Hospital.Help

Berlin – Educate, decide, save lives – for almost 40 years, Organ Donation Day at the beginning of June has been using various activities to raise the issue of organ donation to the forefront of society. Despite this, there is still a blatant shortage of donor organs in Germany.

Around 8,500 seriously ill patients are urgently waiting for an organ. Various legal initiatives in recent years are intended to provide relief and improve the framework conditions for organ donation in hospitals. The legislator considered it particularly important to strengthen the transplant officers in hospitals.

One of them is Anne Trabitzsch. The specialist in surgery, trauma surgery, emergency medicine and intensive care medicine leads the team of transplant coordinators at the Dresden University Hospital. German Medical Journal spoke to her about what has been achieved, ongoing efforts in organ donation as well as further goals and the desire to introduce an opt-out solution for organ donation in Germany.

5 questions for: Anne Trabitzsch, team leader of the transplant department­commissioned at the University Hospital Dresden

In view of the significant shortage of donor organs in Germany, attempts are being made at various levels and with various legislative initiatives to create a culture of organ donation in this country.­donation. Do you think this is possible?
There is progress, but there is still a long way to go. Legislative initiatives and measures such as the “Law to Improve Cooperation and Structures in Organ Donation”, which came into force in 2019, and the introduction of the Organ Donation Register, which was decided in 2020, are important steps.

However, additional efforts are required to achieve the goal. The taboo surrounding organ donation must be removed. This requires comprehensive education, targeted educational campaigns and an open social discussion in order to reduce prejudices and fears and increase acceptance.

You mention the “Law on the Protection of Human Rights” that came into force five years ago.­improving cooperation and structures within the institution­donation”. This and the accompanying Community Organ Donation Initiative Plan should in particular strengthen the system of transplant coordinators (TxB). From your point of view as a TxB, are the improvements effective? Are they actually being implemented in the clinics?
Yes, the system is used in hospitals where the TxBs are legally released from their duties. In these facilities, donor identification works efficiently, the organ donation processes are well structured and this also increases the quality of the results.

The statutory exemption of the TxB has helped them to concentrate fully on their task, which has led to improved coordination and a higher number of successful organ donations. However, the mandatory exemption of the TxB is not implemented in accordance with the law in all hospitals. There is still room for improvement.

In 2022, the law to strengthen the willingness to decide on organ donation came into force­and this spring the nationwide organ donation register was finally launched. What does that mean for you as a TxB? What are you hoping for?
The organ donation register is a modern and useful addition to the declaration of the will to donate organs. For us transplant officers, it involves certain technical efforts in the initial phase. First, all the prerequisites must be created in order to implement the very secure authentication by the TxB.

But it does allow citizens to document their decision to donate organs securely and centrally. However, it is mainly those who have already decided to register. Undecided people will probably not register. Therefore, the register will not lead to an increase in willingness to donate.

However, it is essential for the possible introduction of an opt-out regulation. In addition, the register brings the issue of organ donation back into focus. Media presence helps more people to deal with the issue of organ donation, which in the long term can lead to greater awareness and acceptance in society.

Back to the clinics and your work as a TxB: Studies show that one problem with organ donation is the failure of the removal hospitals to recognize potential irreversible brain dysfunction (IHD). How significant is this problem in your view and how can it be counteracted?
The problem of failure to detect potentially irreversible brain dysfunction is extremely significant because it prevents potential organ donors from being identified and thus life-saving organs from being donated.

Several measures are necessary to counteract this problem: The transplant officers play a central role in identifying potential organ donors. Their adequate release from work, which is required by law, enables them to concentrate fully on this task and improve coordination. However, as already mentioned briefly, the TxB are not given time off for their work across the board, which impairs the effectiveness of their work.

The inclusion of the TxB and improved communication within the hospital are necessary to ensure smooth identification and reporting of potential organ donors. Therefore, the control and consistent implementation of the exemption of the TxB and compliance with the German Medical Association’s guideline on donor identification can contribute to the more efficient implementation of the already good conditions for optimal donor identification. Regular and comprehensive training for medical and nursing staff is also essential in order to recognize the signs of IHA at an early stage.

The use of the electronic screening tool DETECT (which was developed at the Dresden University Hospital, editor’s note) can also support staff in intensive care units and should be introduced nationwide. The tool ensures that the TxB are informed in good time about patients with a potentially impending IHA, which allows the necessary steps for organ donation to be initiated.

By using DETECT, we were able to significantly increase the detection rate of potential organ donors in Dresden and improve the efficiency of donor detection in our hospital. The feedback from staff has been consistently positive, and they particularly appreciate the relief provided by the automated support. DETECT therefore makes a significant contribution to optimizing the organ donation process and therefore represents an important step forward.

In your opinion, what else is needed to improve the situation of organ donation in Germany? Do we need legal changes?
In my opinion, several decisive measures are required: The structures and processes in the removal hospitals still need to be optimized. The electronic screening tool DETECT should become an essential tool for every transplant coordinator.

Strengthening the role of the TxB remains particularly important. The legal exemption of the TxB must be consistently implemented and monitored. Only if the TxB are completely exempted from their tasks can they fully concentrate on identifying relevant patients and implementing structured processes within the framework of organ donation.

The role of the TxB should be further professionalized and academicized. The attractiveness and expertise of this position can be increased through specialized courses of study and certifications, such as those that already exist successfully in other countries. This promotes long-term motivation and high quality in organ donation coordination.

In addition, organ donation should also be possible after cardiovascular death, as is the case in some neighboring countries. This expansion of the organ donor pool could significantly increase the number of available donor organs.

An open discussion about this and the general removal of taboos around organ donation are also of great importance. Overall, consistent implementation of existing plans and an open social discussion as well as the legal implementation of the opt-out solution are crucial to sustainably improving the organ donation situation in Germany. © ER/aerzteblatt.de