[Organ transplantation in Germany - Legal framework and organizational management].
Organ transplantation is the therapeutic option of choice in organ failure and distinct types of cancer. For more than two decades organ transplantation had no legal framework in Germany. Multiple ethical and judicial considerations as well as the complexity of medical and organizational management but also the fears of possible organ donors lead to the enacting of German Transplantation Act (Transplantationsgesetz, TPG) in 1997. The TPG defines controlled brain death and the extended consent as requirements for explantation. This means, the organ donor must have approved the donation of his organs before. This approval can be writtenly documented or approved by the nearest relatives or the closest confidents. It is also possible to denominate an assignee (alt.: to authorize another person) during life time. Living organ donations are also legalized in the TPG. Precondition for any organ donation is the brain death of the organ donor. The diagnostic requirements for brain death are specifically mentioned by guidelines of the German Federal Medical Association (Bundesärztekammer). The major problem today is willingness to organ donation in the German population. There is an eminent deficiency of organ donations in Germany. Therefore local hospitals, regional Transplantation Centres, the supraregional German Foundation for Organ transplantation have to act closely in concert based on the directives of TPG. After successful Transplantation, a life- long immunosuppression is necessary. Nevertheless organ rejections remain still possible. By reason of this and other complications a life-long connection to a responsible Transplantation Centre is necessary for the transplanted patient. Physicians who work at a regional hospital's ICU have to be able to identify possible organ donators. They also should know how to initiate the organizational procedures to provide explantation, rapid procuration, and transportation of the explanted organs based upon to the regulations of TPG.
Rommel
Wolf
W
Klinik für Klinische und Experimentelle Transplantationshepatologie, Universitätsklinikum Münster. wolf.rommel@ukmuenster.de
Schmidt
Hartmut H J
HH
D005858:Germany; D016027:Heart Transplantation / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007391:International Cooperation; D007421:Intestine, Small / Q000637:transplantation; D007883:Legislation, Medical / Q000639:trends; D016031:Liver Transplantation / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data; D009417:Nerve Tissue / Q000637:transplantation; D016377:Organ Transplantation / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D016035:Pancreas Transplantation / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014181:Transplantation Immunology / Q000276:immunology
D007166:Immunosuppressive Agents