Organ donation is always about numbers, about the relationship between seriously ill patients on the waiting list and possible donors from whom organs can be removed after the irreversible failure of their brain functions.

In Germany, this ratio has not been good for years, and the number of donors does not come close to covering the needs of the sick.

Kim Bjorn Becker

Editor in Politics.

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Seen in this way, the most recent announcement by the German Foundation for Organ Transplantation (DSO) on Monday is sobering: last year the number of organ donors fell by a total of 6.9 percent, instead of 933 people as in 2021, only 869 donated one or more organs in the past year.

The main reason was the weak first quarter, in which significantly fewer donations were made due to the corona pandemic.

The figures then stabilized again, but the minus at the end of the year remained large.

Correspondingly fewer organs from Germany were available to the European association Eurotransplant, the number fell by 8.4 percent to 2662 within a year.

As a result, fewer patients were able to use an urgently needed donor organ in the country's 46 transplant centers: Last year, doctors provided 2,695 seriously ill patients with one or more donor organs - after 2,853 in the previous year.

About 8,500 people were on the waiting list.

Axel Rahmel, the DSO's medical director, certainly doesn't like reporting the drop in numbers.

But he also says: "The principle applies that the will of the deceased is decisive." The foundation, which is professionally involved in every possible organ donation in a German hospital, does not see itself as a central office for increasing the number of donors.

But as an institution whose primary purpose is to implement the will of the people.

And that's where the problem begins.

In every second case, the hands of the surgeons are tied

Because often the will of a possible organ donor is not documented at all.

Only a few people carry an organ donor card with them or have their wish regulated in a living will.

The federal government wants to help with its own register for approvals and denials, but its establishment is further delayed.

In hospital practice, a number of patients with brain function failure fail to donate organs for medical reasons, for example because they have an additional illness or die before the organ can be removed - in these cases organ donation is impossible.

Those who meet the medical requirements for organ removal are left - but in every second case, the surgeons' intervention fails due to a lack of consent.

And that rarely comes from the brain dead themselves.

All refusals of the past year were not even based on a declaration of intent by the person concerned in every fourth case.

Only in 7.3 percent of the cases was there a written document that noted the refusal, in 16.3 percent of the cases the person concerned had previously verbally rejected the subject of organ donation.

Around 42 percent of all refusals were based on the presumed wishes of the person concerned, which the relatives deduced - albeit without the person concerned having made a clear statement on the matter during their lifetime.

And in more than every third case, in 35 percent to be exact, the relatives decided alternatively according to their own values ​​and rejected the organ donation because they themselves were against it.

"It's like a coin toss"

"That's an important point," says Rahmel.

Too often the will of those affected is unknown.

"Documenting more is the right approach." In an ideal world, according to Rahmel, every citizen would have explained at the appropriate point how he or she feels about organ donation - so that relatives do not have to reconstruct an attitude and do not have to transfer their own values ​​to family members .

The central register that the federal government is working on could be helpful here.

"It has to be easily accessible and simple, otherwise the goal will be missed." Rahmel thinks it's right that the government has postponed the introduction of the register because of technical and organizational problems.

He says: “A badly done register would harm the cause.

A good one can help at best.”

Overall, German hospitals contacted the DSO 3,256 times last year because they suspected a possible organ donor in one of their intensive care units.

In 2387 cases nothing came of it, 1185 times it was due to a lack of consent.

If the person concerned had documented their will in some form during their lifetime, the person tended to be in favor of organ donation - for example, 260 written consents were opposed to only 81 refusals and 253 verbal consents to only 181 refusals.

The figures correspond to surveys in which a large majority of respondents regularly support organ donation.

However, when it comes to relatives reconstructing the will of their family members who had an accident, they become much more cautious.

In these cases, the rejection rate rises to almost 46 percent.

"It's like a coin toss," says Rahmel.

And if a family member acts according to their own ideas because not even a reconstruction of the wishes of the person concerned seems possible, then this almost always happens at the expense of the organ donation: Last year, for every family member who agreed, there were almost four who refused.

Axel Rahmel doubts that this relationship correctly reflects the will of many people.