ARD documentary on organ donation: Are we a country of moral free riders?

Waiting can be fatal. In the last ten years, around 9,000 people in this country have died while waiting for a donor organ. And this in a country that is at the forefront in terms of transplantation medicine. But all this know-how is of no use if organs that can be transplanted are missing. With a fundamental yes to organ donation, a dying person can save up to seven lives. But this yes is still missing too often.

In the “ARD Story” series, Mareike Müller and Carl Gierstorfer looked for the reasons behind this imbalance. The report “Against Time” stands well on its own, but at the same time it is the intro and factual basis for the second season of the award-winning ARD series “Charité Intensive”, which this time takes up the topic of organ transplantation in four episodes in a gripping and touching way. And thus perhaps contributes more to increasing the population’s willingness to donate than the last federal governments combined.

Positive attitude without consequences

Most recently, in 2020, the Bundestag debated reforming the legal situation surrounding the issue of organ donation. But the majority of parliamentarians decided to retain the so-called decision solution: Kidneys, hearts, lungs, liver and other body parts can only be removed from a dying person if they have agreed to this during their lifetime and, ideally, have an organ donor card. This does not apply to many Germans. And this despite the fact that more than 80 percent actually have a positive attitude towards organ donation. But only half of them recorded this in writing. Bettina Schöne-Seifert, former member of the German Ethics Council, calls this “moral free riding”: Taking organs? Gladly. give organs? Oh, let’s go.

The “ARD Story” gives a face and a name to what many people consider a very theoretical topic: Larissa, 28, is waiting for a donor heart. Without a heart transplant, she will die soon. So she waits in Berlin’s Paulinen Hospital: for a heart or death. Whichever comes first.

Should everyone be an organ donor?

Around 8,400 people in Germany are like Larissa, says Ana Paula Barreiros from the German Organ Transplantation Foundation. “Compared to other countries, the waiting list situation is really precarious.” Because in these other countries the contradiction applies: everyone is a potential organ donor; Anyone who wants to keep their inner life to themselves after death must have expressly noted this during their lifetime. There are therefore significantly more donor organs available elsewhere.

But the decision solution that has been in effect in Germany so far is not the only crux. Possible donors are often not recognized in the clinics: too much time pressure, problematic infrastructure, and a lack of awareness among doctors about the topic. And if there is no organ donor card, the relatives have to decide – in an exceptional psychological situation in which they would like to keep their favorite person alive. “These are the most difficult conversations,” says intensive care physician Daniel Zickler.

Heart or brain death? Germany relies on the “gold standard”

The subtext of the report clearly positions itself as “pro organ donation”. She wants to convince people with information. It explains what “clinically dead” means – the state in which a person’s brain function has irreversibly disappeared and they are only kept alive by machines. Because many people fear that the technology for organ donors may be switched off too early. But the diagnosis of brain death is one of the most complex diagnoses in medicine, explains neurologist Farid Salih: a multi-stage process, at least two independent diagnosticians.

So far, so sure. But in Spain, Europe’s leader in transplantation, it is not brain death but cardiac death that is considered the starting point for a possible organ transplant. This is not an option for Germany, emphasizes Federal Health Minister Karl Lauterbach, SPD: Brain death is “the gold standard. “And we want to continue working with that.”

Larissa’s second life: a gift

After the objection resolution failed in the Bundestag three years ago, the government decided to at least make the decision to donate an organ as simple as possible. But the promised online register in which willing organ donors can register is still missing today. The integration of the organ donation question into the procedure for issuing an identity card has failed. In 2022, fewer organs were donated than in years. For a country like Germany, which also defines itself through its social values, this is an indictment. Sure: Since 2020, one political crisis has followed the next. But for people waiting for a donor organ, there is a daily crisis. Because for them it’s a matter of life and death.

At least: Larissa did it, she got a new heart after eleven months in God’s waiting room. In a rehabilitation clinic, the young woman is now learning to put strain on her body again: she trains in the fitness room, climbs stairs, and goes for walks. Because she wants to grow old with the heart she gave her.

Hank Peter

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