German Organ Research Articles

Computed tomography angiography in the diagnosis of brain death: Implementation and results in Germany.

Computed tomography angiography (CTA) has been investigated as a confirmatory study (CS) for the diagnosis of brain death (BD). International consensus regarding its use, study parameters, and evaluation criteria is lacking. In the German BD guideline, a CTA protocol was first introduced in 2015. The authors obtained a comprehensive dataset of all BD examinations in adults from the German organ procurement organization to investigate implementation, results, and impact of CTA on BD determination during the first 4 years. In 5152 patients with clinically absent brain function, 1272 CTA were reported by 676 hospitals. Use of CTA increased from 17.2% of patients in the first year to 29.7% in the final year. CTA replaced other CS such as electroencephalography without increasing overall CS frequency. Technical failure was rare (0.9%); 89.3% of studies were positive. Negative results (9.8%) were more frequent with secondary brain injury, longer duration of the clinical BD syndrome, or unreliable clinical assessment. Median time to diagnosis was longer with CTA (2.6 h) versus other CS (1.6 h). CTA had no differential impact on the rate of confirmed BD and did not improve access of small hospitals to CS for BD determination. CTA expands the range of available CS for the diagnosis of BD in adults. Real-world evidence from a large cohort confirms usability of the German CTA protocol within the guideline-specified context.

Neo-classical Etude for Flute Solo: Evaluation of Karg Elert “op.107 no.30 Chaconne” in Terms of Technique and Pedagogy

Sigfrid Karg-Elert, one of the German organ composers of the 20th century, introduced the etudes titled 30 Caprices for Flute Solo Op. 107 into the flute education repertoire to meet the technical demands of the period’s orchestral music and flute repertoire. Among these etudes, no.30 Chaconne is a concert etude combining elements that require advanced technique with musical expression and style. This research, which aims to examine Karg-Elert’s op.107 no.30 Chaconne etude in terms of form, technique, and pedagogy, is a descriptive case study. A general form analysis of Chaconne was made in the first dimension of the research. Chaconne was examined from a technical perspective in the second dimension of the study. The techniques included in the etude are categorized as articulation technique, finger technique, sonority/embouchure technique, and ornaments. The techniques’ usage rates in the etude are determined by frequency and percentages. Among the various articulation techniques included in the etude, the legato technique has the highest usage rate, with 42.10%, and among the fingering techniques, chromatic scales had the highest at 30.26%. In sonority techniques, the usage rate of wide intervals of octave and above is very high at 39.47%. In this context, it has been determined that the most decisive difficulty in the etude comes from the use of wide intervals, and it has been concluded that a significant level of flexibility and embouchure control must be provided in the performance of the etude. The technical difficulties included in the etude were determined on a variation basis in the last dimension of the study, and a study guide consisting of original exercise suggestions was presented. This study is novel in the literature as it presents a study guide on Chaconne. Also, this study is thought to contribute to musical literacy by enabling performers to comprehend Karg Elert Chaconne multi-dimensionally.

Vigilance Data in Organ Donation and Solid Organ Transplantation in Germany: Six Years of Experience 2016-2022.

The reporting of serious adverse events (SAE) and serious adverse reactions (SAR) is an essential part of an effective vigilance and surveillance system (V&S) in organ donation and transplantation. All SAE and SAR reported to the German organ procurement organization (DSO) between 2016 and 2022 were analyzed. In case of a possible transmission of a disease to one or more recipients, an assessment of imputability was done according to the grading system of the US Disease Transmission Advisory Committee (DTAC). 543 SAE and SAR cases were reported to the DSO and analyzed in detail. 53 of the 543 reports (9.8%) were proven or probable (P/P) transmissions of infectious diseases, malignancies or other diseases to 75 recipients. Infections were the most frequently reported P/P disease transmission occurrences (30/53, 57%). In case of disease transmission, the mortality of the recipients was high (17/75, 23%), especially when a malignant disease was transmitted (11/22, 50 %). Donor-Derived disease transmission is a rare event (53/8,519; 0.6 %), but when it occurs can lead to significant morbidity and mortality.

Diagnosis of brain death in Germany-Implementation of the guidelines of the German Medical Association

The 4th update of the guidelines of the German Medical Association on the diagnosis of irreversible loss of brain function (brain death, BD) has introduced important new regulations regarding the required qualification of the examiners, approved procedures for ancillary testing, and aclarification regarding the sequencing of diagnostic steps. Investigation of the implementation and practical effects on the diagnosis of brain death. Descriptive evaluation of the routine documentation of the German Organ Procurement Organization, comparing the periods July 2011-June 2015 (3rd update) and July 2015-June 2019 (4th update). Patient numbers decreased from 6100 to 5403. The largest decrease affected hospitals without neurosurgery. Children were not affected. With the 4th update, clinical diagnostics were increasingly performed during on-call hours by external neurologists. Of the patients 83.8% now received ancillary tests compared to 80.1% previously. Computed tomography angiography (CTA), first introduced in the 4th update, was applied in 23.2% and established complete loss of cerebral circulation in 89.4%. The time between first documentation of the clinical signs of BD and certification of BD increased from 7.0 ± 12.7 h to 8.2 ± 14.2 h. The diagnosis was slightly less frequent with 95.3% compared to 96.6%. The updated standards were implemented in accordance with the guidelines. The demand for external consulting neurologists and neurosurgeons as well as the time required for BD assessment have increased. Negative effects on pediatric BD diagnostics were not apparent. CTA is widely and successfully used in adults as anew ancillary diagnostic procedure.

Die Musikalien des Hamburger Organisten Valentin Pralle († 1565)

Even though the manuscript Ms. Hans. III,4 of the Staats- und Universitätsbibliothek Hamburg has been missing since World War II, its descriptions by Johann Ludwig von Bouck and Hugo Leichsenring contribute valuable information about the music library of Valentin Pralle, organist at the Swedish court in 1542 and at St. Katharinen in Hamburg from 1542 until his death in 1565. The article identifies the intabulation sent in a letter by the organist Johan Kellner to Pralle in 1554 (one of the earliest manuscripts in “new” German organ tablature) as the five-part motet Respice in me et miserere mei deus by G. Domale, based either on the prints RISM 15511 or 155412. Furthermore, the antigraph of four Latin motets and ten French chansons, copied in partbooks by Pralle himself, can be identified as the Selectissimae necnon familiarissimae cantiones (RISM 15407). There was another set of partbooks with four hitherto unknown German songs for four and five voices of which at least the first (cited in a quodlibet by Melchior Franck first printed in RISM F 1651) is by Johann Stahel, of whom so far only one five-part secular song in the fifth volume of Georg Forster’s Frischen teutschen Liedlein has been known. The article furthermore discusses a fascicle with German and French songs with incipits of texts only, for which neither Bouk nor Leichsenring give any information concerning the notation. From a note by Otto Kade in his copy of Ludwig Senfl’s Wohl kumbt der Mai taken from RISM 153417, it is evident that Ms. Hans. III,4 contained monophonic versions of this and other songs of which some or at least their melodies are hitherto unknown.

Regional Differences in Waiting Times Before Kidney Transplantation in Germany.

In order to achieve short ischemia times between organ donation and transplantation, regional organ allocation has been assigned priority in the development of allocation rules for kidney transplantation. It is unclear whether this leads to differences in regional waiting times in Germany. A retrospective cohort study over a 24-month observation period was conducted, including all patients who received a kidney-only graft allocated via the standard Eurotransplant Kidney Allocation System (ETKAS) (n = 1487) or the Eurotransplant Senior Program (ESP) (n = 566). Multiple linear regression analyses were performed to investigate differences in waiting times across the regions (ETKAS) or subregions (ESP) as defined by the German Organ Procurement Organization (DSO). Associations between the number of regionally procured kidneys (n = 1444) and regional waiting times were investigated. In ETKAS, the median waiting time was 8.9 years (interquartile range [IQR] 6.7-10.6); in ESP, it was 3.9 (2.4 -5.3) years. Compared with the reference region with the shortest waiting time, waiting times in other regions were 0.6 to 1.7 years longer in ETKAS and 1.3 to 4.4 years longer in ESP. The ratio of the number of patients on the waiting list for a particular region to the number of organs donated in that region was associated with the waiting time in ETKAS (R2 = 0.70). In ESP, this association was markedly less pronounced (R2 = 0.45). In Germany, waiting times depend strongly on the region where a patient is listed for kidney transplantation, especially in ESP. These findings call the current allocation algorithms into question and imply a need for suitable modification.

뇌사 판정 논의와 장기이식법의 개선방안 연구

The Act on Organ Transplantation makes it possible to judge brain death with the consent of the bereaved family, even if the donor does not express his/her intention to donate in writing before death, as long as the donor does not express his/her intention to the contrary. Legislation on long-term donations is a new area that was created relatively recently and is still developing with the development of medical and life science technology. It can be said that it is meaningful to examine the current state of overseas legal systems and the content of legislation in order to identify and improve the problems of laws related to transplantation of organs and other organs. In particular, Germany had an organ transplant scandal (Organspende-Skandal) based on changes in organ transplantation, followed by institutional changes. On this basis, we examined the long-term harvest requirements and consent of the German organ transplantation law and derived some improvements in our organ transplantation law.
 First, as with the consent requirements for determining brain death, there is a problem as to whether or not the bereaved family can refuse the donation despite the donor's consent. If the bereaved family has inherent rights to the long-term donation after the donor's death, the bereaved family will naturally have the right to veto the long-term donation. In the Korean method of determining the scope of relatives, which does not allow such relatives to have the right of veto, it would be a problem to neglect the person's right to self-determination.
 The second is the scope of long-term donors and recipients. Under the Organ Transplantation Law, family members or bereaved families are the subjects of consent or refusal of long-term donation of organs from donors. German long-term transplant law stipulates that close relatives and decision-making authority must only be given to the donor if they have had personal contact within the last two years prior to death. there is That is, close relatives are primarily spouses or registered Lebenspartners, children, parents, siblings and grandparents. In addition, if an arrangement is made among close relatives and there are multiple close relatives in the same position, it is sufficient if one of them satisfies the above circumstances.

Impact of the SARS-CoV-2 Pandemic on Liver Surgery and Liver Transplantations in Germany

The SARS-CoV-2 pandemic has led to restrictions in surgical care worldwide and therefore also posed new challenges to liver surgery. The respective procedures often entail high perioperative risks and resource requirements. However, the indication for liver surgery is frequently without alternatives. To date, there is little knowledge about the impact of the pandemic on liver surgery in Germany. A retrospective data analysis of liver surgery procedures in Germany as well as transplantations was conducted. Evaluations were based on procedure codes recorded between 2010 and 2020 according to diagnosis-related groups (DRG) by the Federal Statistical Office of Germany (Destatis) and data from the German Organ Procurement Organization (Deutsche Stiftung Organtransplantation; DSO). According to DRG procedure codes relating to liver surgery recorded between 2010 and 2020 in Germany, the annual fluctuation for the first year of the pandemic 2020 remained comparable to previous years. Furthermore, the development of post-mortem liver transplantations as well as living liver donations remained stable in Germany in 2020 and 2021. The number of liver surgery procedures in Germany was subject to a dynamic development until 2020, without apparent changes in the first year of the SARS-CoV-2 pandemic. The most frequently performed liver procedures, as well as liver transplantations, remained stable with respect to their annually recorded numbers. Publication of data regarding procedures in liver surgery and transplantation in 2021 need to be awaited and analyzed to evaluate whether the observations presented in this article prove stable any further.

The German Organ Transplant Scandal - Unwritten rules of organizational wrongdoings

Using data from organ transplant medicine in Germany, we propose a method for understanding the content of unwritten rules supportive of violations of written rules in light of the “German Organ Transplant Scandal”. Grounded in the sociology of organizational crime, we reconstruct the cultural repertoires of medical professionals working with organ allocation when confronted with the applicable guidelines using collective mindset analysis. Four dimensions of cognitive and normative rules of interpretation were identified and discussed as a an occupational-professional form of deviance. Apart from not relying on data from the alleged perpetrators and still gazing at the latent structures of meaning behind misconduct, our approach offers a more general methodological framework for empirical studies of the unwritten rules at work in an organizational field where wrongdoing has been reported.

An Automated Electronic Screening Tool (DETECT) for the Detection of Potentially Irreversible Loss of Brain Function.

A major reason for the low number of organ donors in Germany is a deficit in the recognition of patients who may have impending irreversible loss of brain function (ILBF) in hospitals capable of organ retrieval. We used anonymized data from the German Organ Procurement Organization (Deutsche Stiftung Organtransplantation, DSO) to compare two 12-month periods (a reference period and an evaluation period) before and after the implementation of an electronic screening tool (DETECT) at the University Hospital Dresden (UKD) with four other university hospitals without tool implementation (comparative cohort). DETECT is intended to aid in the recognition of potentially impending ILBF. The study endpoints encompassed patients with potentially unrecognized ILBF, patients with recognized ILBF, organ donations performed, and reports to the DSO. Changes in absolute risk were compared with Breslow-Day tests. 309 patients who died with primary or secondary brain lesions were identified in the UKD in the reference and evaluation periods (164 and 145 patients, respectively), and 1060 (529, 531) in the comparative cohort. In the UKD, the number of unrecognized cases of possibly impending ILBF was 14/164 (8.54%) in the reference period and 1/145 (0.69%) in the evaluation period, yielding an absolute reduction of 7.85% (95% confidence interval [--3.36; --12.33]); by contrast, in the comparative cohort, there was a 0.55% absolute increase between the two periods ([--2.21; 3.30]; p = 0.002 for the comparison between the two cohorts). Only minor differences in absolute risk change were seen with regard to the probability of recognized ILBF (7.09% [0.29; 13.88] vs. 2.42% [1.18; 6.01]; p = 0.234), organ donation (4.70% [--0.89; 10.28] vs. 0.55% [--2.17; 3.26]; p = 0.214), or reporting to the DSO (4.17% [--1.77; 10.11] vs. 2.22% [--1.44; 5.89; p = 0.447); these changes may have arisen by chance. These findings suggest that the use of DETECT can help to reduce the deficit in the recognition of patients with impending or manifest ILBF.

The role of the the transplant coordinator

Alle Krankenhäuser, die nach dem Sozialgesetzbuch V als Entnahmekrankenhäuser definiert sind, sind verpflichtet, einen Transplantationsbeauftragten (TxB) zu stellen. Das Aufgabenfeld des TxB beinhaltet nicht nur die Spendererkennung, die Diagnose eines irreversiblen Hirnfunktionsausfalls sowie die Spenderevaluation und Organprotektion, sondern er begleitet den gesamten Organspendeprozess. Er verantwortet die Festlegung von innerklinischen Standards sowie die Organisation von Fort- und Weiterbildungen und ist Ansprechpartner rund um das Thema Organspende. Darüber hinaus fungiert er als Bindeglied zwischen der Koordinierungs- (Deutsche Stiftung Organtransplantation) und der Vermittlungsstelle (Eurotransplant). Seine Tätigkeit unterliegt dem Transplantationsgesetz und dessen Ausführungsgesetzen; er benötigt aber auch entsprechende Kenntnisse der verschiedenen Richtlinien zu Organspende bzw. -transplantation. Letztendlich ist der TxB auch für die Qualitätssicherung des Organspendeprozesses verantwortlich.

Agogiikka ja rekisteröiminen esittäjän keinovaroina saksalaisessa urkumusiikissa

The subject of my doctoral studies is the use of agogics in German organ music between the 17th and the 19th century. The repertoire of my five concerts proceeded chronologically in order to demonstrate the evolution of agogics. In my written thesis, I investigate my methods of choosing stops when performing German romantic music.

Clavier-Übung III by Johann SebastIan Bach – "German organ mass"

Clavier-Übung III is the third of four movements in the Clavier-Übung cycle by Johann Sebastian Bach. As a result of publishing confusion in the 19th century, the pieces included in the collection were published separately along with the composer’s other organ works. It was not until deeper musicological research and the discovery of the first printed edition of Clavier-Übung III that the composition was shown in a new light. In this article, the author presents Clavier-Übung III from the perspective of a religious message taking into account the formal plan and the symbolism that the composer included in the work by using musical means. The text attempts to explain the term “German Organ Mass” as it has been commonly called. This is done based on the origins of the work, a description of its internal construction, and an analysis of the score material of individual pieces. The main goal of the work is to present Clavier-Übung III as a complementary work that constitutes a certain closed whole as a collection of pieces to be performed in the order proposed by the composer.

Alexander Nemtin’s Concerto for Organ

Moscow-based composer Alexander Nemtin (1936–1999) is best known for his completed version of Alexander Scriabin’s “Prefatory Action,” a mystical musical composition conceived by the famous composer during the last years of his life, which was not destined to see the light of day. In 1970 Nemtin took on himself the task of recreating the “Prefatory Action,” which he completed in 1996. It is an immense musical score in three parts for orchestra, chorus, solo singers, piano and organ. Nemtin’s own musical compositions are much less known to musicians or music lovers. They are written mostly in a traditional style, with predominantly diationic harmonies, their textures follow the vein of Romantic instrumental music with a very moderate implementation of neoclassical and more modernist elements of 20th century music. Among them is a large-scale work, titled the Concerto for Organ, which was composed in 1963. This composition is for solo organ, although in the large scale of its instrumental texture and the six varied movements comprising its overall formal design, it validates its somewhat extraordinary title. The Concerto for Organ is characterized by extended diatonic harmonies complemented with a large number of dissonant sonorities. It contains a dialogue with the Baroque style and elements of stylization in the vein of Bach and other Baroque composers. Stylization in the Concerto for Organ is expressed most visibly by its adherence to the genres of the Baroque period – preludes, canons, chorales, arias, ricercars and fugues. Nemtin’s Concerto follows an extended tradition of lengthy and massive works for solo organ and organ with orchestra. Its academic formal qualities, broad use of contrapuntal techniques and adherence to well-known Baroque genres makes it aesthetically closer to the German organ tradition. In his instrumental composition of a large-scale genre Alexander Nemtin demonstrated himself as a master of large-scale form capable of thinking in categories of massive dramaturgy and philosophic thought. He has established his place in music history not only be creating the completed version of Scriabin’s “Prefatory Action,” but also with his own musical compositions which continue the tradition of orchestral, vocal and chamber instrumental music by 20th century Russian composers. Keywords: Alexander Nemtin, Concerto for Organ, organ music, large-scale form, prelude, canon, aria, fugue, stylization, stylistic dialogue with the Baroque period.

Declined Liver Grafts - Analysis of the German Donor Population from 2010 to 2018

The lack of suitable allografts limits the availability of liver transplantation in Germany. The quality of potentially available German donor livers has to date not been analyzed. Analysis of all donors for potential liver transplantations reported to the Eurotransplant by the German Organ Transplantation Foundation from 2010 to 2018. Categorization of transplanted and discarded organs utilizing available histopathological reports and predefined extended criteria for organ donation. A total of 8594 livers were offered for transplantation, of which 15.2 % were discarded. During the analysis period the proportion of donor livers from extended criteria donors increased from 65 % to 70 % (p = 0.005). In 2018, 21.3 % of offered donor livers were discarded, more than half (56.4 %) of these organs came from donors meeting multiple extended criteria. Livers were significantly more likely to be not transplanted, when from donors of older age (> 65 years; 41 vs. 28 %), BMI > 30 kg/m2 (29vs. 14 %) or elevated transaminase levels (all p < 0,001). Despite the consistent organ scarcity in Germany, a relevant amount of livers cannot be transplanted due to a multitude of organ quality limitations. This should stimulate the search for concepts such as normothermic ex vivo machine perfusion to evaluate, protect and potentially improve organ quality.

Amendments to the Transplantation Act and impact on the donor situation in Germany

Seit Jahrzehnten besteht in Deutschland ein Mangel an Spenderorganen, 2017 erreichte die Zahl der Organspender einen historischen Tiefstand. Eine sorgfältige Analyse der Ursachen zeigte u. a. strukturelle Defizite in der Spendererkennung und -meldung und veranlasste die politisch Verantwortlichen zum Handeln. Am 01.04.2019 trat das Gesetz zur Verbesserung der Zusammenarbeit und der Strukturen in der Organspende in Kraft, das insbesondere die Rolle der Transplantationsbeauftragten in den Entnahmekrankenhäusern stärkt und für eine aufwandsgerechte Finanzierung der organspendebezogenen Aufgaben der Entnahmekrankenhäuser sorgt. Gleichzeitig wird die Kooperation der Transplantationsbeauftragten mit der Koordinierungsstelle gefördert. Um die Auseinandersetzung mit dem Thema Organspende in der Bevölkerung zu fördern, folgte am 16.01.2020 das Gesetz über die Stärkung der Entscheidungsbereitschaft bei der Organspende. Die Umsetzung der verschiedenen Einzelmaßnahmen der beiden Gesetze wird von einem Gemeinschaftlichen Initiativplan Organspende begleitet. Die rechtlichen Bestimmungen und deren praktische Umsetzung werden ausführlich dargestellt.

Attitudes and knowledge about post-mortem organ donation among medical students, trainee nurses and students of health sciences in Germany : Across-sectional study.

ObjectiveIn 2018 Germany had the lowest rate of post-mortem organ donation in the Eurotransplant network. Healthcare trainees and students will be important advisors on organ donation for patients in the future. This study aimed to examine 1) attitudes and knowledge about post-mortem organ donation, 2) how past transplantation scandals have affected those attitudes and 3) how satisfied respondents were with the knowledge provided on the courses.MethodsA cross-sectional study was conducted between 20 March and 8 July 2019 at a university hospital and nursing schools in Berlin and Potsdam, Germany. Study participants were 209 medical students, 106 health sciences students and 67 trainee nurses.ResultsOf the respondents 29.3 and 50.8% knew the tasks of the German Organ Transplantation Foundation and Eurotransplant, respectively. All brain death questions were correctly answered by 56.3% of the medical students, 25.7% of the health sciences students and 50.9% of the trainee nurses (Fisher’s exact test p < 0.001, Cramer’s V = 0.242). Transplantation scandals had damaged attitudes towards organ donation for 20.7% of the medical students, 33.3% of the health sciences students and 13.6% of the trainee nurses (χ2-test p = 0.001, Cramer’s V = 0.164). Asked whether post-mortem organ donation was sufficiently addressed in their courses, 39.5% of the medical students, 60.4% of the health sciences students and 51.9% of the trainee nurses said this was not or tended not to be the case (Kruskal-Wallis H-test p < 0.001, Spearman’s rho r = −0.112).ConclusionGiven the knowledge gaps identified and the respondents’ dissatisfaction with the knowledge they received, organ donation should be better integrated into curricula and training programs.

Living donor kidney transplantation

Due to the discrepancy between the increasing need of kidneys for transplantation and the continuously low numbers of brain dead donors, the possibility of living donor kidney transplantation is gaining importance. The indications and evaluation of donors in living donor kidney transplantation were investigated. The statistics of the German Organ Transplantation Foundation (DSO) were evaluated. The fundamental references in the literature and expert opinions are discussed. Living donor kidney transplantation is an excellent option for patients with end-stage kidney failure. A thorough evaluation of potential donors and their aftercare is indispensable. There is agreat potential to expand the living donor programs.

Einstellungen zur Organspende in Deutschland – Qualitative Analysen zur Ergänzung quantitativer Evidenz

BackgroundTo this day, the general population's attitude towards post-mortem organ donation has primarily been analyzed using quantitative representative surveys. These studies presuppose the willingness of the interviewees to participate. Since this agreement can be positively correlated with the willingness to donate organs, a systematic bias of the samples in favor of people willing to donate cannot be excluded. Using innovative qualitative databases and methods, rarely observed positions and arguments can be systematically identified. In this way, existing quantitative empirical studies can be beneficially supplemented. MethodsThis qualitative-empirical study analyzes online discussion threads applying the GABEK® method (Software WinRelan®). Differentiated according to positive and negative attitudes towards organ donation, determinants of attitudes are extracted and condensed using network graphs. A similar procedure is used to work out assessments of alternative solutions to the existing scarcity problem in the German organ allocation system. ResultsDiscussants with a favorable attitude are mainly motivated by altruism and reciprocity. A disapproving attitude is particularly due to problems with the concept of brain death and distrust concerning the health and organ donation system. It can be demonstrated that negative attitudes are more often than not based on missing information and misinformation. With regard to alternative system solutions, monetary compensations are regarded positively, whereas the opt-out solution (“Widerspruchslösung”) and concepts based on reciprocity are discussed controversially. ConclusionThere is still a great need for information and trust-generating work in the German organ donation and allocation system. Qualitative analyses in addition to quantitative evidence are necessary in order to localize these needs and concretize their content.

The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate.

The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Germany in 2006 in order to reduce waiting list mortality. The purpose of this study was to evaluate post-transplant results and waiting list mortality since the introduction of MELD-based allocation in our center and in Germany. Adult liver transplantation at the Charité—Universitätsmedizin Berlin was assessed retrospectively between 2005 and 2012. In addition, open access data from Eurotransplant (ET) and the German Organ Transplantation Foundation (DSO) were evaluated. In our department, 861 liver transplantations were performed from 2005 to 2012. The mean MELD score calculated with the laboratory values last transmitted to ET before organ offer (labMELD) at time of transplantation increased to 20.1 from 15.8 (Pearson’s R = 0.121, p < 0.001, confidence interval (CI) = 0.053–0.187). Simultaneously, the number of transplantations per year decreased from 139 in 2005 to 68 in 2012. In order to overcome this organ shortage the relative number of utilized liver donors in Germany has increased (85% versus 75% in non-German ET countries). Concomitantly, 5-year patient survival decreased from 79.9% in 2005 to 60.3% in 2012 (p = 0.048). At the same time, the ratio of waiting list mortality vs. active-listed patients nearly doubled in Germany (Spearman’s rho = 0.903, p < 0.001, CI = 0.634–0.977). In low-donation areas, MELD-based liver allocation may require reconsideration and inclusion of prognostic outcome factors.