Organ donation

Which organs can be donated?

In principle, the following organs can be used as donor organs:

• Heart
• Lung
• Liver
• Kidney
• Pancreas
• Intestine

Apart from organ donation, patients can also benefit from tissue donation. These include:

• Cornea of the eyes
• Valves
• Skin
• Blood vessels
• Bone, cartilage, and soft tissue

Organ Donation: Age Limit

In order to be allowed to donate organs, only the condition of the organs is key, not the biological age. Of course, the health of younger people is often better than that of seniors, but even the functioning organ of a 70-year-old can be successfully transplanted. This is especially true if the organ goes to an older recipient.

There is no lower age limit for donation, but the decision for children under 14 years of age is up to the parents. From their 14th birthday, children may then object to organ donation on their own and from their 16th birthday they may also consent.

Organ Donation: Criticism

There is a rather sceptical attitude towards organ donation among the population. In recent years, criticism has been triggered above all by organ donation scandals, in which patients were given preferential treatment in the allocation of organs by manipulating the waiting list. In the course of this, the Transplantation Act was revised in 1997 with the aim of increasing transparency in the allocation of organs. In particular, the penalties for doctors who deliberately violate the guidelines have also been increased: such doctors can now be prosecuted with a fine or imprisonment of up to two years.

The allocation of organs through the Eurotransplant Foundation depends on the urgency and chances of success of a transplant. The financial situation of the recipient does not matter. The Transplantation Act also prohibits organ trafficking and criminalizes both the sale of an organ and the receipt of a purchased organ.

Regarding the concerns about post-mortem organ donation: The argument that brain death in the organ donor cannot be determined beyond doubt can be refuted – with the help of the prescribed examinations, brain death can be medically determined beyond doubt.

Organ removal is always carried out with the same surgical care as an intervention on a living patient. After the procedure, the surgeon closes the body again and the body is handed over to the relatives without disfiguring injuries.

Organ Donation: Ethics

The issue of organ donation raises many ethical aspects, in particular whether a person’s brain death justifies the removal of their organs. In 2015 (last amended in 2021), the German Ethics Council issued a statement in which it considers the removal of organs for transplantation purposes to be acceptable – provided that the consent of the donor or his or her relatives has been obtained.

Another ethical issue is the equitable distribution of donated organs. It is based on the basic principle of the greatest possible medical benefit. This means that the patient who needs the organ most and has the greatest chance of being cured will receive the available organ. There is broad social agreement that financial aspects or the social position of a patient should not play a role in the distribution.

Organ donation: pros and cons

The motivations for deciding for or against organ donation are manifold. Common reasons for rejection are a lack of trust in the allocation system or – in the case of living donations – fears of disfigurement or health disadvantage. Spiritual or religious reasons usually do not play a role, as none of the larger religious communities in Germany has so far spoken out against organ donation.

For many relatives of dead organ donors, the knowledge of having helped a sick person with the donor organs helps them cope with the grief of losing a loved one.

It is important to note that everyone has to make the decision “Organ donation: yes or no?” for themselves. It is helpful to deal with the issue and to document your will or to discuss it with your relatives. In Germany, in contrast to most other European countries, there is a decision-making regulation, a modification of the consent regulation:

Organs from a deceased person may only be removed if the person concerned has expressly permitted this during his or her lifetime or if the surviving relatives have explicitly consented to organ donation. In addition to Germany, this regulation also applies in Northern Ireland. An extended consent regime, in which the next of kin or proxy decides if there is no documentation of the deceased person, exists in Denmark, Ireland, Iceland, Lithuania, Romania, Switzerland and the United Kingdom.

Many other countries (e.g. Spain, Italy, Austria, Hungary, England with Wales and Scotland) follow the objection regulation: Here, every deceased person becomes an organ donor if he or she has not expressly decided not to do so during his or her lifetime and has also documented this in writing. The relatives have no say in this.

In Germany, unless the patient’s wishes are documented, the patient’s relatives must make decisions to the best of their knowledge and belief.

When do you need an organ donation?

Organ donation is often the only life-saving treatment for chronic or sudden organ failure. Organ donation may be considered for the following medical conditions:

• Final stage of cirrhosis of the liver
• Liver cancer
• severe organ damage caused by iron storage disease (haemochromatosis) or copper storage disease (Wilson’s disease)
• acute liver failure (mushroom poisoning, diseases and malformations of the bile ducts)
• Diabetes mellitus (type I or type II) with kidney damage
• polycystic kidney disease
• chronic nephritic syndrome (a kidney disease)
• Congenital heart defects
• Valvular heart disease
• Coronary artery disease (CHD)
• Heart muscle disease (cardiomyopathy)
• Heart failure
• functional disorders of the intestine
• Chronic obstructive pulmonary disease (COPD)
• Pulmonary fibrosis
• Cystic fibrosis
• Sarcoidosis
• “Pulmonary hypertension” (pulmonary hypertension)

What do you do when you donate your organs?

The process of organ donation is defined by law and follows a precise scheme.

·       Procedure for post-mortem organ donation

Before a patient can be considered as a donor, it must be clearly determined that he or she is brain dead. To this end, the doctor informs the German Organ Donation Foundation (DSO), which then refers independent neurologists to determine brain death. According to the Transplantation Act, two doctors must independently determine brain death in the patient. This is done according to a fixed three-stage scheme:

• Evidence of severe, incurable and irreversible damage to the brain
• Detection of loss of consciousness, ability to breathe on its own, and failure of brainstem-controlled reflexes
• Verification of irreversible brain damage by examinations after prescribed waiting periods

The doctors record the course of the examinations and their results in a protocol sheet, which can also be viewed by the relatives of the deceased.

Once brain death has been determined, the deceased’s consent to organ donation must be clarified. If there is no written documentation of his or her will (e.g. living will or organ donor card), the next of kin must decide.

If consent to organ donation has been given (by the patient or his relatives), the DSO arranges for various laboratory tests to be carried out on the deceased. They are used to rule out contagious diseases that could be transmitted to a donor. Blood group, tissue characteristics and the functionality of the organ to be donated are also tested. In addition, the DSO provides information to Eurotransplant, which searches for a suitable recipient according to medical criteria such as the likelihood of success and urgency of the transplant.

·       Living Donation Process

Are you thinking about donating an organ to a loved one? Then you should first contact the attending physicians at the transplant or dialysis center. In an initial consultation, it can be clarified whether a living donation is actually possible in the present case. The final authority in this examination is the Living Donor Commission, which is usually affiliated with the State Medical Association.

If you meet all the legal and health requirements for a living donation, the doctor will inform you about the risks of the procedure and donation. Only then can you, as a potential donor, make an informed decision. If it is positive, you and the organ donor recipient will be admitted to hospital and examined again. The transplant usually takes place the following day.

First, the surgeon starts by removing the donor organ. Shortly before the end of the procedure, the recipient’s operation begins in parallel, so that the donor organ can be implanted directly with as little loss of time as possible.

What are the risks of organ donation?

The removal of an organ or part of an organ entails general risks for a living donor, which can occur with any operation:

• Wound healing disorders
• Scarring with an unaesthetic result
• Bleedings
• Injury to nerves
• Wound infection
• Anesthesia incidents

It is still unclear whether kidney donation increases patients’ risk of suffering from high blood pressure or an increasing loss of protein in the urine (proteinuria) in the future.

What do you have to consider after organ donation?

The transplant center is a central point of contact for living donors and relatives before and after organ donation.

·       After post-mortem organ donation

After a post-mortem organ donation, the body is handed over to the relatives for burial. If desired, the relatives can also be cared for by employees of the German Organ Transplantation Foundation (DSO). After some time, they will be informed by the DSO about which organs have been transplanted and with what success this has been done. However, you will not receive any information about the name or medical condition of the recipient.

·       After living donation

If there are no complications, you are allowed to go home as a donor after ten to 14 days. After a kidney or liver donation, you can expect to be unable to work for about one to three months – depending on how much physical strain you are under at work.

The organ recipient must stay longer in the hospital so that it can be monitored and checked whether the new organ is resuming its work.

As a donor, you usually don’t have to expect any long-term health problems. Regular examinations ensure that any long-term effects of organ removal can be detected and treated in good time. Ask the transplant center for advice on the intervals at which you should go for follow-up care after an organ donation.

Organ Donation in the UAE

Health insurance usually does not cover transplant surgeries unless you have a premium health insurance plan or international private medical insurance. The proposed law, set to amend existing regulations on organ donations and transplantation and has called to collaborate the incorporation of medical insurance provisions into the National Programme for Organ and Tissue Donation and Transplantation, known as “Hayat”.

The very recent update on Organ Donation is that the UAE has mandated medical insurance coverage for Organ Donors and Recipients in the country.

Details are still under in the workings with insurer’s however, this is a pro-active step of the nation. The DHA is collaborating with the national committee to enforce this mandate in Dubai. Official representatives from various health authorities in the UAE met with insurance companies to discuss mechanisms ensuring accessibility and sustainability of the organ transplant program for everyone, regardless of nationality or gender.