In Germany, It Is All Too Easy To Skip The Organ Waiting List

A recreation of Dr Barnard's first human heart transplantation in the Heart of Cape Town Museum
A recreation of Dr Barnard's first human heart transplantation in the Heart of Cape Town Museum
Johannes Wiedemann

BERLIN - Normally in Germany, there’s a waiting list procedure for organ transplants. The Deutsche Stiftung Organtransplantation (German Foundation for Organ Transplantation) coordinates the information about available organs from donors, and these organs are then allocated by the Netherlands-based Eurotransplant to seven central European member countries. In Germany, transplants take place at 50 transplant centers located around the country.

But that’s only half the truth. Increasingly, organs donated by older, sick people are being fast-tracked directly to patients requiring transplants, thus bypassing the waiting list procedure. This also means that the questions that are usually asked -- such as, what are the chances that the transplant will be a success? or just how urgent the patient’s need for a replacement organ is -- are not being asked.

German Health Ministry statistics obtained by Green party MP Harald Terpe indicate that this accelerated donation process has increased markedly.

According to the new Health Ministry statistics, the number of fast-tracked liver donations grew from 9.1% to 37.1% between 2002 and 2012. For hearts, those figures were 8.4% to 25.8%, and for lungs 10.6% to 30.3%. The biggest increase of all was for pancreases: in 2002, only 6.3% were expedited, as opposed to 43.7% in 2012.

Terpe said the huge increase in these expedited transplants called for an explanation. He told the Berliner Zeitung that after recent cases of organ manipulation in Göttingen and Regensburg, "we must do everything to ensure that the system isn’t being manipulated elsewhere."

The organ manipulation scandal Terpe was referring to relates to two transplant doctors who, at the Göttingen and Regenburg university hospitals, are alleged to have falsified medical records in nearly 50 cases, to push patients further up on the Eurotransplant waiting list. The scandal had observers concluding that if the regular system was so easy to manipulate, then bypassing it must be even simpler.

Left-wing politician Kathrin Vogler, who is vice chair of the federal parliament’s committee on health issues, called for immediate examination at an open meeting of all regulations concerning organ donation and allocation.

Manipulation and corruption

However, the president of the German Medical Association, Frank Ulrich Montgomery, told Die Welt that it would be wrong to draw the conclusion that the rising number of expedited transplants is down to manipulation. He said that the exceptions -- as set down in the German Medical Association guidelines -- for which fast-tracking is considered legitimate were in no danger of becoming the rule. If there was an increase in the practice, he stated, it was due to changes in directives made between 2002 and 2008. The number of allowed expedited procedures varies with each organ.

Also speaking against any assumption of manipulation and corruption, he said, was the fact that across the country, the number of transplants had increased at all the centers -- no particular center stood out. Finally, he pointed out that Eurotransplant was involved, and that patients who got fast-tracked organs were on their lists. The organization is monitoring expedited transplant practices.

Montgomery added that the changes to the guidelines regarding fast-tracking are down to changing demographics and increasing instances of particular diseases. The expedited procedure mainly concerns organs that are otherwise considered unfit, he said.

According to Montgomery: "Donors are getting older and older, and they often have pre-existing conditions or are overweight." In the regular Eurotransplant procedure, their organs are often refused by doctors who say that these organs aren’t suitable for recipients. Yet while a liver may be too big for someone’s abdominal region or have gallstones -- it doesn’t mean that it can’t save someone’s life."

If an organ is refused for medical reasons three times (for livers, five times) Eurotransplant no longer considers it allocable and it is up to the transplant centers to decide who receives it. Montgomery believes the expedited system makes sense: "Germany lacks so many donor organs that we can’t waste a single one."

Wolfgang Zöller, the German federal government’s commissioner for patient’s affairs, also told Bayerischer Rundfunk that fast-tracking had been introduced so as toavoid wasting a single organ.

Eugen Brysch, the chairman of the patient protection organization Deutsche Hospiz Stiftung, takes a more critical stance towards fast-tracking, saying that a report it commissioned years ago stated that the practice was susceptible to manipulation and corruption. "The 50 transplantation centers mostly remove, allocate and transplant organs on their own hook," he said.

Brysch believes that it is entirely possible that richer patients have easier access to organs. He is therefore seeking more information about the number of private patients and foreign patients who receive fast-tracked organs.

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Saving The Planet Is Really A Question Of Dopamine

Our carelessness toward the environment could be due, in part, to the functioning of a very primitive area of our brain: the striatum.

Ad scuba-diver and brain coral

Stefano Lupieri

PARIS — Almost every week, a new scientific study alerts us to the degradation of the environment. And yet, we continue not to change anything fundamental in our systems of production and habits of consumption. Are we all suffering from blindness, or poisoned by denial?

In his popular books Le Bug humain (The Human Bug) and Où est le sens? (Where is the Sense?), Sébastien Bohler, a journalist in neuroscience and psychology, provides a much more rational explanation: The mechanism responsible for our propensity to destroy our natural environment is in fact a small, very deep and very primitive structure of our brain called the striatum.

This regulator of human motivation seems to have been programmed to favor behaviors that ensure the survival of the species.

Addictions to sex and social media

Since the dawn of humanity, gathering information about our environment, feeding ourselves, ensuring the transmission of our genes through sexual intercourse and asserting our social status have all been rewarded with a shot of dopamine, the 'pleasure hormone.'

Nothing has changed since then; except that, in our society of excess, there is no limit to the satisfaction of these needs. This leads to the overconsumption of food and addictions to everything from sex to social media — which together account for much of the world's destructive agricultural and energy practices.

No matter how much we realize that this is leading to our downfall, we can't help but relapse because we are prisoners of the dopamine pump in the striatum, which cannot be switched off.

Transverse section of striatum from a structural MRI image

Lindsay Hanford and Geoff B Hall via Wikipedia

Tweaking genetics 

According to Bohler, the only way out is to encourage the emergence of new values of sobriety, altruism and slowness. If adopted, these more sustainable notions could be recognized by the striatum as new sources of dopamine reward. But there's the challenge of promoting inspiring stories that infuse them with value.

Take the photo-collage exhibition "J'agis ici... et je m'y colle" ("I'm taking action here... and I'm sticking to it"), a collection of life-size portraits of residents committed to the energy transition, displayed on the walls of the French coastal city of La Rochelle.

Backed by the French National Center for Street Arts, photographer Martin Charpentier may be employing artistic techniques, but he's also tinkering with neuroscience in the process.

Les Echos
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