9/30/2016 Germany‘s Campaign I have nothing to disclose. to Increase Organ Donation Christiane Kugler, PhD Witten University, Department of Health, and Hannover Medical School, Hannover, Thoracic Transplant Program, Germany UCSF Transplant 2016: Building Bridges to Excellence San Francisco, September 29-30, 2016 Outline Outline 1. Current condition of organ allocation and 1. Current condition of organ allocation transplantation and transplantation 2. Organ donation decrease 2. Organ donation decrease 3. Organ donation campaigns 3. Organ donation campaigns 1
9/30/2016 Current Condition Current Condition Eurotransplant Collaborative Framework Eurotransplant Collaborative Framework • To date, eight countries cooperate within • One central waiting list Eurotransplant • 'Pooling' donor organs depending on – Austria, Belgium, Croatia, Germany, Hungary, population and allocation of collaborative Luxemburg, the Netherlands and Slovenia – Total population 135 Mill. Inhabitants countries • Int’l collaborative framework includes all transplant centers, tissue-typing laboratories and hospitals where organ donations take place Eurotransplant. org Eurotransplant. org Current Condition Current Condition Eurotransplant Collaborative Framework Organ balance… • necessary condition for cooperation - ensuring that the exchange of organs between countries remains reasonably in balance and • to compensate for the differences in donor ratio and • for the effect of different criteria for allowing patients on the waiting list Eurotransplant. org Eurotransplant. org 2
9/30/2016 Legal Prerequisites Legal Prerequisites Concepts and Systems of organ donation Concepts and Systems of organ donation • Organ donation is automatically considered in patients • Voluntary system of organ donation, whereby relatives give Presumed diagnosed brain dead, unless they have specifically Informed permission at the time of death, usually in the knowledge Consent registered their wish not willing to donate Consent that the potential donor had expressed a wish to become a • In some countries, doctors will still ask permission from donor relatives • Voluntary system of organ donation, whereby relatives give Donor Card Informed permission at the time of death, usually in the knowledge Consent that the potential donor had expressed a wish to become a donor Legal Prerequisites Current Condition German Organ Transplantation Foundation Legal constitution differs within the countries of (DSO)… Eurotransplant region …is an incorporated foundation according to civil law Country Donor's legal situation in Germany Austria Presumed consent … after the German Transplant Law was passed in Belgium Presumed consent 1997, the DSO was officially assigned the role of Croatia Presumed consent organ procurement agency by a contract which Germany Informed consent outlined its responsibilities in coordinating the organ Hungary Presumed consent donation procedure Luxemburg Presumed consent The Netherlands Informed consent …promote and support for organ donation and Slovenia Presumed consent transplantation Eurotransplant. org www.dso.de 3
9/30/2016 Outline Organ Donation Decrease 1. Current condition of organ allocation and Series of Organ Transplantation Scandals • July 2012: media report on manipulation of listing status of patients transplantation for liver tx, two physicians under investigation at the university clinics Goettingen 2. Organ donation decrease • August 2012: one of the two physicians under investigation in Goettingen may have performed manipulation to fast-track patients 3. Organ donation campaigns for liver tx at university hospital in Regensburg • January 2013: media report on manipulation of listing status of patients for tx, university hospital Munich (TUM), Leipzig • August 2014: report to the authorities of false manipulations related to transplant wait list procedures at the heart center in Berlin dpa Organ Donation Decrease Organ Donation Decrease Federal Responses to Organ Transplantation Scandals Public Responses to Organ Transplantation Scandals • July 2012: Physicians under investigation are suspended • June 2013: Federal Parliament changes transplantation act in order to allow sanctioning of manipulations and fraud related to transplant wait list procedures 37% decrease of deceased • August 2013: start of lawsuit against head physician from university organ donors clinic Goettingen • August 2013 - onwards: audits of independent experts of archived patient documentations in all transplant centers dpa dso.de 4
9/30/2016 Organ Donation Decrease Organ Donation Decrease Consequences of Organ Transplantation Scandals Consequences of Organ Transplantation Scandals - Published statistics available provide limited - More than 10,000 pts on the waitlist information to compare pre- versus post-scandal (Eurotransplant, 09.2016) conditions - Current donor shortage of donor organs results in the death of 1,000 pts on the waitlist every year (Kaiser et al.,2016) dso.de dso.de Organ Donation Decrease Organ Donation Decrease Consequences of Organ Transplantation Scandals Consequences of Organ Transplantation Scandals - Drop in donor numbers - Drop in donor numbers - 2012-2011: 13% (Stafford, 2013) - 2012-2011: 13% (Stafford, 2013) - Drop in transplantations performed - Drop in transplantations performed - 2015: overall 3,777 transplants performed - 2015: overall 3,777 transplants performed dso.de dso.de 5
9/30/2016 Organ Donation Decrease Organ Donation Decrease Consequences of Organ Transplantation Scandals – Consequences of Organ Transplantation Scandals – huge interest from the media huge interest from the media Decrease per region; • Print media – over- comparison organ donations 2013 regional distribution 1.5 versus mean Mill exemplars status 2000-2012 • 216 articles within 12mts dso.de; Spiegel-online.de Hoisl, et al., The Anesthesiologist 2015 Organ Donation Decrease Outline Consequences of Organ Transplantation Scandals – 1. Current condition of organ allocation and huge interest from the media transplantation Content analysis of 216 articles 2. Organ donation decrease • Most categories (63.8%) placed negative evaluative opinion (e.g. loss of confidence, enrichment of persons involved, fraud, 3. Organ donation campaigns misconduct, rejection of brain death and disturbing the peace of the dead) • Minority of 36.2% of news articles tried to convey objective information (e.g. problems, and consequences of organ shortage) Hoisl, et al., The Anaestesiast 2015 6
9/30/2016 Organ Donation Campaigns Organ Donation Campaigns -1 st wave- Public Promotion in a wide Range of Activities - First Public Promotion in a wide Range of Activities wave in 2014 • DSO performed an analysis of 1,284 donation requests, • Since 2014 a wide range of public education and including the outcome information activities are underway including – National multi-media campaigns – 38% of donations based on expected will – Advertising – 23% consent from relatives – Research activities to better understand specific needs – 12% carried a donor card DSO.de Organ Donation Campaigns Organ Donation Campaigns -1 st wave- -1st wave- Public Promotion in a wide Range of Activities Public Promotion in a wide Range of Activities Campaign between June- “I decide” December 2014 • Advertisements in newspapers and magazines • 10,000 Large-scale poster walls, and 13,000 city light posters with a reach of 44.18 Mill. people, and 7.78 Mill. young adults DSO.de DSO.de 7
9/30/2016 Organ Donation Campaigns Organ Donation Campaigns -2 nd wave- -2nd wave- Public Promotion in a wide Range of Activities Public Promotion in a wide Range of Activities June 1, 2016 Press release • In 2016, second wave of public education and information activities including • Preliminary findings from a second nation-wide – National multi-media campaigns representative survey on “beliefs, knowledge, and behavior – Advertising with respect to organ- and tissue donation in German citizens in 2016” – Research activities • with 4,003 participants in the age range 14-75 years DSO.de Pressestelle BMG Bund, 2016 Organ Donation Campaigns Organ Donation Campaigns -2 nd wave- -2nd wave- Public Promotion in a wide Range of Activities Public Promotion in a wide Range of Activities June 1, 2016 Press release Brochure • Uses “known faces” like actors, • 54% feel well informed (2013: 44%) Comedians, moderators, sports men • 81% report on having a “positive attitude” on tissue- and organ donation” (2010: 79%) • 32% carry a donor card (2010: 25%) • “Organ donation?! – I have made my decision” Pressestelle BMG Bund, 2016 DSO.de 8
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