Advertisement

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

A systematic review
  • E. TackmannEmail author
  • S. Dettmer
Originalien
  • 35 Downloads

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.

Keywords

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

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

Eine systematische Übersicht

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.

Schlüsselwörter

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

Notes

Funding

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

Compliance with ethical guidelines

Conflict of interest

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.

Supplementary material

101_2019_600_MOESM1_ESM.docx (22 kb)
Supplementary Table 1 Selected articles listed by country
101_2019_600_MOESM2_ESM.docx (34 kb)
Supplementary Table 2 Included articles listed by country

References

  1. 1.
    Barker CF, Markmann JF (2013) Historical overview of transplantation. Cold Spring Harb Perspect Med 3(4):a14977.  https://doi.org/10.1101/cshperspect.a014977 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Rosenblum AM, Li AHT, Roels L, Stewart B, Prakash V, Beitel J, Young K, Shemie S, Nickerson P, Garg AX (2012) Worldwide variability in deceased organ donation registries. Transpl Int 25(8):801–811.  https://doi.org/10.1111/j.1432-2277.2012.01472.x CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rithalia A, McDaid C, Suekarran S, Myers L, Sowden A (2009) Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ 338.  https://doi.org/10.1136/bmj.a3162 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med 6(7):e1000097CrossRefGoogle Scholar
  5. 5.
    Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 12(12):1495–1499CrossRefGoogle Scholar
  6. 6.
    WHO (2017) United Kingdom statistics summary (2002–present). http://apps.who.int/gho/data/node.country.country-GBR?lang=en. Accessed 31 Oct 2017Google Scholar
  7. 7.
    WHO (2017) Spain statistics summary (2002–present). http://apps.who.int/gho/data/node.country.country-ESP. Accessed 31 Oct 2017Google Scholar
  8. 8.
    WHO (2017) Germany statistics summary (2002–present). http://apps.who.int/gho/data/node.country.country-DEU. Accessed 31 Oct 2017Google Scholar
  9. 9.
    WHO (2017) Netherlands statistics summary (2002–present). http://apps.who.int/gho/data/node.country.country-NLD. Accessed 31 Oct 2017Google Scholar
  10. 10.
    World Bank (2017) Health expenditure per capita (in US-$). http://databank.worldbank.org/data/reports.aspx?source=2&series=SH.XPD.PCAP&country=. Accessed 31 Oct 2017Google Scholar
  11. 11.
    Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP (2012) The variability of critical care bed numbers in Europe. Intensive Care Med 38(10):1647–1653.  https://doi.org/10.1007/s00134-012-2627-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Jansen NE, Haase-Kromwijk BJ, van Leiden HA, Weimar W, Hoitsma AJ (2009) A plea for uniform European definitions for organ donor potential and family refusal rates. Transpl Int 22(11):1064–1072.  https://doi.org/10.1111/j.1432-2277.2009.00930.x CrossRefPubMedGoogle Scholar
  13. 13.
    Simillis C (2010) Do we need to change the legislation to a system of presumed consent to address organ shortage? Med Sci Law 50(2):84–94.  https://doi.org/10.1258/msl.2010.009016 CrossRefPubMedGoogle Scholar
  14. 14.
    Dominguez-Gil B, Haase-Kromwijk B, Van Leiden H, Neuberger J, Coene L, Morel P, Corinne A, Muehlbacher F, Brezovsky P, Costa AN, Rozental R, Matesanz R (2011) Current situation of donation after circulatory death in European countries. Transpl Int 24(7):676–686.  https://doi.org/10.1111/j.1432-2277.2011.01257.x CrossRefPubMedGoogle Scholar
  15. 15.
    Roels L, Rahmel A (2011) The European experience. Transpl Int 24(4):350–367CrossRefGoogle Scholar
  16. 16.
    Rieu R (2010) The potential impact of an opt-out system for organ donation in the UK. J Med Ethics 36(9):534–538.  https://doi.org/10.1136/jme.2009.031757 CrossRefPubMedGoogle Scholar
  17. 17.
    Vincent A, Logan L (2012) Consent for organ donation. Br J Anaesth 108(suppl_1):i80–i87CrossRefGoogle Scholar
  18. 18.
    Price DP (2012) Legal framework governing deceased organ donation in the UK. Br J Anaesth 108(Suppl 1):i68–i72.  https://doi.org/10.1093/bja/aer356 CrossRefPubMedGoogle Scholar
  19. 19.
    Stammers T, James M (2014) Opt-outs and upgrades. Ethics and law in the United Kingdom. Camb Q Healthc Ethics 23(3):308–318.  https://doi.org/10.1017/s0963180113000911 CrossRefPubMedGoogle Scholar
  20. 20.
    Fabre J (2014) Presumed consent for organ donation: a clinically unnecessary and corrupting influence in medicine and politics. Clin Med 14(6):567–571CrossRefGoogle Scholar
  21. 21.
    Levitt M (2015) Could the organ shortage ever be met? Life Sci Soc Policy 11(1):6CrossRefGoogle Scholar
  22. 22.
    Griffiths J, Verble M, Falvey S, Bell S, Logan L, Morgan K, Wellington F (2009) Culture change initiatives in the procurement of organs in the United kingdom. Transplant Proc 41(5):1459–1462.  https://doi.org/10.1016/j.transproceed.2008.12.032 CrossRefPubMedGoogle Scholar
  23. 23.
    Johnson RJ, Bradbury LL, Martin K, Neuberger J (2014) Organ donation and transplantation in the UK-the last decade: a report from the UK national transplant registry. Transplantation 97(Suppl 1):S1–S27.  https://doi.org/10.1097/01.tp.0000438215.16737.68 CrossRefPubMedGoogle Scholar
  24. 24.
    Broderick AR, Manara A, Bramhall S, Cartmill M, Gardiner D, Neuberger J (2016) A donation after circulatory death program has the potential to increase the number of donors after brain death. Crit Care Med 44(2):352–359CrossRefGoogle Scholar
  25. 25.
    Matesanz R, Dominguez-Gil B, Coll E, de la Rosa G, Marazuela R (2011) Spanish experience as a leading country: what kind of measures were taken? Transpl Int 24(4):333–343.  https://doi.org/10.1111/j.1432-2277.2010.01204.x CrossRefPubMedGoogle Scholar
  26. 26.
    Gil-Díaz C (2009) Spain’s record organ donations: mining moral conviction. Camb Q Healthc Ethics 18(3):256–261CrossRefGoogle Scholar
  27. 27.
    Domínguez-Gil B, Duranteau J, Mateos A, Núñez JR, Cheisson G, Corral E, De Jongh W, Del Río F, Valero R, Coll E (2016) Uncontrolled donation after circulatory death: European practices and recommendations for the development and optimization of an effective programme. Transpl Int 29(8):842–859CrossRefGoogle Scholar
  28. 28.
    Fabre J, Murphy P, Matesanz R (2010) Presumed consent: a distraction in the quest for increasing rates of organ donation. BMJ 341:c4973.  https://doi.org/10.1136/bmj.c4973 CrossRefPubMedGoogle Scholar
  29. 29.
    Manyalich M, Mestres CA, Balleste C, Paez G, Valero R, Gomez MP (2011) Organ procurement: Spanish transplant procurement management. Asian Cardiovasc Thorac Ann 19(3–4):268–278.  https://doi.org/10.1177/0218492311411590 CrossRefPubMedGoogle Scholar
  30. 30.
    De la Rosa G, Domínguez-Gil B, Matesanz R, Ramón S, Alonso-Álvarez J, Araiz J, Choperena G, Cortés J, Daga D, Elizalde J (2012) Continuously evaluating performance in deceased donation: the Spanish quality assurance program. Am J Transplant 12(9):2507–2513CrossRefGoogle Scholar
  31. 31.
    Matesanz R, Marazuela R, Dominguez-Gil B, Coll E, Mahillo B, de la Rosa G (2009) The 40 donors per million population plan: an action plan for improvement of organ donation and transplantation in Spain. Transplant Proc 41(8):3453–3456.  https://doi.org/10.1016/j.transproceed.2009.09.011 CrossRefPubMedGoogle Scholar
  32. 32.
    Coppen R, Friele RD, Gevers SK, Blok GA, van der Zee J (2008) The impact of donor policies in Europe: a steady increase, but not everywhere. Bmc Health Serv Res 8:235.  https://doi.org/10.1186/1472-6963-8-235 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Escudero D, Valentín M, Escalante J, Sanmartín A, Perez-Basterrechea M, De Gea J, Martin M, Velasco J, Pont T, Masnou N (2015) Intensive care practices in brain death diagnosis and organ donation. Anaesthesia 70(10):1130–1139CrossRefGoogle Scholar
  34. 34.
    Domínguez-Gil B, Coll E, Elizalde J, Herrero JE, Pont T, Quindós B, Marcelo B, Bodí MA, Martínez A, Nebra A (2017) Expanding the donor pool through intensive care to facilitate organ donation: results of a Spanish multicenter study. Transplantation 101(8):e265–e272CrossRefGoogle Scholar
  35. 35.
    Bernhardt AM, Rahmel A, Reichenspurner H (2013) The unsolved problem of organ allocation in times of organ shortage: the German solution? J Heart Lung Transplant 32(11):1049–1051.  https://doi.org/10.1016/j.healun.2013.08.012 CrossRefPubMedGoogle Scholar
  36. 36.
    Goroll T, Gerresheim G, Schaffartzik W, Schwemmer U (2015) Post-mortem organ donation. Anaesthesist 64(7):543CrossRefGoogle Scholar
  37. 37.
    Söffker G, Komm N, Kluge S (2014) Organ donation in Germany-when and how? A task for in-house coordinators. Med Klin Intensivmed Notfmed 109(6):396–402CrossRefGoogle Scholar
  38. 38.
    Hess R (2014) Sicherung der transplantationsmedizin. Med Klin Intensivmed Notfmed 109(6):403–407CrossRefGoogle Scholar
  39. 39.
    Haverich A, Haller H (2016) Organ transplantation in Germany: Critical examination in times of scarce resources. Internist 57(1):10–14.  https://doi.org/10.1007/s00108-015-3803-z CrossRefGoogle Scholar
  40. 40.
    Formanek M, Schöffski O (2010) Difficulties with the organ donation process in small hospitals in Germany. Transplant Proc 42(5):1445–1448.  https://doi.org/10.1016/j.transproceed.2010.01.067 CrossRefPubMedGoogle Scholar
  41. 41.
    Kaiser G, Heuer M, Stanjek M, Schoch B, Müller O, Waydhas C, Mummel P, Radunz S, Wirges U, Lütkes P (2010) Process of organ donation at a maximum care hospital. Dtsch Med Wochenschr 135(42):2065–2070CrossRefGoogle Scholar
  42. 42.
    Rey J, Komm N, Kaiser G (2012) Inhouse coordination to promote organ donation: a pilot Project in three full-service hospitals. Dtsch Med Wochenschr 137(38):1847–1852CrossRefGoogle Scholar
  43. 43.
    Schaub F, Fischer-Fröhlich C‑L, Wolf C, Kirste G (2013) Family approach—retrospective analysis of 6,617 donation requests. Dtsch Med Wochenschr 138(43):2189–2194CrossRefGoogle Scholar
  44. 44.
    Jansen NE, van Leiden HA, Haase-Kromwijk BJ, Hoitsma AJ (2010) Organ donation performance in the Netherlands 2005-08; medical record review in 64 hospitals. Nephrol Dial Transplant 25(6):1992–1997.  https://doi.org/10.1093/ndt/gfp705 CrossRefPubMedGoogle Scholar
  45. 45.
    Coppen R, Friele RD, Gevers SK, Van Der Zee J (2010) Donor education campaigns since the introduction of the Dutch organ donation act: increased cohesion between campaigns has paid off. Transpl Int 23(12):1239–1246CrossRefGoogle Scholar
  46. 46.
    van Leiden HA, Jansen NE, Haase-Kromwijk BJ, Hoitsma AJ (2010) Higher refusal rates for organ donation among older potential donors in the Netherlands: impact of the donor register and relatives. Transplantation 90(6):677–682CrossRefGoogle Scholar
  47. 47.
    de Jonge J, Kalisvaart M, van der Hoeven M, Epker J, de Haan J, IJzermans JNM, Grune F (2016) Organ donation after circulatory death. Nervenarzt 87(2):150–160.  https://doi.org/10.1007/s00115-015-0066-9 CrossRefPubMedGoogle Scholar
  48. 48.
    Coppen R, Friele RD, Van der Zee J, Gevers SK (2010) The potential of legislation on organ donation to increase the supply of donor organs. Health Policy (New York) 98(2–3):164–170CrossRefGoogle Scholar
  49. 49.
    Bendorf A, Kelly PJ, Kerridge IH, McCaughan GW, Myerson B, Stewart C, Pussell BA (2013) An international comparison of the effect of policy shifts to organ donation following Cardiocirculatory death (DCD) on donation rates after brain death (DBD) and transplantation rates. PLoS ONE 8(5).  https://doi.org/10.1371/journal.pone.0062010 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Murphy PG, Smith M (2012) Towards a framework for organ donation in the UK. Br J Anaesth 108(Suppl 1):i56–i67.  https://doi.org/10.1093/bja/aer402 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Medical Sociology and Rehabilitation ScienceCharité—Universitätsmedizin BerlinBerlinGermany

Personalised recommendations