Berlin – Germany could learn a lot from Spain when it comes to organ donation, digitalization and warming plans. Bundestag member Tina Rudolph (SPD) explained in an interview how exactly Spain is a pioneer in this regard German medical journal.
The doctor was in the Spanish capital, Madrid, last week, with other members of the Bundestag Health Committee, and got an overview of the local healthcare system. For example, she learned that not only solving the Spanish contradiction, but also other medical procedures contribute to high organ donation rates. Rudolph also announced a new legal push for organ donation in Germany.
Furthermore, the medical staff ratio in Spain appears to be better than in Germany, Rudolph said. But what is very similar to the situation here is that young Spanish doctors are increasingly moving towards medical specialty areas 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 what parts of the Spanish healthcare system did you find particularly impressive?print?
The most impressive thing was being able to delve deeper into the Spanish organ donation system. Spain is a pioneer in Europe when it comes to organ donation and records more than 40 organ donations per million inhabitants. For Germany it is around ten per million inhabitants. I learned these numbers in college and they haven’t changed much since then.
The state of digitization was also impressive. Spain is one step ahead of us in this regard. There has been an electronic medical record there for a long time and the population has been using a health application (Tarjeta Sanitaria) since the COVID-19 pandemic.
You can use this to book doctor’s appointments, fill out forms, download certificates such as incapacity for work, view vaccinations and manage your own illness history. Your personal attitude towards organ donation can also be recorded there. Primary care centers, that is, the outpatient medical area, are linked to this system.
When developing this digitalization, Spain relied mainly on private providers, but digital applications – as I learned in the autonomous region of Madrid – are developed together with the responsible department of the ministry. In any case, health data is stored centrally (on two servers in two locations to reduce risk). This would be hardly conceivable in Germany and I would not like it either and I am pleased that we prefer more decentralized solutions.
Unlike Germany, the opt-out solution applies to organ donation in Spain. In Germany, the extended consent solution applies; The organ donation registry was recently put online. Is Germany taking the right direction or what needs to change here to increase the number of donors?
I am convinced that the objection system can achieve a lot, but it will still not take us to the level of Spain. It is necessary to look at the different building blocks that lead to high donor rates.
Spain introduced the solution to the contradiction in 1979, even though Franco’s dictatorship had only ended four years earlier. I would have thought that society would then have to trust the State again. But the law was so well approved at the time because the Spanish population was and still is proud of its very accessible healthcare system.
Spain has a tax-funded healthcare system in which everyone is insured and receives the same benefits. The credo of the time: everyone receives services, even expensive and complex ones, such as organ donation.
So it cannot be too much to ask if the population deals with the issue and those who do not want to donate organs express a contradiction, but otherwise it can be assumed that it is in everyone’s interest that many donations are made because This can happen to anyone. This attitude and argumentation were effective then and continue to be effective today.
Furthermore, other underlying conditions lead to the high donor rate. Organ donation based on the cardiac death criterion has been permitted in Spain for several years. About 45 percent of donations come from this. In Germany this is only permitted after brain death. You can also tell from the organ donation organization that it is well thought out.
In the palliative treatment of seriously ill people, potential organ donation is also taken into account with the patient’s consent. I don’t know this idea from Germany. In this country there is often concern that patients think that the focus of medical staff is on donating organs rather than treating people. Of course this is nonsense.
When it comes to resolving the objection, there is often concern that family members will no longer be able to make a decision after the death. But in Spain and also in Austria, for example, the family is closely involved in this issue, despite contradictory regulations.
In Spain there is also the possibility of establishing organ donation if assisted suicide is intended. This has been possible since 2021 and, since then, a double-digit number of organ donations have been made this way. In Germany, this would probably initially be a difficult mental step.
Will there be a new attempt to introduce the objection solution in Germany?
I find a project of this type very useful and I know I’m not alone in this opinion. There will probably be a multi-party Bundestag project again.
The Federal Council has already taken a position and I note that both the composition of the Bundestag and the attitude of some colleagues on the matter have fundamentally changed towards supporting an objection regulation.
However, voting will once again be a decision of conscience because it concerns an ethical issue.
We must also continue to monitor the implementation of structural improvements decided in the last legislative session – for example, the possibility of exemption for transplant agents. This is not going well everywhere and smaller hospitals in particular do not have as many potential donors as would be statistically expected.
The theme of the delegation’s trip was also the theme of heat. How is Spain dealing with this? Which aspects of the Spanish national thermal protection plan should also be applied in Germany?
Spain has been conducting very accurate regional thermal mapping for a long time. This allows authorities to warn about heat events at a regional and local level. The Spanish National Action Plan comes into force from May to September each year and acts as a kind of state of alarm.
During this period, temperatures are closely monitored and if there is local heat, that is, if a certain temperature is reached on a few days in a row, alerts and recommendations are sent to the population. These recommendations are usually the usual ones, such as drinking plenty of water or wearing light clothing.
However, where I saw less important progress than I expected was in the systematic ability to allow cities to adapt to climate change, for example through adjustments in urban development.
In Madrid, some squares were reduced and equipped with green spaces, large trees that provide shade and water irrigation systems. However, as in Germany, these measures also depend heavily on the financial strength of the respective municipality or region, so there are large differences.
They also analyzed the Spanish hospital sector. What did you see there and what surprised you as a doctor?
The Spanish healthcare system is structured in a more centralized way than the German one. The 17 autonomous communities are responsible for planning and financing the hospitals. There are regional budgets that take into account factors such as the number of inhabitants, but also morbidity and mortality rates.
In a given area of influence there is always at least one large hospital and several small ones, in the outpatient area there are mainly primary care centers; There is no specialized dual carriageway like the one we have there.
I noticed that the ratio of medical personnel is very good. However, salaries there are significantly lower than here. In Spain, medical staff also occasionally go on strike for more pay. Medical services are accessible to everyone, although in some regions there are long waiting times for operations.
The trend in Spain is for more and more people to take out additional private insurance to get appointments faster. This, in turn, also has consequences for healthcare professionals, for whom it is often more profitable – at least additionally – to work in the private sector.
I also noticed that popular topics are changing a bit. So far in Spain, the field of surgery in Madrid or Barcelona has apparently been particularly popular among young doctors. Radiology, dermatology and ophthalmology are now more preferred here because there is good earning potential and a good work-life balance. © cmk/aerzteblatt.de