Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK

A systematic review

Beeinflussende Maßnahmen auf die postmortalen Organspenderaten in Deutschland, den Niederlanden, Spanien und dem Vereinigten Königreich

Eine systematische Übersicht

Abstract

Background

German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation.

Methods

A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy.

Results

Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns.

Conclusion

Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.

Zusammenfassung

Hintergrund

Die postmortale Organspenderate in Deutschland sinkt seit 2010. Gleichzeitig wird postmortale Organspende in deutschen Medien infolge vergangener Unregelmäßigkeiten bei der Organvergabe häufig negativ thematisiert. In Spanien, dem Vereinigten Königreich und den Niederlanden steigen dagegen die postmortalen Organspenderaten in den vergangenen Jahren.

Methode

Im November 2017 wurde auf PubMed, PsycINFO und Web of Science ein systematisches Review von Publikationen durchgeführt, die (1) gesetzliche Aspekte, (2) postmortale Organspenderaten und (3) Maßnahmen zur Steigerung der Organspenderaten in Europäischen Nationen betrachten und zwischen 2007 und 2017 in Englisch oder Deutsch veröffentlicht wurden. Zudem wurden Qualitätsparameter der WHO und der Weltbank einbezogen.

Ergebnisse

Deutschland und die Niederlande, welche ein Opt-in-System etabliert haben, besaßen 2016 die niedrigsten Organspenderaten der betrachteten Nationen. In den Jahren 2008 bis 2015 stieg die postmortale Organspenderate im Vereinigten Königreich um 37,4 %, folgend der Implementierung der Donation Task Force, während das Opt-in-System beibehalten wurde. Die Einführung von Transplantationskoordinatoren und die Erneuerung der Gesetzgebung in Deutschland im Jahr 2012 resultierte nicht in einer Steigerung der Organspenderaten. Durch Informationskampagnen trat das Thema Organspende in den Niederlanden stärker in das öffentliche Bewusstsein.

Schlussfolgerung

Organspende nach Herztod („donation after cardiac death“, DCD), erweiterte Spenderkriterien, Verbesserung der öffentlichen Wahrnehmung und die Einführung eines Spenderregisters sollten als mögliche Mittel der Organspenderatensteigerung in Deutschland weiter diskutiert werden.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Correspondence to E. Tackmann.

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E. Tackmann and S. Dettmer declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Tackmann, E., Dettmer, S. Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK. Anaesthesist 68, 377–383 (2019). https://doi.org/10.1007/s00101-019-0600-4

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Keywords

  • Tissue and organ procurement
  • Tissue and organ procurement/organization and administration
  • Organ transplantation
  • Europe

Schlüsselwörter

  • Gewebe- und Organspende
  • Gewebe- und Organspende/Organisation und Administration
  • Organtransplantation
  • Europa