Berlin – Germany could learn a lot from Spain when it comes to organ donation, digitalization and heat plans. In an interview with the German Bundestag, Tina Rudolph (SPD) explained exactly how Spain is a pioneer in this regard. German Medical Journal.
Last week, the doctor was in the Spanish capital Madrid with other members of the Bundestag’s Health Committee and gained an insight into the health system there. For example, she learned that not only the Spanish opt-out solution, but also other medical procedures contribute to high organ donation rates. Rudolph also announced a new legal initiative on the subject of organ donation in Germany.
Furthermore, the doctor-staff ratio in Spain appears to be better than in Germany, said Rudolph. But what is very similar to the situation here is that young Spanish doctors are increasingly turning to medical specialties that promise a better work-life balance.
Tina Rudolph (SPD), /Maximilian Bubinger
5 questions for Tina Rudolph (SPD)
What experiences did you have in Spain and which parts of the Spanish health system did you find particularly impressive?printing?
The most impressive thing was being able to take a closer look at the Spanish organ donation system. Spain is a pioneer in organ donation in Europe and records more than 40 organ donations per million inhabitants. In Germany, the figure is around ten per million inhabitants. I learned these figures when I was studying and they haven’t really changed since then.
The level of digitalization was also impressive. Spain is one step ahead of us in this respect. They have had an electronic patient record for some time and the population has been using a health app (Tarjeta Sanitaria) since the COVID-19 pandemic.
This can be used to book doctor’s appointments, fill out forms, download certificates such as certificates of incapacity for work, view vaccinations and manage your own medical history. Your personal attitude towards organ donation can also be recorded there. The primary care centers, i.e. the outpatient medical sector, are connected to this system.
Spain relied primarily on private providers to develop this digitization, but the digital applications are – as I have learned for the autonomous region of Madrid – developed together with the relevant department in the ministry. In any case, the health data is stored centrally (on two servers in two locations to reduce the risk). That would hardly be conceivable in Germany and I would not like it either, and I am glad that we prefer more decentralized solutions here.
In contrast to Germany, Spain has the opt-out solution for organ donation. In Germany, the extended consent solution applies, and the organ donation register recently went online. Is Germany on the right track or what needs to change in this country to increase the number of donors?
I am convinced that the opt-out rule could achieve a lot, but it will still not bring us to the level of Spain. You have to look at the different components that lead to the high donation rate.
Spain introduced the opt-out solution in 1979, even though the Franco dictatorship had only ended four years earlier. I would have thought that society would have had to regain trust in the state after that. But the law passed so well at the time because the Spanish population was and still is proud of their very accessible health system.
Spain has a tax-financed health system in which everyone is insured and receives the same services. The credo at the time: everyone gets services, even expensive and complex ones like organ donation.
Then it cannot be too much to ask that the population addresses the issue and that those who do not want to donate organs simply state that they are opposed to it, but otherwise one can assume that it is in the interest of every individual if many donations can be made, because it can also affect anyone. This attitude and argument was valid then and still is today.
There are also other factors that contribute to the high donation rate. Organ donation based on cardiac death has been permitted in Spain for several years. Around 45 percent of donations are based on this. In Germany, this is only permitted after brain death. The way organ donation is organized also shows that it is well thought out.
In the palliative care of seriously ill people, with the patient’s consent, a potential organ donation is also taken into account. I am not familiar with this idea in Germany. In this country, there is often concern that patients think that the medical staff is more concerned about organ donation than about treating the people. This is of course nonsense.
With regard to the opt-out solution, there is often concern that relatives will no longer be able to make decisions after death. But in Spain and also in Austria, for example, the family is very closely involved in this matter despite the opt-out regulation.
In Spain, there is even the possibility of making organ donation compulsory if you seek assisted suicide. This has been possible since 2021 and since then a double-digit number of organ donations have already been made in this way. This would also probably be a difficult mental step in Germany at first.
Will there be a new attempt to introduce the opt-out solution in Germany?
I would consider such a plan to be very sensible and I know that I am not alone in this opinion. There will probably be another cross-party draft from the Bundestag.
The Bundesrat has also already taken a position and I notice that both the composition of the Bundestag and the attitude of some colleagues on the issue have fundamentally changed in the direction of supporting an opt-out regulation.
However, the vote will again be a matter of conscience, as it is an ethical issue.
We must also continue to keep an eye on the implementation of the structural improvements decided in the last legislative period – for example the possibility of exemption for transplant coordinators. This is not yet ideal everywhere and smaller hospitals in particular are not registering as many potential donors as one would statistically expect.
The delegation’s trip also addressed the issue of heat. How is Spain dealing with it? Which aspects of the Spanish national heat protection plan should also be applied in Germany?
Spain has been carrying out very precise, regional heat mapping for some time now. This allows authorities to issue regional and local warnings about heat events. The Spanish national action plan comes into force every year from May to September and functions as a kind of state of alarm.
During this time, temperatures are monitored very closely and when there is local heat, i.e. when a certain temperature is reached several days in a row, warnings and recommendations are issued to the population. These recommendations are usually the usual ones, such as drinking plenty of fluids or wearing light clothing.
Where I saw a smaller breakthrough than I had hoped, however, was in systematically enabling cities to adapt to the changing climate, for example through urban planning adjustments.
In Madrid, some squares have been reduced in size and provided with green spaces, large trees that provide shade and water sprinklers. However, as in Germany, these measures depend heavily on the financial strength of the respective municipality or region, so there are big differences.
You also looked at the Spanish hospital sector. What did you see there and what surprised you as a doctor?
The Spanish health system is more centralized than the German one. The 17 autonomous communities are responsible for hospital planning and financing. There are regional budgets that take into account factors such as population size, as well as morbidity and mortality rates.
In a given catchment area there is always at least one large hospital and several small ones, and in the outpatient sector there are mainly primary care centers. There is no double specialist track like we have there.
I noticed that the ratio of doctors to staff is pretty good. However, the salaries there are significantly lower than here. In Spain, too, doctors occasionally go on strike for higher salaries. Medical services are available to everyone, but in some regions there are long waiting times for operations.
The trend in Spain is that more and more people are taking out private supplementary insurance in order to be able to get appointments more quickly. This in turn has consequences for healthcare workers, for whom it is often more lucrative to work in the private sector – at least in addition to their job.
I also noticed that the popular subjects are changing somewhat. Up until now, the field of surgery in Madrid or Barcelona was particularly popular among young doctors in Spain. Now, radiology, dermatology and ophthalmology are also more popular here because they offer good earning potential and a good work-life balance. © cmk/aerzteblatt.de
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