Today, 36% of Germany's residents have an official donor card
As "Russkaya Germaniya" notes, today only 36% of Germany's residents have an official donor card (according to a survey commissioned by the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) this year). At the same time, medical statistics from last year indicate that the number of organ donations in the country reached a minimum: in 2017, 2,594 organs were donated in Germany, and the number of donors fell to 797 people. This is significantly less than in Poland, Switzerland, Austria, France, the USA, and Spain.
Five years ago, the Federal Medical Chamber (Bundesärztekammer) uncovered serious violations in a number of German liver transplant centers, which were systemic in nature: the violations concerned the allocation of donor organs. Inspectors reviewed 1,200 medical records, confirming that falsifications often occurred: false information from fake medical records was entered into the European organ transplant database Eurotransplant, causing certain patients to move up the waiting list for donor organs.
The manipulations occurred at the university clinics in Göttingen, Leipzig, Munich, and Münster, where internal organ transplants were performed. The court proceedings were widely covered, and sociological studies showed that potential donors were very skeptical of transplant surgeons and were not at all sure that donated organs would go to those most in need of a transplant.
As a result of the scandal that erupted at the time, Germans' willingness to become donors has become very low over the past five years, with only a relative increase between 2017 and 2018.
German legislation regarding donation differs markedly from other European countries. Since 2012, every resident of Germany with health insurance, upon reaching the age of 16, independently decides whether they want to become an organ donor. Those who express willingness receive a special document – a donor card, but consent can also be documented in a free-form document. At the same time, if a person did not express opposition during their lifetime, close relatives can give consent for the transplantation of their organs after death – but such a request does not occur automatically.
In the United Kingdom, Greece, Denmark, Lithuania, Romania, and Switzerland, a request to relatives is made in any case if the person did not leave instructions during their lifetime. In Belgium, Lithuania, Norway, Finland, and Estonia, the relatives of the deceased can object to organ donation. In 16 European countries (Austria, Bulgaria, Hungary, Ireland, Italy, Spain, Cyprus, Latvia, Liechtenstein, Luxembourg, Poland, Portugal, Slovakia, Slovenia, France, Czech Republic), every person becomes an organ donor if they did not clearly state during their lifetime that they are against transplantation and were not entered into the corresponding register of objectors.
The Netherlands went further: since the beginning of 2018, a rule has been in effect there according to which every adult is a potential organ donor.
Jens Spahn proposes that Germany follow the path of most European countries, making every person who did not express clear disagreement during their lifetime a potential organ donor by default – or if such disagreement was not expressed by close relatives after death.
There is a chronic shortage of donor organs in Germany, as well as willingness to become a donor; doctors describe the situation as dramatic. Every year, about a thousand people die without receiving an operation, even though organ transplantation could probably save these patients. Often, desperate patients try to find organ donors abroad, which often happens illegally and is almost always associated with health risks for the patient.
Preparation of the corresponding bill in the Ministry of Health is not yet underway: according to Spahn, the Ministry of Health wants to listen to the public debate. It turned out to be quite emotional: during the debates, it became clear that the idea of donation by default has many opponents. Many are concerned about the moral and ethical side of the issue. The church opposes it, and the skepticism of those who are not sure that a donor liver or kidney will not fall into the hands of fraudsters has not gone away.
Three-quarters of BZgA survey respondents at the time stated that the main motivating factor for a donor is altruism. And under coercion from the state, altruism no longer exists.
Who can become a donor?
The medical aspect of organ donation is no less important than the ethical one. Not everyone is suitable as a donor; simple consent is not enough. Organ donation is possible only if two doctors independently certify brain death – the complete cessation of activity of the hemispheres, cerebellum, and brain stem, without hope of recovery. In such a case, doctors will artificially maintain the activity of the circulatory system so that organs can be transplanted.
But death rarely occurs this way: much more often it occurs as a result of cardiac arrest, when blood circulation stops, making organ donation most often impossible.
A number of politicians state that coercion to organ donation by the state limits citizens' rights to personal freedom and self-determination, and that when the new rules come into force, the very concept of donation as a voluntary decision of an individual will disappear.