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What is organ donation?
Any questions?
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Organ donation
Organ donation –
an important decision
Your decision
What is the success rate of
organ transplants?
Made up your mind?
Simply fill in the donor card,
cut it out and always carry it with you,
for example in your purse or wallet.
Organ and tissue donation poses a considerable challenge
for everyone – at the end of the day, it’s a decision that has
to be taken by the individual. There’s no right or wrong
answer. But there are pros and cons that you can weigh up
for yourself.
For many terminally ill patients, organ transplants are a
godsend. Transplanting a foreign organ holds the promise of
sustained life and a future; it enables the recipient to live on,
it enhances their quality of life and means that they can once
again join in with day-to-day family activities and re-enter
the world of work. But all of this is only made possible by an
organ transplant. Apart from a living donation, for example
when a relative donates a kidney, the only option is for a person to donate their organs to someone in need after death.
Organ donor card
to download on
www.aok.de/bayern/organspende
Please fill out with a ballpoint pen!
With
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donor ca
Organ donation is the process whereby an organ from one person (the donor) is transplanted into another person (the recipient). Living donations involve a living person donating one of
their organs. In post-mortem donation, a person donates their
organs once brain death has been declared. This guide deals
only with organ and tissue donation occurring post-mortem.
If you weigh up the arguments for yourself, you can save
your relatives a tough decision at a difficult time. We would
like to offer you our expert advice to make it easier for you to
decide for or against organ donation. Scientists from the
University of Hamburg have joined forces with specialists to
answer questions on organ donation. These can be found in
AOK’s extensive online guide to making a decision at
www.aok.de/bayern/organspende. This brochure contains
a summary of the key topics.
The success of a transplant is normally determined by whether or
not a transplanted organ is accepted by the recipient’s body. For
example, approx. 70 % of transplanted livers and 90 % of kidneys
will still be working one year after transplant, while 55 % of transplanted livers and 70 % of transplanted kidneys will still be working five years after transplant.
The success of a transplant is contingent on a number of different factors. It therefore follows that the faster an organ is implanted into the recipient’s body once harvested, the better the
chance of success. The better a match the donor tissue is with
the recipient, the smaller the risk of rejection. The recipient’s
health and age also have a part to play.
How beneficial is an organ donation for the
recipient?
The benefits of an organ transplant for the recipient lie in their increased life expectancy and the improvement in their quality of
life. Following a successful organ transplant the recipient is, in the
majority of cases, able to lead a virtually normal life.
The increase in life expectancy varies depending on the organ.
Some 75 % of liver transplant patients are still alive five years after
a transplant, while 25 % of them will be deceased. Without a
transplant, all patients would die within 72 hours as a result of
complete liver failure. The survival rate after complete kidney
failure is higher following a transplant than it is for patients on
dialysis. 87 % of patients are still alive five years after a kidney
transplant, while 13 % of them are deceased. 38 % of patients are
still alive five years after being put on permanent dialysis, while
62 % of them are deceased.
What are the potential side effects of organ
donation for the recipient?
As with all operations, complications may arise at short notice;
these can include embolisms or the surgical wound becoming
infected. In order to avoid the organ being rejected, medication
must be taken for life. This may cause side effects and taking it
permanently may be regarded a burden. Psychological problems
may also present themselves, for example fear of the donor
organ being rejected or the perception of the organ as a foreign
body. A patient who has received an organ must live with the risk
of possible side effects. The alternative is to decide against a
transplant.
Will I continue to receive the same high level of
care if I fall ill or have an accident should I
declare my willingness to be an organ donor?
The aim of all treatment in the event of an accident or serious
illness is to save the patient’s life. Organ donation only becomes
an issue when a patient is declared brain-dead.
What role do religious beliefs play in organ
donation?
The commandment that teaches help and solidarity is enshrined
in Christianity, Islam, Judaism and other faiths. However, no religion dictates an obligation to donate organs – this decision is left
up to the individual. From a Christian perspective there are no
fundamental objections when it comes to harvesting organs. The
Central Council of Muslims in Germany (Zentralrate der Muslime
in Deutschland) also has no objections provided that certain
Islamic rules are not broken. There are some objections against
organ harvesting in parts of the Jewish faith, as brain death is not
seen as being the same thing as death. The Chief Rabbinate in
Israel does, however, endorse the brain death criterion in relation
to organ transplants. In the Buddhist faith, there are no reservations when it comes to organ transplants.
How is the human dignity of the donor
preserved when the organ is harvested?
The dying person’s human dignity is preserved through palliative
care and respectful handling of the donor’s body, including during the organ donation itself. Many relatives assume that they
will be able to witness the moment of death from the patient’s
bedside. This is, however, not possible in cases of brain death, as
intensive measures are taken to artificially preserve the patient’s
cardiovascular and respiratory functions. Organs can only be harvested under these conditions.
How do I document my consent to, or refusal to
make, an organ donation?
You can document your wishes on a donor card. Even if you
have already documented your wishes in an advance directive, it
is still advisable to carry a donor card, as this may be found sooner in an emergency. It is also a good idea to inform your relatives
of your decision. If you have both a donor card and an advance
directive, the wishes they express should be the same. If not,
your wishes will be ambiguous and your relatives may be asked
to make a decision on your behalf. In order to avoid contradictions, it is important to phrase your wishes clearly in the
advance directive. The wording suggested by the German
Federal Ministry of Justice (Bundesjustizministerium) can be
found at www.bmj.de/broschueren.
Brain death is diagnosed in several stages. First of all, any causes
that could be mistaken for brain death must be ruled out. The
next stage is to determine whether the brain’s functions are actually beyond repair.
Various tests must be performed in order to diagnose brain
death. These must always be conducted by two qualified doctors
working independently of each other. If any doubt remains, then
an individual may not be declared brain dead.
Can people under 18 complete a donor card in
their own name?
Minors are entitled to declare their consent to donate organs
from the age of 16, and their refusal from the age of 14.
What happens if a decision is made against
organ donation after brain death has been
diagnosed?
Who makes the decision about an organ
donation if I did not complete a donor card
whilst alive?
If this is the case, your next of kin will be asked. This can be your
spouse, civil partner or a child of legal age. The order of priority is
defined by law. If relatives of the same legal standing hold opposing views, each of them has the right to object to organ removal.
Any decision must reflect the wishes or the assumed wishes of
the deceased. If these cannot be ascertained, their next of kin will
be asked to make a decision. If the relatives are unable to reach a
decision, this will be taken as a refusal of organ harvesting.
If I haven’t documented my wishes, those left
behind will be forced to decide on my behalf.
Can I put them through this?
The decision on whether to allow organ harvesting takes place in
emotionally charged circumstances. Surviving relatives may well
find themselves overwhelmed by such a decision. If the deceased
has expressed clear wishes for or against an organ donation, this
often comes as a great relief to those left behind. It should be
borne in mind, however, that a decision made while alive can also
be an emotional burden for surviving relatives, as they may have
made a different decision.
I’m deciding for
myself
How is brain death diagnosed?
What are the requirements for proceeding with
an organ donation?
There are two fundamental conditions that must have been met
before organs can be removed for a transplant: there must be no
All measures designed to preserve organs, e.g. mechanical ventilation, will be discontinued.
What criteria are used to regulate the allocation
of donated organs?
doubt about the diagnosis of brain death and consent for organ
removal must have been given.
Is there an age limit and what circumstances
rule organ donation out?
There are certain medical conditions that generally prevent people from donating organs, because the transplanted organs
would constitute too great a risk for the recipient. These include
HIV, severe non-treatable septicaemia and terminal cancer.
Donors are not ruled out solely on the grounds of age.
What is the definition of “brain death”?
The term “brain death” means that the entire brain has irreversibly ceased to function. This is always caused by severe brain
damage, which might be as a result of a serious accident or a
specific illness. The brain has been so severely damaged that it is
not possible to restore its functions. In order to ascertain that
someone is actually dead, certain signs must be present. These
include rigor mortis and post-mortem lividity. A diagnosis of brain
death is also used as an indicator that a person is dead.
In order to ensure a fair chance for all, organs are allocated in line
with predefined criteria such as urgency and prospects of success. These criteria have been defined by the German Medical
Association (Bundesärztekammer).
There is a central waiting list for organ allocation. Only patients registered on this list are eligible to receive organs. The
waiting list is managed by Eurotransplant, an agency responsible
for allocation.
Do I have any say over which organs and tissue
may be harvested, and which may not?
Yes. Under the German Transplant Act (Transplantationsgesetz),
the potential donor may decide which organs/tissue may be harvested, and which may not. No reasons need to be given. On the
donor card are boxes to indicate the organs. Normally, the intention to – or not to – donate organs/tissue is documented at this
time. Should the individual concerned agree to only donating
one of the two, the other must be clearly crossed out.
What does tissue donation involve?
Besides organs, tissue may also be donated upon death. This
also applies to corneas, bones, tendons, cardiac valves and blood
vessels. Tissue can be harvested up to three days after the
donor’s death. As a rule, tissue transplants are not carried out
immediately. Instead, tissue is specially processed and stored in
tissue banks, and released upon request.
What are the differences between organ and
tissue donation?
Whereas organs are transplanted unchanged and in their entirety,
tissue must be processed in special tissue banks. Moreover,
human tissue can be converted into medication using elaborate
processes.
Who organises the actual organ donation?
If all the requirements for an organ donation have been met, then
the necessary medical and logistical measures are initiated.
These are organised and managed by the German Organ Transplantation Foundation (Deutsche Stiftung Organtransplantation).
Which organs can be donated?
Once brain death has been diagnosed, the following organs in
particular can be transplanted: kidneys, pancreas, liver, heart,
lungs and small intestine.
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