When do doctors perform an organ transplant
Questions and answers about organ donation
The Transplantation Act (TPG) has been in force since December 1, 1997. It regulates the donation, removal, placement and transfer of organs that are donated after death or during lifetime.
The requirements for the removal of organs from the deceased and the living are precisely defined by law. Two doctors must independently determine the ultimate, unrecoverable brain failure before an organ donation can be carried out. In addition, the donor's consent is mandatory. The law provides for a strict organizational and personal separation of the areas of organ donation, organ placement and organ transplantation and thus clearly defines responsibilities. The German Organ Transplantation Foundation (DSO) is responsible for organ donation. The Eurotransplant Foundation (ET) is responsible for arranging organ donations.
1. Coordination office according to § 11 TPG
The German Organ Transplantation Foundation (DSO) has been contracted to coordinate organ donation in Germany by the German Medical Association (BÄK), the Central Association of Statutory Health Insurance Funds (GKV) and the German Hospital Society (DKG). It is a non-profit foundation under civil law based in Frankfurt am Main.
As a so-called coordination center in accordance with Section 11, Paragraph 1, Sentence 1 of the TPG, the German Organ Transplantation Foundation must organize and coordinate all the steps in the organ donation process, from notifying the Eurotransplant agency about a possible donor to organ transport and the handover of the organs to the almost 50 German transplant centers . Since the joint task of organ donation has to be carried out in regional cooperation, the German Organ Transplantation Foundation has set up seven regional subdivisions in addition to its national headquarters. The regions include one or more federal states. The tasks of the German Organ Transplantation Foundation are financed by a budget that is negotiated annually with its clients (National Association of Statutory Health Insurance Funds, German Hospital Association and German Medical Association) in agreement with the Association of Private Health Insurance. The budget depends on the number of organs to be transplanted. From this budget, the hospitals receive a corresponding reimbursement of expenses in the form of lump sums from the German Organ Transplantation Foundation for their services to enable post-mortem organ donation.
One of the tasks of the coordination office is
- Organize the removal of organs requiring mediation as a joint task of the transplant centers and the other hospitals (removal hospitals) in regional cooperation,
- to support the hospitals in performing their tasks under the Transplantation Act,
- to ensure the necessary examinations in connection with organ removal to protect the organ recipient and to clarify in cooperation with the transplant centers whether the potential donor meets the requirements for organ removal,
- organize the removal and preservation of organs and their transport,
- to support the transplant centers with quality assurance measures,
- support the transplant centers in maintaining the waiting lists.
Your clients (National Association of Statutory Health Insurance Funds, German Hospital Association and German Medical Association) have to monitor compliance with the contract with the coordination office in accordance with Section 11 (3) sentence 3 TPG. They have set up a monitoring commission (see below) to carry out these tasks.
2. Exchange according to § 12 TPG
The German Medical Association, the German Hospital Association and the National Association of Statutory Health Insurance Funds have contracted the Eurotransplant Foundation (based in the Netherlands) to organize the organ mediation. As an intermediary agency (since 1969), it organizes organ mediation for the entire Eurotransplant association, which today includes Germany, the Netherlands, Belgium, Luxembourg, Austria, Slovenia, Croatia and Hungary. The cross-border cooperation increases the chances that the waiting patients can be assigned a suitable life-saving organ more quickly. Eurotransplant mediates the organs that have been reported to be subject to mediation to suitable patients who are on the waiting list. In doing so, she must strictly observe the guidelines of the German Medical Association on organ placement and waiting lists.
The clients (GKV-Spitzenverband, German Hospital Association and German Medical Association) have to monitor compliance with the contract with the placement agency in accordance with Section 12, Paragraph 5, Clause 3 of the TPG. They have set up an examination committee (see below) to carry out these tasks.
3. Collection hospitals and transplant centers
The transfer of organs from deceased donors as well as the removal and transfer of organs from living donors may only be carried out in approved transplant centers according to § 10 TPG. Both the extraction hospitals and transplant centers are subject to state supervision by the federal states.
There are around 1,300 removal hospitals and around 50 transplant centers in Germany.
Removal hospitals are those approved in accordance with Section 108 of Book Five of the Social Security Code or other statutory provisions that are capable of removing organs from possible donors under the conditions of Sections 3 and 4 of the TPG in accordance with Section 11, Paragraph 11 4 sentence 5 TPG. The competent authority names the extraction hospitals to the coordination office that meet the requirements of Section 9 (1) sentence 1 TPG and notifies the extraction hospitals in writing of this designation.
Organ donation is a collective task. The transplant centers and the removal hospitals are obliged to cooperate with each other and with the coordination office for the removal of organs and the removal of tissues from possible organ donors. The coordination office clarifies whether the requirements for organ removal are met. To do this, she needs the personal details of the possible organ donors and other personal data required to carry out the organ removal and placement. The extraction hospitals are obliged to collect this data and transmit it to the coordination office. The organ removal is organized by the coordination office.
4. Transplantation officer according to § 9b TPG
All extraction hospitals are obliged to appoint transplant officers.
The transplant officers are responsible for identifying and reporting potential organ donors who are appropriately accompanied by donor relatives. They also ensure that the medical and nursing staff in the extraction hospital are regularly informed and kept up to date about the importance and process of organ donation.
The extraction hospitals appoint at least one medical transplant officer who is professionally qualified to perform his or her tasks. It is also possible to name transplant nursing officers. The transplant officer is directly subordinate to the medical management of the extraction hospital in the performance of his duties. He is independent in the performance of his duties and is not subject to any instructions.
If a removal hospital has more than one intensive care unit, at least one transplant officer should be appointed for each of these wards. The transplant officer is released from his or her other medical duties using an intensive care bed key. The exemption is made with a share of at least 0.1 position per 10 intensive care beds, i.e. if a hospital has 100 intensive care beds, the transplant officer must be fully released. The financial outlay of the hospitals for this exemption of the transplant officer is fully refinanced by the statutory health insurances.
The transplant officers are also to be released for further training. The clinics must bear the training costs.
Since April 1, 2019, the transplant officers have been given various rights by law. You are always to be consulted by the treating physician if a patient is considered a potential organ donor according to a medical assessment. They are granted access to the intensive care unit and they must be provided with all the information they need to be able to evaluate the donor potential in their clinic.
The strengthening of the transplant officers is intended to ensure that organ donation is regularly considered as an option when treating patients at the end of life. Because only in this way can a possible patient's will to make a donation be implemented at all.
The transplant officers must also develop procedural instructions for their hospital, evaluate all deaths with primary or secondary brain damage in their clinic and report regularly to the hospital management on this as well as their activities and the status of organ donation in their hospital.
The transplant officers only work in the area of organ donation. In order to avoid conflicts of interest, they are not involved in either the removal or the placement of organs.
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