Decline in Organ Donation in Germany

Abstract

Background: The annual number of post-mortem organ donations in Germany has declined by more than 30% since 2010. The causes of this development have not yet been adequately determined.

Methods: All patients hospitalized in Germany between 2010 and 2015 (112 172 869 hospitalizations in total) were included in this nationwide secondary analysis. Among the deceased patients we identified those who had died in the presence of a brain damage and for whom organ donation was not excluded either by a medical contraindication or by the patient's not having been artificially ventilated. The analysis was also conducted separately for six German university hospitals.

Results: Over the period 2010-2015, the number of potential organ donors per year in Germany rose by 13.9%, from 23 937 to 27 258. This development was due to an increase in the number of deaths with severe brain damage as well as an increase in the percentage of patients who were treated with invasive ventilation before death. The contact quotient, i.e., the percentage of potential donors for whom contact was made with the German Foundation for Organ Transplantation (Deutsche Stiftung Organtransplantation, DSO) fell over this period from 11.4% to 8.2%. At the same time, the realization quotient (the percentage of potential donors who became actual donors) fell from 5.4% to 3.2%, and the conversion quotient (the percentage of potential donors for whom contact was made who became actual donors) fell from 47% to 39.1%. From 2010 to 2012, the falling realization quotient was accounted for mainly by the falling conversion quotient; from 2012 to 2015, it was accounted for mainly by the falling contact quotient. The contact and realization quotients among the six university hospitals studied differed markedly (by factors of 17.5 and 23.3, respectively), while the conversion quotients differed only minimally (by a factor of 1.3).

Conclusion: The decline in post-mortem organ donation is due to a deficiency in the recognition and reporting of potential organ donors in hospital. If this process were better supported on the organizational and political level, far more organs could be transplanted.

Figure 1

Comparative representation of potential organ donors and actual organ donations, 2010–2015

Figure 2

Comparative analysis of the contact, realization, and conversion quotients of six university hospitals in the year 2015. The red dotted line represents the quotient achieved by the reference hospitals in the DSO In-House Coordination Project. The blue dotted line represents the average quotient of all German category A hospitals in 2015. DSO, German Foundation for Organ Transplantation (Deutsche Stiftung für Organtransplantation); UH, university hospital

eFigure 1

Attitude of the population to organ donation. Results of representative surveys conducted by the German Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) on the topic of organ and tissue transplantation (5). The term “active acceptance” refers to the readiness of the respondents to agree to organ transplantation in case the relevant situation should arise

eFigure 2

The analytical algorithm