Organ Donation In Germany Research Articles

How to effectively communicate health information on social media depending on the audience's personality traits: An experimental study in the context of organ donation in Germany

ObjectiveThe shortage of organs donated for transplantation is a global concern. Even though increasing awareness can boost organ donation registration rates (thus leading to a higher number of available organ transplants), public organ donation campaigns lack effectiveness and are rarely tailored to audiences. To further enhance the effectiveness of digital health (i.e., organ donation) communication, we assessed the perception of social media organ donation campaign strategies (i.e., transformational, informational, neutral) as a function of personality traits (i.e., Big Five). MethodData was collected through an online experiment with 1000 participants (i.e., German citizens between 18 and 70 years) who were recruited via Facebook and Prolific between Jun–Aug 2022. Perceived message effectiveness of the organ donation posts was measured on a 5-point Likert scale applying the AIDA model and consequently analyzed using multiple regression analyses. ResultsMessaging strategy applied in the social media campaigns served as a predictor for message effectiveness depending on the personality traits of the audience when controlling for demographics and donor status. Extraversion was positively associated with higher message effectiveness of the transformational post while neuroticism showed a significant positive association with informational content. Agreeableness was positively correlated with transformational as well as informational post effectiveness. Furthermore, higher perceived post effectiveness increased the likelihood to sign-up for further organ donation information. ConclusionOur results show that Instagram in Germany is an underleveraged but potentially effective platform to spread organ donation knowledge. Based on our results, we urge public health authorities to revisit and start tailoring their (digital) health (i.e., organ donation) campaigns to audiences (i.e., personality traits) to increase their effectiveness.

Organspende nach irreversiblem Hirnfunktionsausfall

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.

GPs education about organ donation: what factors influence the success?

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. GPs were surveyed via a web-based questionnaire in November and December 2021. 215 data sets have been utilized. 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. 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.

Brain Death and Treatment of (Potential) Organ Donors and Interactions with their Relatives

In recent years, the diagnosis of irreversible brain function loss in severely brain-damaged patients has gained in importance. Brain death, defined as an irreversible loss of the overall function of the cerebrum, cerebellum and brain stem, is a prerequisite for organ removal in the context of organ donation. The article presents the legal and organizational framework.Brain death is determined on the basis of the latest update of the guidelines of the German Medical Chamber (Bundesärztekammer) using a three-step scheme and consists of clinical and instrumental examinations. After the final diagnosis of brain death, the phase of organ-preserving treatment for the potential organ donor begins. In the case of patients who themselves or their relatives have not agreed to organ donation, the intensive care therapy must be terminated promptly. The legal framework for the determination of brain death and for the removal of organs from potential organ donors is provided by the Transplantation Act. The German Foundation for Organ Transplantation (DSO) is responsible for the coordination of organ donations in Germany. The DSO supports hospitals in many ways during the organ donation process, but also in training courses for medical staff on organ donation. The main contact person of the DSO is the transplant officer in the hospitals. The care of the relatives of a potential organ donor is of great importance.

Critical analysis of communication strategies in public health promotion: An empirical-ethical study on organ donation in Germany.

Given the need for organs, public organizations use social marketing strategies to increase the number of donors. Their campaigns employ a variety of moral appeals. However, their effects on audiences are unclear. We identified 14 campaigns in Germany from over the last 20 years. Our approach combined a multimodal analysis of categorized posters with a qualitative analysis of responses, collected in interviews or focus groups, of 53 persons who were either skeptical or undecided about organ donation. The combined analyses revealed that the posters failed to motivate laypersons in general to donate, and were even less effective on skeptical or undecided individuals. We explain this in terms of the types of moral messages found on posters and the limits of such social marketing strategies. Furthermore, we discuss certain ethical aspects of organ donation campaigns pertaining to communicating norms and trust in public institutions.

Current political aspects of transplantation medicine in Germany: Organ donation in contradiction?

Despite the claimed high organ donation willingness in Germany, the real numbers for organ donation are far below the international average. About 8000 patients in Germany are waiting for atransplant kidney, of which only afraction, after years of waiting, can be treated with asuitable transplant. Further changes to the transplantation law to improve organ donation in Germany were recently adopted. However, it remains the demand for areorganization of organ donation towards the opting out solution. The political decision on this is at the time of delivery of the article.

Welcome Address

Welcome Address

Compulsory organ donation-acontroversial topic

The number of organ donations in Germany has continuously fallen in recent years. The proposed Transplantation Act stipulates that every German citizen is considered an organ donor if he/she has not objected during his/her lifetime. This proposal has received wide approval, but also much criticism. The German Society for Urology, the German Society for Surgery, the German Society for Nephrology and the German Transplantation Society have all spoken out in press releases in favor of the introduction of an opt out (presumed consent) solution. The German Bundestag will decide on the proposed bill in autumn.

Reasons for the low organ donation rate in Germany

The number of organ donations in Germany decreased by 32.3% between 2010 and 2017. For this reason, more than 1500 fewer organ transplantations were performed in 2017 than in 2010. What are the causes of this development? Analysis of available statistics and scientific publications. Adecline of the organ donation potential can be ruled out as the cause of the declining organ donation figures, since the number of patients who were eligible for organ donation from amedical point of view increased during the period under consideration. Similarly, there is no indication that achange in the population's attitude towards organ donation can be held responsible for this development. The decline is rather due to arecognition and reporting deficit of potential organ donors. The extent of this deficit differs considerably between different hospitals and is not only responsible for the decline in the donor rate in recent years, but also for the low donor numbers in Germany by international standards. The low organ donation figures in Germany are due to arecognition and reporting deficit. The number of organ donations could be considerably increased by improving the internal processes in hospitals.

Treatment of hepatocellular carcinoma in the cirrhotic and non-cirrhotic liver

The treatment of hepatocellular carcinoma (HCC) includes surgical, interventional and systemic approaches. This review highlights the importance of surgical treatment approaches in the multimodal treatment of HCC, based on the currently available literature, corresponding German guidelines as well as current developments in organ donation in Germany. Curative treatment options for HCC include liver transplantation, partial liver resection, and local ablative procedures depending on the lesion size. In the case of an early HCC in acirrhotic liver fulfilling the Milan criteria, liver transplantation is the treatment of choice. In view of the organ shortage in Germany and improved results after partial liver resection, surgery can alternatively be performed in patients with asufficient liver function. In selected patients with multinodular HCC, regional lymph node metastases or macrovascular invasion, the possibility of liver resection must be decided on an individual basis; however, the latter two criteria are contraindications for transplantation. Local ablative procedures can be considered as an alternative to resection in selected patients with early solitary HCC. Surgery of HCC in the non-cirrhotic liver with a curative intent is guided by the general principles of oncological liver surgery. Curative treatment options for HCC include liver transplantation, partial liver resection and local ablative procedures. Current developments in the area of organ donation and technical advances in minimally invasive liver surgery should be included in decision-making in tumor boards.

Organ donation in Germany: Don't we want to? Can't we? Or are we not allowed?

Organ donation has reached anew low in Germany. The number of organ donations dropped from 1296 in 2010 to just 797organ donations in 2017. This represents adecrease of 916kidney transplants in the last six years. Thus, Germany occupies the penultimate position in the Eurotransplant association with the number of organ donors per million inhabitants. Only Luxembourg has fewer because of foreigners proportion of 47.5% and many of them lives in the neighboring european countries. However, Germany is not only far behind in the Eurotransplant association with the number of organ donors, but Germany is also at the bottom in comparison with other European countries with comparable political, ethical, religious and social structures-are we so different from our European neighbors? Germany is a country with one of the best health care systems in the world, but not in the field of organ donation. In an international comparison of organ donation, even emerging economies are in afar better position than Germany. Thus, we should ask ourselves if aflaw in the system is leading to this organ donor shortage. But what is the cause and how can we change it? There is no single and general solution to this problem. There are many different points to consider and tackle. These include educating the population, indicating of the will to donate organs or its rejection, training physicians to recognize potential organ donors, support for transplant officers, and much more. In particular, however, thought should be given to an opt-out (presumed consent) solution. It is time to question the system of organ donation in Germany and to discuss it objectively.

Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study

The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. Avoluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons for rejecting organ donation among the general public. Previous transplantation scandals are aprimary reason for anegative change in attitudes. Main reasons for objection among the next of kin of potential organ donors are known objections of the deceased and the lack of knowledge about the will of the deceased. In addition, only 58.1% of all explanted organ donors documented their will in written or verbal form. Education on organ donation can be ameans to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.

Survey on Attitudes Towards Death Concepts and Procedures Related to Organ Donation in Germany

Background The European Union announced the problem of increasing mismatch of organ donors and patients requiring organ transplantation. They estimated 16 people die daily while waiting for a transplant. Especially Germany is known for low rates for organ donation; opt in is in practice and there is no acceptance for donation after cardiac death. Interestingly, one of the obstacles remains the fear of German politicians and decision makers to discuss openly death concepts and procedures related to organ donation. We therefore addressed this topic to evaluate attitudes towards organ donation amongst medical students. Methods/Materials As a spin-off project of ESOT-ELPAT we developed a survey which was introduced into the curriculum of medical students at the University of Münster in Germany. Since June 2016 medical students in their 3rd clinical semester, were asked to participate with the aim to evaluate beliefs and opinions in regard to death and organ donation. The survey was accompanied by a tutor in case of questions. Multiple answers were possible. Results So far 233 medical students were interviewed. Most respondents felt being moderate informed on legal, medical, and psychosocial aspects in death criteria and organ donation. Interestingly, many had difficulties in their opinions once they were asked to neglect the current practice of organ donation in Germany. Attitudes towards defining death revealed that mostly “body as whole is non-functional” (86/227), “person is gone despite some left body functions” (137/227) and death defined (84/227) by law were accepted. “Thoughts and feelings of a person are gone” were acknowledged as death concept for organ donation in 51/227. A cranioplasty after craniotomy using bandaging was accepted in 49/229, while 111/229 accepted organ donation once prognosis is fatal without further diagnostics/procedures. Organ donation after cardiac death was accepted in 197/227 responders. The wish of the patient to donate was higher appreciated than the legal regulations. Furthermore, organ quality in the process of donation was relevant in decision making for most students. Conclusion Attitudes amongst medical students towards death concepts and procedures related to organ donation seem to be liberal, which is in contrast to the taboo of German decision makers. Patient centered decisions were more accepted than legal regulations.

Hirntod – Organspende

According to the German Transplantation Law, determining brain death follows a distinct brain death code published by the scientific committee of the German Medical Association. There must be severe structural damage to the brain parenchyma with deep coma, loss of all brainstem reflexes and apnoea. Reversible conditions that might influence clinical findings must be excluded. According to the age of the patient and the kind of brain damage, either neurological follow-up investigations after defined intervals or additional tests serve to prove the irreversibility of clinical findings. Determination of brain death means determining a definite sign of death. This is the prerequisite for postmortal organ donation. The German Foundation for the Transplantation of Organs (DSO) organises organ donation in Germany in accordance with transplantation law. It makes preliminary checks on donor eligibility of potential donations, provides consultative assistance in the determination of brain death and offers support in talks with relatives. The DSO also coordinates organ removal and allocation via Eurotransplant.

Organtransplantationen – Aktuelle rechtliche und organisatorische Rahmenbedingungen

Organ transplantation is the therapeutic option of choice in organ failure and distinct types of cancer. For more than two decades organ transplantation had no legal framework in Germany. Multiple ethical and judicial considerations as well as the complexity of medical and organizational management but also the fears of possible organ donors lead to the enacting of German Transplantation Act (Transplantationsgesetz, TPG) in 1997. The TPG defines controlled brain death and the extended consent as requirements for explantation. This means, the organ donor must have approved the donation of his organs before. This approval can be writtenly documented or approved by the nearest relatives or the closest confidents. It is also possible to denominate an assignee (alt.: to authorize another person) during life time. Living organ donations are also legalized in the TPG. Precondition for any organ donation is the brain death of the organ donor. The diagnostic requirements for brain death are specifically mentioned by guidelines of the German Federal Medical Association (Bundesärztekammer). The major problem today is willingness to organ donation in the German population. There is an eminent deficiency of organ donations in Germany. Therefore local hospitals, regional Transplantation Centres, the supraregional German Foundation for Organ transplantation have to act closely in concert based on the directives of TPG. After successful Transplantation, a life- long immunosuppression is necessary. Nevertheless organ rejections remain still possible. By reason of this and other complications a life-long connection to a responsible Transplantation Centre is necessary for the transplanted patient. Physicians who work at a regional hospital's ICU have to be able to identify possible organ donators. They also should know how to initiate the organizational procedures to provide explantation, rapid procuration, and transportation of the explanted organs based upon to the regulations of TPG.

New guidelines seek to boost organ donation in Germany

New guidelines seek to boost organ donation in Germany

Organ donation in Germany

Organ donation in Germany

Cost-benefit approach in evaluating investment into donor action: the German case.

Donor Action (DA) is an international initiative to help critical care units (CCUs) increase their own donation rates through improved-quality donation practices. Following a validated diagnostic review (DR), areas of weakness can be identified, and the appropriate changes introduced. Data gathered from a number of centers in nine European countries (including Germany) 1 year after the introduction of targeted improvement measures demonstrated a 59.2% (P=0.0015) increase in donation rates. This analysis computes the cost-benefit thresholds of implementing the DA methodology from a German health-economic point of view, taking into account the treatment alternatives for end-stage renal disease (dialysis and transplantation) and comparing the DA program with current organ-donation practice. Lifetime direct medical costs and quality-adjusted life years (QALYs) were calculated for both arms, considering only changes in cadaveric renal transplantation rates. If DA leads to a 59% overall increase in organ donation in Germany, the program will result in 33 QALYs and 1.8-million euro cost savings per million population (PMP). Therefore, DA would be cost-effective below 2.66-million euro implementation cost PMP (or 218-million euro for the whole country). As the partial implementation cost of the program was far below the threshold, DA is more cost-effective than other publicly reimbursed medical intervention.

A proposal for an anonymous living organ donation in Germany

In Germany, living organ donation of paired and usually not regenerating organs is restricted by law to related individuals, as well as persons who ‘obviously entertain an especially intimate personal relationship’. When this law was adopted in 1997, the intention of the legislator was to guarantee the free will of the donor and to exclude any trade of organs. Since then the transplantation of cadaveric organs has not increased. Additional organs were donated from living donors. However, for a number of reasons only a limited array of transplantation centers use living organ donation as a supply facing a steadily increasing number of patients with chronic renal failure. Living organ donation raises a variety of medical, ethical and legal questions. Although transplantation is a generally accepted therapeutic approach for impaired organ function, doctors do not promote it actively. Prospective donor–recipient pairs use the information obtained via internet and other sources before they contact the clinician. Doctors are hesitant to operate a healthy individual for allowing her or him to profit from this organ loss only emotionally or in an altruistic sense. Often a complex relationship between donor and recipient, as well as tissue incompatibility (ABO, HLA) may be additional reasons to restrain from carrying out living organ transplantation. To improve the chances for good organ function and better life quality of the patients we here propose a model for anonymous living organ donation with special reference to kidney transplantation.

Brain death and organ donation in Germany: analysis of procurement in a neurosurgical unit and review of press reports.

A prospective study was undertaken to determine the number of potential organ donors in a neurosurgical intensive care unit and to record the actual number of organ donations. The reasons for refusal of organ donations were analysed with respect to the controversial public discussion of the brain death concept and the transplantation law in Germany. From 1994 to 1997, the number of cases of brain death, and the number of cases in which relatives consented or refused to organ donation as well as the number of actual organ explantations was recorded. Over the same period, press reports of 5 German language newspapers were analysed with regard to the authors' position on brain death and transplantation law, their qualification, intention, and mode of presentation. Annually, about 70 deaths occurred on the department's intensive care unit of which almost 30% of the patients were determined to have suffered brain death without any obvious contraindications against organ donation. The refusal rate of relatives rose from 56% up to 78%, and the rate of organ donors thus decreased from 5% in 1994 to 4% presently in the department. About 100 reports were published each year in the analysed newspapers, of which about 90% voiced approval of organ transplantation. During the review period, the depiction became more objective (57% in 1994 to 82% in 1997) and the suspicious attitude toward the technique of brain death diagnosis declined. Whereas 50% of the articles rejected the brain death concept in 1994, this figure decreased to 39% in 1997 and conversely the concept of consent rose from 33% in 1994 to 56% in 1997. In Germany, the relatives refusal rate in organ donation is continuously high, presumable due to a depressing 39% of press reports rejecting the brain death concept, and resulting in a very low number of organ donations. There is hope that the transplantation law which has finally passed German parliament in 1997, confirming the brain death concept as well as the legal principle of prior consent by the donor or consent by the relatives will eventually result in an increase of organ donation especially when supported by an educational campaign which is embodied in the transplantation law.