Transplants: why organ donations are declining

8,700 seriously ill people are currently waiting in Germany for an organ transplant. This is mainly due to the fact that there are not enough potential donors. But that’s not the only reason.

It’s her first trip with a new heart. Nine months after the transplant. Tamara Schwab sits on a cliff overlooking the sea. The air smells of salt, the water glitters, her heart is pounding. Regularly, beat by beat. This is still unusual for Schwab. The 29-year-old thinks of the donor at this moment. And hopes that he can feel “the love that flows through the heart every day. What love for this wonderful life.” This is how she writes it on her Instagram account.

Schwab was lucky. She got a donor heart last year after just a few weeks on the waiting list. Today – on the day of organ donation – around 300 people in Germany are waiting for a heart transplant, around 700 for a lung and around 6800 for a kidney.

Recently, the number of organ donations has decreased significantly. There are many reasons why hearts get out of rhythm or stop suddenly, kidneys stop working or other organs fail. It affects people of all ages.

ventricular fibrillation. cardiac arrest

Schwab’s story goes like this: It begins in January 2018. She was 24 years old then. Schwab is training in the gym when she suddenly falls off her bike. ventricular fibrillation. cardiac arrest. Beside her: five young men. You feel the pulse. Nothing. chest compressions. Schwab survived. Two more times her heart will stop in the years to come. She was not bathed in bright light, no memories rushed by. It just felt like being stuck in a dark tunnel, Schwab writes in her book “My Speed-Dating with Death.”

A late-discovered genetic defect had made her heart weaken. Last year she received a heart from an organ donor. Schwab now wants to encourage people to opt for organ donation cards. She knows the fears of many people: that doctors will not do everything if you are seriously injured.

“We doctors are there to save lives”

“But,” says Schwab, “when I had my first cardiac arrest, I was young, athletic, a non-smoker, and I had an organ donor card. I would have been the ideal donor. But I was saved!” The concerns of many people are also known at the German Foundation for Organ Transplantation (DSO). But that’s how it is, explains Ana Barreiros, managing doctor at the DSO: “We doctors are there to save lives. Only when someone has been in an intensive care unit for several days, we have given everything, but could not save their lives. Then someone is an organ donor in question.”

Two independent teams of doctors would first have to determine the complete loss of all brain functions. In other words, without machines, survival would be impossible. In surveys, the willingness of people in Germany to donate organs after so-called brain death seems to be high.

The Forsa Institute recently asked about this on behalf of Techniker Krankenkasse. According to this, almost half of the 18 to 39-year-olds state that they have an organ donor card. In the 40 to 59 year olds it is 43 percent, in the age group over 32 percent. In reality, however, little of this is felt, according to the DSO.

Establishment of register delayed

Many had hoped that a donation register would be set up this spring that would provide reliable information on who would like to donate organs when brain death is diagnosed in an intensive care unit. At the moment, potential donors must have consented to an organ removal during their lifetime, usually documented by an organ donation card or relatives must decide. However, the establishment of the register has been delayed. The Federal Ministry of Health (BMG) states that they currently want to avoid an additional burden on hospitals, which is associated with the connection to the register. In addition, it remains to be clarified how the information will be collected.

The idea was that authorities would query them when citizens apply for passports or ID cards, for example. “It is currently still unclear whether and to what extent the federal states will implement this obligation. Since June 2021, the BMG has been holding technical discussions with the health and interior departments of the federal states,” said the ministry. A register is expected at the end of the year at the earliest.

“Many just can’t anymore”

However, according to many experts, there is another reason for the current decline in donations. Hospitals would have worked at the limit – or above – during the Corona Pandemic. Additional staff and operating rooms for organ donations are difficult at the moment. “Many just can’t take it anymore and no one can blame them for that,” says a doctor.

André Ebbing, who coordinates organ transplants for the DSO, calculates: “For an organ transplant you need surgical teams at the site of removal and where the transplant takes place. Personnel in laboratories, drivers, sometimes pilots. In the end there are up to 100 Persons.” Around 8,700 people in Germany are currently waiting for an organ transplant.