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Englbrecht JS, Schrader D, Alders JB, Schäfer M, Soehle M. Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis. Front Public Health 2024; 12:1356285. [PMID: 38444435 PMCID: PMC10912160 DOI: 10.3389/fpubh.2024.1356285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction The COVID-19 pandemic had a negative impact on the number of solid organ transplantations. After a global decline of 16% in 2020, their numbers subsequently returned to pre-pandemic levels. In contrast, numbers in Germany remained almost constant in 2020 and 2021 but fell by 6.9% in 2022. The reasons for this divergent development are unknown. Methods The number of deceased with a severe brain damage, potential and utilized donors after braindeath and the intensive care unit treatment capacity were retrospectively compared for the years 2022 and 2021 at five university hospitals in North Rhine-Westphalia, Germany. Reasons for a donation not utilized were reviewed. To enable a comparison of the results with the whole of Germany and the pre-pandemic period, numbers of potential and utilized donors were extracted from official organ donation activity reports of all harvesting hospitals in Germany for the years 2019-2022. Results The numbers of deceased with a severe brain damage (-10%), potential (-9%), and utilized donors after braindeath (-44%), and intensive care unit treatment capacities (-7.2%) were significantly lower in 2022 than 2021. A COVID-19 infection was a rarer (-79%), but donor instability (+44%) a more frequent reason against donation in 2022, whereas preserved brain stem reflexes remained the most frequent reason in both years (54%). Overall numbers of potential and utilized donations in Germany were lower in 2022 than in the pre-pandemic period, but this was mainly due to lower numbers in hospitals of lower care. The number of potential donors in all university hospitals were higher in 2022 but utilized donations still lower than in 2019. Conclusion The decrease in potential and utilized donations was a result of reduced intensive care unit treatment capacities and a lower conversion rate at the five university hospitals. A COVID-19 infection did not play a role in 2022. These results indicate that ICU treatment capacities must be restored to increase donations. The lower number of potential donors and the even lower conversion rate in 2022 throughout Germany show that restructuring the organ procurement process in Germany needs to be discussed to increase the number of donations.
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Affiliation(s)
- Jan Sönke Englbrecht
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel Schrader
- The Medical Director's Staff Division of Organ Donation Coordination, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jörg Benedikt Alders
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Melanie Schäfer
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Martin Soehle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Englbrecht JS, Schrader D, Kraus H, Schäfer M, Schedler D, Bach F, Soehle M. How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia. Transpl Int 2023; 36:11186. [PMID: 37252613 PMCID: PMC10211426 DOI: 10.3389/ti.2023.11186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023]
Abstract
Organ donation after brain death is constantly lower in Germany compared to other countries. Instead, representative surveys show a positive attitude towards donation. Why this does not translate into more donations remains questionable. We retrospectively analyzed all potential brain dead donors treated in the university hospitals of Aachen, Bielefeld, Bonn, Essen, Düsseldorf, Cologne and Münster between June 2020 and July 2021. 300 potential brain dead donors were identified. Donation was utilized in 69 cases (23%). Refused consent (n = 190), and failed utilization despite consent (n = 41) were reasons for a donation not realized. Consent was significantly higher in potential donors with a known attitude towards donation (n = 94) compared to a decision by family members (n = 195) (49% vs. 33%, p = 0.012). The potential donor´s age, status of interviewer, and the timing of the interview with decision-makers had no influence on consent rates, and it was comparable between hospitals. Refused consent was the predominant reason for a donation not utilized. Consent rate was lower than in surveys, only a known attitude towards donation had a significant positive influence. This indicates that survey results do not translate well into everyday clinical practice and promoting a previously documented decision on organ donation is important.
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Affiliation(s)
| | | | | | | | | | - Friedhelm Bach
- Protestant Hospital Bethel (EvKB), Bielefeld, Germany
- Medical School OWL, Bielefeld University, Bielefeld, Germany
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Williment C, Beaulieu L, Clarkson A, Gunderson S, Hartell D, Escoto M, Ippersiel R, Powell L, Kirste G, Nathan HM, Opdam H, Weiss MJ. Organ Donation Organization Architecture: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1440. [PMID: 37138552 PMCID: PMC10150918 DOI: 10.1097/txd.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
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Affiliation(s)
- Claire Williment
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - Anthony Clarkson
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - David Hartell
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Richard Ippersiel
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Linda Powell
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Gunter Kirste
- Albert Ludwigs University Freiburg, Medical Center, Freiburg, Germany
| | | | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, Australia
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Gift of Life Donor Program, Philadelphia, PA
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
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4
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Felder S, Fischer P, Böhler K, Angermair S, Treskatsch S, Witte W. [Anaesthesiological management of postmortem organ donors - What Evidence is Out There?]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:183-193. [PMID: 36958314 DOI: 10.1055/a-1839-5014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The transplantation of organs from postmortem organ donors has been a lifesaving and quality-of-life-improving therapy for patients with irreversible organ failure for many years. In Germany, however, there has been an imbalance between the number of organs donated postmortem and the number of patients on the waiting list for years. The anesthesiological management of multiple organ harvesting (MOE) in postmortem organ donors is not an everyday challenge for various reasons: A lack of practical expertise due to the small number of MOE, even at university hospitals (usually < 20 per year), complex pathophysiological changes in the cardiovascular system and other organ functions of the postmortem organ donor and the lack of guidelines complicate anesthesiological management. This paper compiles the existing literature and reviews whether evidence-based recommendations can be derived for anesthesiologic management for MOE.
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5
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[Organ donation after determination of brain death : Legal aspects and practical approach]. DIE ANAESTHESIOLOGIE 2023; 72:67-78. [PMID: 36637499 PMCID: PMC9839225 DOI: 10.1007/s00101-022-01241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/14/2023]
Abstract
The prerequisites for post-mortem organ donation in Germany include the determination of irreversible loss of brain function, consent to organ donation, and the exclusion of medical contraindications. In addition, mainly because of the shortage of donor organs in Germany and the sometimes controversial social and media discussions on the topic of organ donation, all physicians involved in the donation process must be familiar with the relevant laws, guidelines, and procedural instructions. This applies especially to those who are to carry out the verification of irreversible brain death. Only then, can they act safely in this challenging situation and serve as competent consultants for all involved.
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Heise M, Bechstein WO. [Not Available]. Zentralbl Chir 2022; 147:413-418. [PMID: 36220061 DOI: 10.1055/a-1904-1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ZusammenfassungDie Transplantation ist eine effiziente und standardisierte Therapie in der Behandlung des irreversiblen Organversagens. Damit möglichst viele geeignete Patienten in Deutschland von
dieser Therapieoption profitieren, muss der im internationalen Vergleich niedrige Organmangel in Deutschland als ein zentrales Problem der Transplantationsmedizin behoben werden.
Die Ursachenanalyse des Organmangels führte zu Änderungen im Gesetz über die Spende, Entnahme und Übertragung von Organen und Gewebe (Transplantationsgesetz – TPG), welche
konsekutiv Prozessanpassungen und Strukturverbesserungen der Rahmenbedingungen der Organspende in Deutschland zur Folge hatten und zu einer Steigerung der Organspenderzahlen
beitragen sollten. Die aktuellen Organspenderzahlen zeigen, dass die angestoßenen strukturellen Maßnahmen kurzfristig nicht zu einer Trendwende führten. Das geänderte
Transplantationsgesetz wird aber nur dann langfristige Effekte erzielen, wenn die gemeinschaftliche Aufgabe zur Organspende in der deutschen Gesellschaft breiten Konsens findet.
Ein rationaler öffentlicher Diskurs in Deutschland über die Optionen zur Behebung des Organspendemangels – dazu gehören auch die Widerspruchslösung und die Organspende nach Herz-
und Kreislauftod (DCD) – ist dringend geboten.
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Affiliation(s)
- Michael Heise
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Wolf Otto Bechstein
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
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Fehring Z, Boehme P, Wirth S, Prinz C, Fehring L. [GPs education about organ donation: what factors influence the success?]. MMW Fortschr Med 2022; 164:3-10. [PMID: 35449486 DOI: 10.1007/s15006-022-0854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND According to the new legislation on organ donation in Germany, general practitioners (GPs) should regularly inform and educate their patients about organ donation from March 1, 2022. This is because of the persistently low organ donation rate in Germany. So far, there is a lack of information about the factors influencing the medical education of patients regarding organ donation provided by GPs. METHOD GPs were surveyed via a web-based questionnaire in November and December 2021. 215 data sets have been utilized. RESULTS GPs see themselves in charge for educating people about organ donation (86%). However, most of them invest little time in educating patients. 75% of GPs think that there is no time available for educational talks in the daily routine and 80% perceive difficulties in raising the issue of organ donation due to social taboos. Only 24% of GPs are aware of the new legislation. Only half of the respondents feel sufficiently informed to provide information about organ donation. On average, GPs consider a reimbursement of about 40 euros to be appropriate. CONCLUSIONS GPs have not dealt much with the topic of organ donation and need more comprehensive information for the education of patients. GPs require more time to accommodate education in everyday life. Younger citizens can only be reached by GPs to a limited extent. This group must be addressed by other means.
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Affiliation(s)
- Zoë Fehring
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Philip Boehme
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | | | | | - Leonard Fehring
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
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8
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[New German laws on organ donation-clinicians' perspectives on effects, potential and limitations]. Urologe A 2021; 60:1570-1578. [PMID: 34643759 PMCID: PMC8654720 DOI: 10.1007/s00120-021-01645-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND The new German laws on organ donation of 2019 and 2020 intend to increase the organ donation rate. They include the optimization of organizational structures, the introduction of an online registry to document the patient's will and measures to improve information of the public. To date, little is known about clinicians' perspectives on these new laws. METHODS We conducted a two-stage sequential-mixed-method study. As part of an online survey, 1235 physicians from more than 90 hospitals throughout Germany participated. RESULTS Many clinicians name structural deficits as causes for the low donation rate in Germany. Less than half of the physicians who are exposed to organ donors regularly consider themselves to be adequately educated about organ donation. Physicians' educational discussions with patients have a significant influence on patients' decision-making but are rarely provided by doctors. In the decision-making situation, relatives are often overwhelmed because they have dealt with the topics of death and organ donation too little during their lifetime. General practitioners play a key role in educating and informing the population. Only a few respondents expect a positive impact on the organ donation rate by the introduction of an online donation registry. CONCLUSION With the latest legislation, the most relevant structural deficits named by physicians have been addressed. An additional increase in organ donation rate could be achieved through professionalized care for relatives. A more frequent public discussion about death and organ donation could facilitate decision-making by relatives in individual cases.
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Griffin C, Vilain R, King S, Nixon S, Gooley A, Bray S, Lynam J, Walker MM, Scott RJ, Paul C. Mind Over Matter: Confronting Challenges in Post-Mortem Brain Biobanking for Glioblastoma Multiforme. Biomark Insights 2021; 16:11772719211013359. [PMID: 35173408 PMCID: PMC8842456 DOI: 10.1177/11772719211013359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Over the past 10 years, there has been limited progress for the treatment of brain cancer and outcomes for patients are not much improved. For brain cancer researchers, a major obstacle to biomarker driven research is limited access to brain cancer tissue for research purposes. The Mark Hughes Foundation Brain Biobank is one of the first post-mortem adult brain banks in Australia to operate with protocols specifically developed for brain cancer. Located within the Hunter New England Local Health District and operated by Hunter Cancer Biobank, the boundaries of service provided by the Brain Bank extend well into the surrounding regional and rural areas of the Local Health District and beyond. Brain cancer biobanking is challenging. There are conflicting international guidelines for best practice and unanswered questions relating to scientific, psychosocial and operational practices. To address this challenge, a best practice model was developed, informed by a consensus of existing data but with consideration of the difficulties associated with operating in regional or resource poor settings. The regional application of this model was challenged following the presentation of a donor located in a remote area, 380km away from the biobank. This required biobank staff to overcome numerous obstacles including long distance patient transport, lack of palliative care staff, death in the home and limited rural outreach services. Through the establishment of shared goals, contingency planning and the development of an informal infrastructure, the donation was facilitated within the required timeframe. This experience demonstrates the importance of collaboration and networking to overcome resource insufficiency and geographical challenges in rural cancer research programmes.
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Affiliation(s)
- Cassandra Griffin
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Ricardo Vilain
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Simon King
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Research Alliance
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Sandy Nixon
- Division of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Alisha Gooley
- Division of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Samara Bray
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - James Lynam
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Rodney J Scott
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, Australia
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Hoffmann OM, Dinse C, Masuhr F. [Diagnostics of irreversible brain death : Limitations and potential for improvement from the perspective of transplantation officials]. Anaesthesist 2020; 70:563-572. [PMID: 33337528 DOI: 10.1007/s00101-020-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Germany, postmortem organ donation requires a diagnosis of irreversible brain death (BD) in strict compliance with the guidelines of the German Medical Association. OBJECTIVE Identification of factors that have a limiting effect on the initiation and execution of BD diagnostics. Identification of potential for improvement. MATERIAL AND METHODS Anonymous survey of transplantation officials in hospitals in Berlin, Brandenburg and Mecklenburg-Western Pomerania. RESULTS There is considerable heterogeneity with respect to the frequency of BD diagnostics and hospital-specific procedures, including the use of an existing consultation service. The local availability of qualified doctors and of suitable ancillary diagnostic tests has a structurally limiting effect. This is especially true for pediatric patients. Potential for improvement was seen in the identification of affected patients, the motivation of staff and the role of transplantation officials. CONCLUSION According to the recently amended German Transplantation Act, a centrally organized consultation service for BD diagnostics must be implemented as soon as 2021. Recommendations can be derived from the present survey and from the experience of the regionally established consultation service. In addition to neurological and neurosurgical expertise, qualified pediatricians and mobile ancillary instrumental diagnostics should also be provided. Expert advice from neurointensive care physicians should be available at an early stage in order to identify potentially affected patients. The highly variable participation of hospitals in organ donation, despite the availability of an expert diagnostic service free of charge, points to an important role of additional factors, some of which may be nonmedical in nature.
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Affiliation(s)
- Olaf Martin Hoffmann
- Klinik für Neurologie, Alexianer St. Josefs-Krankenhaus Potsdam, Allee nach Sanssouci 7, 14471, Potsdam, Deutschland.
| | - Corinna Dinse
- Klinik für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Florian Masuhr
- Klinik für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
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