available organs. Of the approximately 80,000 dialysis patients, for example, nearly 8,000 have been placed on the transplant waiting list. Their number is almost four times the number of organs transplanted per year: 1,921 kidneys were transferred in Germany in 2017. Currently, the average waiting time for a kidney is about six years. Although about 80 percent of the population is in favor of organ donation, only a few clearly document it with an organ donor card. In 2017, a historic low was reached: only 797 Germans donated organs after their death (source: German Foundation for Organ Transplantation).
Successes of transplant medicine
Meanwhile, the transfer of organs and tissues is part of the standard of medical care for the population. Nevertheless, even these do not usually proceed without complications. In particular, the complicated transfer of small intestine is an extremely risky procedure, whereas kidney transplantation has the highest success rate, with a 1-year survival rate of approximately 90 percent and a 5-year functional rate of 70 percent, respectively. Kidney transplants are so successful because kidneys can be kept functioning outside the organism for a relatively long time after removal, so that an analysis of HLA characteristics and matching with the recipient can be performed. In the case of the heart, liver, lungs, and pancreas, there is not enough time for this typing, so blood group analysis must be used. Other factors that influence the success of a transplant are primarily the recipient’s health status.
Organ failure due to the body’s own defense response.
The main reason for organ failure is the body’s defense reactions against the organ recognized as foreign. The rejection must be suppressed with drugs from the beginning. Despite this measure, the defense reactions against the transplant become stronger over time, so that the foreign organ can be destroyed. It may then be necessary to transplant again. On the other hand, these drugs reduce the body’s defenses against infections and malignant diseases or have organ-toxic effects themselves, so that complications may also arise as a result.
Organ survival and function rates after transplantation.
The following is an overview of the survival or function rates of various organs after a transplant has been performed.
| 1-year survival rate | 5-year survival rate | |
|---|---|---|
| Kidney | 90 % | 70 % |
| Heart | 80 % | 60 % |
| Liver | 68% (function) | 59 % |
| Lungs | 70 % | 44 % |
| Pancreas | 40% – 80% (function) | 64 % |
No figures are available for the success rate of tissues that can be transplanted, such as parts of the skin, cornea of the eyes, ossicles, heart valves, and parts of blood vessels, meninges, bone tissue, cartilage tissue, and tendons.
Legal basis: the Transplantation Act
The Transplantation Law, which came into force on December 01, 1997, regulates the following:
- The donation during life or after death.
- The removal and transfer of organs, organ parts and tissues to other people
- Preparation of these measures
The aim of the law is to prevent organ trafficking.Therefore, it also prescribes a strict separation of responsibilities for organ removal and organ procurement. The German Medical Association issues guidelines:
- On the waiting list and organ procurement
- On investigations for the protection of the recipient
- To determine the brain death
- For quality assurance
Under this law, organ donation will also be possible if there is no clear expression of the will of the deceased, but the relatives can be asked about the presumed will (extended consent solution). If they cannot be reached, organs may not be removed.
Organ donor card: relieving the burden on relatives
Often, relatives are overwhelmed with this decision, which usually has to be made as quickly as possible. In view of the psychological stress caused by the unexpected death of a loved one, an all too understandable reaction. In order to relieve those close to them of such decision-making difficulties, everyone should think about how to proceed after their death while they are still alive and record this in the organ donor card and discuss it with their relatives. Of course, the decision can be changed at any time.
Procedure for organ donation
Organ donors are usually accident victims with severe craniocerebral injuries or patients with brain hemorrhages who are admitted to an intensive care unit. In these patients, brain death occurs, i.e. irreversible failure of all brain functions, but not cardiac arrest under artificial respiration and drug support. Brain death must be determined independently by two physicians qualified to do so. These physicians may not be involved in the removal or transfer of organs, nor be subject to the instructions of any physician involved. If the deceased does not have a declaration of organ donation with him or her, the relatives are questioned about the presumed will of the deceased. If they decide against organ donation, machine ventilation is switched off immediately; if they consent, it is switched off hours after the organs have been removed. If the cause of death is unnatural, such as an accident, the body must still be cleared for burial by the public prosecutor’s office.
Who organizes organ transplantation?
The intensive care unit informs the German Organ Transplant Foundation, which arranges for the necessary tests to be performed, the organs to be removed, and the organs to be transported. In addition, the ICU informs the organ procurement center Eurotransplant, which maintains waiting lists for organ recipients in Germany, Austria, the Benelux countries, and Slovenia. The latter identifies suitable recipients, notifies the transplant centers, and coordinates the schedule for organ removal and transfer.
Which organs can be donated?
The organ donor card can indicate whether to consent to organ donation, decline donation, or transfer the decision to another person. The donation can be limited to certain organs or it can be declared which organs should not be removed. The following organs and tissues can be donated:
- Heart
- Lungs
- Liver
- Kidneys
- Pancreas
- Parts of the skin
- The cornea of the eyes
- Ossicles
- Heart valves
- Parts of the blood vessels, meninges, bone tissue, cartilage tissue and tendons.
The high-risk small bowel transfer is very rarely performed in Germany.
Transplantation of tissue
In general, tissues are transplanted more often than organs. Transplants of tissue also cause complications less often than organ transplants. In addition, tissue can still be donated up to 72 hours after clinical death, which is not the case with organ donation. With 6,000 corneal transplants per year, this is the most commonly transplanted tissue in Germany. The cornea is the transparent part in front of the pupil and is crucial for vision. People with clouded or injured corneas can be given new vision through transplantation.
Biological age is the determining factor in organ donations
The age of the donor is not decisive in organ donation. The only important factors are the biological age, i.e. the individual’s state of health, and the functional capability of the organs or tissue, respectively, as determined by the physician at the time of removal.While it is generally true that younger deceased people have more organs and tissues suitable for transplantation, healthy and fit older people can also donate functional organs. However, while there is an upper age limit of 65 years for the donation of ligaments and tendons, there is no such limit for tissue types such as bone or cornea. For skin donation, there is an age limit of 75 years. For children up to 14 years of age, the decision to donate an organ or tissue rests with the parents.
Where can I get an organ donor card?
The organ donor card is available free of charge from health insurance companies, health offices and many pharmacies and doctors’ offices, or can be requested via the information telephone of the Federal Center for Health Education and the German Foundation for Organ Transplantation at 0800/ 90 40 400. This ID card can be printed out on the website of the Federal Center for Health Education.
Church support: organ donation as an act of charity
The decision to make one’s organs available to others after death is also seen and supported by the church as an act of charity. Thus, even after one’s death, one can give one or even more other people the chance of a new life.
