Organization of organ donation--concepts and experiences in Niedersachsen/Ostwestfalen.

Organ transplantation is a well-established therapeutic for the organization of organ donation in the region of Niedersachsen/Ostwestfalen (Nds./Ow) to the procedure. However, too many patients must wait for a transplant and many of them die on the waiting list. regional subdivision of the German foundation for organ transplantation, the ‘Deutsche Stiftung OrganIn the rich western countries, further expansion of organ transplantation is not prevented by a lack of transplantation’ (DSO). The DSO has developed new organizational structures for Nds./Ow. Its subdivision financial means. Rather, the ‘disaster’ of not being able to provide valuable and often life-saving treatment for Nds./Ow works in close cooperation with the transplantation centres but it is an organization in its which is, in principle, available is caused by the shortage of transplantable organs. own right, independent from the transplantation centres. In looking for a remedy for organ shortage, it is important to understand the true reasons for its emerThe DSO-Nds./Ow serves an area of 6.8 million inhabitants, 150 hospitals (126 of which are quite gence. As far as this is concerned, it should be observed first that across European countries consent rates are small, having less than 500 beds) and seven transplantation programmes (now also including programmes in quite similar, whereas realized organ donation rates per million inhabitants vary between different countries Göttingen and Bad Oeynhausen). Under the new institutional arrangement, the from 13 (in some countries even less) to more than 30. Thus, variations in the willingness to donate cannot number of organ donations has increased to a level of 21 donors per million inhabitants in 1998 (in comparbe the main reason for organ shortage. Contrary to conventional wisdom, in particular in ison, the average level in Germany is 13). Therefore, it may be viewed as a paradigm indicating possible Europe, neither a lack of medically suitable potential donors nor an insufficient willingness of the public to reforms for the system of organ donation in other areas as well. The basic approach, the results, the donate organs is the most prominent reason let alone the sole cause of the shortage of transplants. The main experiences and the potential consequences of this new organ donation system in Nds./Ow shall be outlined reason for the shortage of transplantable organs is located elsewhere: hospitals and doctors do not partiin the following. cipate sufficiently in the process of organ donation. In particular, potential donors are not indicated in all Underlying idea and basic approach cases in which organ donation would, in principle, be possible. In brief: organ shortage is mainly an organizaPotential donors exist in every intensive care unit in tional problem. New concepts for the organization of every hospital, irrespective of the size of the hospital. organ donation should, therefore, be considered. I will However, many potential donors are not recognized present one example of such a new organizational form as such. In principle, the following problems may be subsequently. responsible for this: (i) the hospital staff ’s lack of information about the criteria and procedures of donation; (ii) the lack of motivation of hospital staff; Steps towards a new regional organization of organ (iii) the lack of experts or necessary equipment, e.g. to transplantation perform the brain death diagnosis. (iv) Also, the hospital staff might be afraid of jeopardizing the hospital’s In 1994 the transplantation centres Hannover and routine procedures by a time-consuming realization of Hann.-Münden handed over the basic responsibility potential organ donations. To cope with the four potential obstacles to organ Correspondence and offprint requests to: Prof. Dr. Gundolf donation, a new strategy has been developed. It is Gubernatis, Deutsche Stiftung Organtransplantation, based on four elements each specifically designed to Organisationszentrale, Stadtfelddamm 65, D-30625 Hannover, Germany. solve one of the aforementioned problems.