1. IMPACT OF LEGAL REGULATIONS IN ORGAN TRANSPLANTATION Daniela Norba, Günter Kirste Deutsche Stiftung Organtransplantation Buenos Aires, November 30th 2011
Good morning everybody. It is a pleasure and honour to me to have the opportunity to share with you some thoughts about – the access of non residents to transplantation medicine. Since the time I have startet my work as legal advisor for the DSO years ago I have been confronted with this legally and ethically very interesting and equally difficult problem. You are all experts in the field of organ donation and transplantation so I probably need not to stress that the peculiarity of transplantation is not only that it is an very expensive medical treatment – but that one of the most limiting factors is the organ shortage. The questions in this context therefore are: Do we want to share? – from a social and ethical point of view Do we have to share? – from a legal point of view (do constitutional rights or the European law force us to share
Post mortem donation is based on the principle of consent. Thus personnel rights of the deceased and his family are protected. The necessity of consent is laid down in the national transplantation acts of the majority if not all European countries as an indispensable precondition for organ retrieval. This common standard is reflected in … Based on the fact that the donor himself can naturally only express his consent during life-time two concepts have developed in the participating countries and throughout Europe in order to obtain this consent: They are known as the model of presumed consent and the model of informed consent. It is important to note that the terms presumed consent and informed consent give only the idea of two very general concepts. Please allow me just briefly to go over the 2 concepts
Why do day to day practice and legal text differ? It can never be ruled out that the deceased did not wish to donate even though he/she did not express his/her will in the officially foreseen manner Hospital staff and donor coordinators would not feel at ease to pursue organ retrieval if there is the slightest doubt about the donor will or protest of the relatives Only positive connotations of donor families with organ donation will enhance the positive image of organ donation and allow for an increase of organ donation in the long run
The next two slides show 6 countries that have all a hbd, living donation, nhd program The left column is the the number of hbd; the right column adds together HB, Living and NHBD and shows a percentage of each group out of this total Therefore without living and nhbd Austria has 24, 8 donors PMP and 29, 8 PMP if you add donation groups together. In Belgium the proportions are comparable. In Switzerland we can spot that the HB donation rate is 12, 1 pmp and only with almost as many living donations a rate of 23, 6 can be achieved. For the analysis in figures 18 a and 18 b only countries that have transplantation programs based on Heart Beating Donation (HBD), Non Heart Beating Donation (NHBD) and Living Donation (LD) were selected. Figures 18 a and b show that countries with a large number of HBD (pmp) such as Spain, Austria and Belgium have a remarkably lower percentage of NHBD and LD than countries with a relatively low HBD donation rate such as UK, Switzerland and the Netherlands. The highest percentage of LD (54%) and NHBD (23 %) can be found in the Netherlands. Hence the percentage of HBD is as low as 23 % in the Netherlands.
Very interesting is the following slide: Spain 89 percent of all donations are from HBD, only 7 from NHBD and 4 from living In the Netherlands we see a completely different development. Without NHBD the cadaveric rate is only 7,3 and 14 PMP are only reached with NHBD – the living donation program is extremely high This is also true for UK with 42 percent of all donations. Those 2 slides show very well that HB donor numbers are very low in countries with highly developed LD and NHBD programs And that it is absolutely necessary not to neglect one over the other .
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