“The topic of organ donation must be removed from taboos”

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Written By Kampretz Bianca

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Berlin – Educate, decide, save lives – for almost 40 years, Organ Donation Day, at the beginning of June, has brought the theme of organ donation to the center of society with various actions. However, there is still a glaring shortage of organ donors in Germany.

Around 8,500 seriously ill patients are urgently waiting for an organ. Several legal initiatives in recent years are aimed at remedying and improving the framework conditions for organ donation in clinics. The legislator considered it particularly important to reinforce those responsible for transplants in clinics.

One of them is Anne Trabitzsch. The specialist in surgery, trauma surgery, emergency medicine and intensive medicine leads the transplant team at Dresden University Hospital. O German medical journal talked to her about what has been achieved, the ongoing efforts in organ donation as well as other goals and the desire to introduce a contradictory solution to organ donation in Germany.

5 questions for: Anne Trabitzsch, Transplant Department Team Leader­commissioned at the Dresden University Hospital

Taking into account a clear shortage of organ donors in Germany, attempts are being made at various levels and with various legal initiatives to create an organ culture in this country as well.­to create a donation. In your opinion, is this a success?
There is progress, but there is still a long way to go. Initiatives and legal 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, decided in 2020, are important steps.

However, additional efforts are needed to achieve the objective. The topic of organ donation must be removed from taboos. This requires comprehensive information, targeted educational campaigns and open social debate in order to reduce prejudices and fears and increase acceptance.

You mention the “Verification Law” that came into force five years ago­Improving cooperation and body structures­This and the accompanying Community Initiative Plan for Organ Donation should, in particular, strengthen the Transplant Officers (TxB) system. From your perspective as a TxB, are the improvements effective? are they really experienced in clinics?
Yes, the system works in hospitals where TxBs are legally released from work. In these establishments, donor identification works efficiently, the organ donation processes are well structured and this also increases the quality of the results.

TxB’s legal exemption helped them focus fully on their task, which led to better coordination and a greater number of successful organ donations. However, the prescribed TxB exemption is not implemented in accordance with the law in all clinics. This still has potential for optimization.

In 2022, the law came into force to strengthen the willingness to make decisions about organ donation­and this spring the national organ donation registry was finally launched. What does this mean for you as a TxB? What do you expect?
The organ donation registry is a modern and useful complement to expressing the desire to donate organs. For us, transplant agents, it involves certain technical efforts in the initial phase. All prerequisites must be created first to implement very secure authentication through TxB.

But it allows citizens to document their decision to donate their organs in a secure and centralized way. However, these are mainly those who have already decided to join the register. Undecided people are unlikely to sign up. Therefore, registration will not lead to an increase in willingness to donate.

However, it is essential for the possible introduction of an opposition regulation. The registration also brings back the topic of organ donation. Presence in the media helps more people 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 a problem with organ donation also lies in the failure of donor hospitals to recognize the potential irreversible loss of brain function (IHA). How significant is the problem in your opinion and how can it be tackled?
The problem of lack of detection of a potential irreversible loss of brain function is extremely important as it means that potential organ donors are not identified and therefore no life-saving organs can be donated.

To counter this problem, several measures are needed: Transplant managers play a central role in identifying potential organ donors. Adequate time off, required by law, allows them to fully concentrate on this task and improve coordination. However, as has already been briefly mentioned, TxB do not benefit from full time for their work, which affects the effectiveness of their work.

The inclusion of TxB and improved intra-hospital communication are necessary to ensure easy identification and notification of potential organ donors. Therefore, control and consistent implementation of the TxB exemption as well as compliance with the German Medical Association guideline “donor identification” can contribute to the more efficient implementation of the already good conditions for optimal donor identification. Regular and comprehensive training of medical and nursing staff is also essential to recognize the signs of ALF at an early stage.

The use of the electronic screening tool DETECT (which was developed at Dresden University Hospital, editor’s note) can also support staff in intensive care units and should be introduced widespread. The tool ensures that TxB is informed in a timely manner about patients with potentially imminent AIH, meaning that the necessary steps towards organ donation can 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. Feedback from the team is consistently positive and the relief provided by automated support is particularly appreciated. DETECT therefore makes a significant contribution to optimizing the organ donation process and therefore represents important progress.

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

Strengthening the role of TxB continues to be particularly important. The legal exemption for TxB must be implemented and monitored consistently. Only when TxB are fully freed from their duties will they be able to fully focus on identifying relevant patients and implementing structured processes in the context of organ donation.

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

Furthermore, as in some neighboring countries, organ donation should also be possible after cardiovascular death. This expansion of the organ donor pool could significantly increase the number of available organ donors.

An open discussion on the subject and the general elimination of taboos on the topic of organ donation are also of great importance. Overall, the consistent implementation of existing plans and an open social discussion as well as the legal implementation of objection resolution are crucial to sustainably improving the organ donation situation in Germany. © ER/aerzteblatt.de

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