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Zeybek A, Le NS, Settmacher U, Koch M, Arbogast H, Ziganshyna S, Hahnenkamp K, Nashan B. Organ donation in Germany: opt-in vs. opt-out-opinions and voting patterns in the 19th German Bundestag. FRONTIERS IN TRANSPLANTATION 2025; 4:1526238. [PMID: 40084041 PMCID: PMC11903739 DOI: 10.3389/frtra.2025.1526238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 02/10/2025] [Indexed: 03/16/2025]
Abstract
In early 2024, 8,394 patients were waitlisted for solid organ transplantation in Germany. Long waiting times and declining donor numbers highlight the urgency for political measures to improve the organ donation system. This retrospective analysis examined the attitudes of the 19th German Bundestag members towards organ donation and their voting behavior on the opt-out system, which was decided on January 6, 2020. The results were analyzed in relation to party affiliation, age, gender, and educational background. Among members of parliament (MP), 34% were in favor for organ donation, 8% were critical, and 58% made no statement on organ donation at all. Younger members were less likely to express an opinion than older ones (p < 0.001). CDU/CSU (50%) and members of the SPD (48%) showed the highest approval, while The Green Party (39%) showed the lowest approval rate. AfD members had the highest abstention rate (96%, p < 0.001). SPD (66%, OR 33.24) and CDU/CSU (63%, OR 28.32) strongly supported the opt-out system, while AfD (94%) and The Green Party (88%) strongly rejected. Overwhelming majorities of the AfD (94%), The Green Party (89%), and FDP (81%) members who had not previously expressed an opinion to organ donation and legislation voted against the opt-out system, whereas majorities of SPD (66%) and CDU/CSU (66%) voted in favor. Most members who held opposing views on organ donation voted against the opt-out solution. Party affiliation was strongly correlated with both attitudes towards organ donation and voting behavior as well as a considerable lack of in-depth knowledge regarding transplant legislation. A fact-based discussion involving medical professionals, who play a key role in the organ donation process, is essential, along with a thorough understanding of the organ transplant law.
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Affiliation(s)
- Asli Zeybek
- Department of Internal Medicine, Zuger Kantonsspital, Baar, Switzerland
| | - Nguyen-Son Le
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Martina Koch
- Department of General, Visceral and Transplant Surgery, University Hospital Mainz, Mainz, Germany
| | - Helmut Arbogast
- Department of General, Visceral and Transplant Surgery, LMU-Clinic Munich – Campus Großhadern, München, Germany
| | - Svitlana Ziganshyna
- Organ Donation Coordinator Unit, University of Leipzig Medical Center, Leipzig, Germany
| | - Klaus Hahnenkamp
- Department of Anaesthesia, Intensive Care, Emergency and Pain Medicine, University Clinic Greifswald, Greifswald, Germany
| | - Björn Nashan
- Department of Hepato-Pancreatico-Biliary Surgery and the Transplantation Center, University of Sciences & Technology of China, Anhui, China
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Englbrecht JS, Bajohr C, Zarbock A, Stummer W, Holling M. A ten-year retrospective analysis of decompressive craniectomy or craniotomy after severe brain injury and its implications for donation after brain death. Sci Rep 2024; 14:15233. [PMID: 38956393 PMCID: PMC11219913 DOI: 10.1038/s41598-024-66129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
Craniotomy or decompressive craniectomy are among the therapeutic options to prevent or treat secondary damage after severe brain injury. The choice of procedure depends, among other things, on the type and severity of the initial injury. It remains controversial whether both procedures influence the neurological outcome differently. Thus, estimating the risk of brain herniation and death and consequently potential organ donation remains difficult. All patients at the University Hospital Münster for whom an isolated craniotomy or decompressive craniectomy was performed as a treatment after severe brain injury between 2013 and 2022 were retrospectively included. Proportion of survivors and deceased were evaluated. Deceased were further analyzed regarding anticoagulants, comorbidities, type of brain injury, potential and utilized donation after brain death. 595 patients were identified, 296 patients survived, and 299 deceased. Proportion of decompressive craniectomy was higher than craniotomy in survivors (89% vs. 11%, p < 0.001). Brain death was diagnosed in 12 deceased and 10 donations were utilized. Utilized donations were comparable after both procedures (5% vs. 2%, p = 0.194). Preserved brain stem reflexes as a reason against donation did not differ between decompressive craniectomy or craniotomy (32% vs. 29%, p = 0.470). Patients with severe brain injury were more likely to survive after decompressive craniectomy than craniotomy. Among the deceased, potential and utilized donations did not differ between both procedures. This suggests that brain death can occur independent of the previous neurosurgical procedure and that organ donation should always be considered in end-of-life decisions for patients with a fatal prognosis.
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Affiliation(s)
- Jan Sönke Englbrecht
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
| | - Charis Bajohr
- Department of Anesthesiology, Herz-Jesu-Hospital Münster-Hiltrup, Münster, Germany
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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M M, Attawar S, BN M, Tisekar O, Mohandas A. Ex vivo lung perfusion and the Organ Care System: a review. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:23-36. [PMID: 38725180 PMCID: PMC11075812 DOI: 10.4285/ctr.23.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/29/2024] [Accepted: 03/08/2024] [Indexed: 05/14/2024]
Abstract
With the increasing prevalence of heart failure and end-stage lung disease, there is a sustained interest in expanding the donor pool to alleviate the thoracic organ shortage crisis. Efforts to extend the standard donor criteria and to include donation after circulatory death have been made to increase the availability of suitable organs. Studies have demonstrated that outcomes with extended-criteria donors are comparable to those with standard-criteria donors. Another promising approach to augment the donor pool is the improvement of organ preservation techniques. Both ex vivo lung perfusion (EVLP) for the lungs and the Organ Care System (OCS, TransMedics) for the heart have shown encouraging results in preserving organs and extending ischemia time through the application of normothermic regional perfusion. EVLP has been effective in improving marginal or borderline lungs by preserving and reconditioning them. The use of OCS is associated with excellent short-term outcomes for cardiac allografts and has improved utilization rates of hearts from extended-criteria donors. While both EVLP and OCS have successfully transitioned from research to clinical practice, the costs associated with commercially available systems and consumables must be considered. The ex vivo perfusion platform, which includes both EVLP and OCS, holds the potential for diverse and innovative therapies, thereby transforming the landscape of thoracic organ transplantation.
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Affiliation(s)
- Menander M
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Sandeep Attawar
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Mahesh BN
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Owais Tisekar
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
| | - Anoop Mohandas
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences (KIMS) Hospital, Secunderabad, India
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Cruz Mususú W, García-Lopez A, Lozano-Suarez N, Gómez-Montero A, Orellano-Salas M, Vargas-Pérez L, Escobar-Chaves X, Girón-Luque F. Understanding the dynamics of deceased organ donation and utilization in Colombia. Rev Panam Salud Publica 2024; 48:e24. [PMID: 38464873 PMCID: PMC10921909 DOI: 10.26633/rpsp.2024.24] [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] [Received: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
Objective To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.
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Affiliation(s)
| | - Andrea García-Lopez
- Colombiana de TrasplantesBogotáColombiaColombiana de Trasplantes, Bogotá, Colombia
| | | | - Andrea Gómez-Montero
- Colombiana de TrasplantesBogotáColombiaColombiana de Trasplantes, Bogotá, Colombia
| | | | | | | | - Fernando Girón-Luque
- Colombiana de TrasplantesBogotáColombiaColombiana de Trasplantes, Bogotá, Colombia
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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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