Transplantation Ethics

According to World Journal of Transplantation, 2015, “transplantation ethics is the philosophy that incorporates systematizing, defending, and advocating concepts of right and wrong related to organ donation and allocation.”1 Initially, the supervision of transplant activities and centers in Germany was based on a mutual trust and interdependence. That changed after several scandals shook the transplant community. In Germany, the Deutsche Stiftung Organtransplantation [(DSO)German Organ Transplantation Foundation] is responsible for the coordination of organ donation.2 The agency, which was renamed after the reunification of East and West Germany, was assigned the role of organ procurement in 1997 after the enactment of the German transplant

Increased mistrust was fueled by largely negative articles about enrichment of those involved in transplantation, fraud, misconduct, rejection of determining brain death and disruption of peace of the dead.7

After these scandals became widely publicized public outcry rocked the DSO. In a backlash to the transplant community, Germany experienced a 40% decrease in available organs.3 Donations drastically declined from 16 donations per million population (pmp) in 2010 to 10 pmp in 2014.2 These scandals have led to loss of public confidence in the organ transplant system. Now there are fewer organs available for transplantation. This loss of trust in the system while understandable has cause grave concerns for patients on the transplant waiting list.2,3 The potential result of this lack of available organs will likely lead to avoidable deaths in some of the country’s most vulnerable

In 1990 after the reunification the European nations tried to balance the organ allocation fairly but resentment grew over organs going to the previously underserved East Germans. Discontent about organs being donated in one country such as the Austria could be given to recipients in another country even though the flow goes in both directions was heigthend. The Germans are caught in a difficult position; push for more donations, and they raise the spector of Nazis medical policies; back off and they risk the appearance that they are poaching organs from other countries.’11 German organ donations have always been lower than other nations that are members of the Eurotransplant International. Interestingly there has been controversy in Europe and discontent about organs being donated in one country such as Austria could be given to recipients in another country even though the flow goes in both