There is a shortage of donor organs in Germany. To counteract this, the FDP proposes to redefine the requirements for organ donation.
The FDP in the Bundestag wants to expand the definition of death as a prerequisite for organ donation. In the future, cardiovascular arrest should also be the basis for a self-determined removal of organs – until now, brain death had to be proven. This is intended to increase the number of donors. But what exactly does this proposal mean in practice?
Experts speak of brain death when all brain functions, such as the reaction to stimuli such as pain or breathing, cease irreversibly. This failure must affect both the cerebrum and the cerebellum and the brainstem. This means that the person’s death is definitely determined according to neurological criteria. Causes of brain death include severe brain damage as a result of cerebral hemorrhages, brain tumors, strokes or meningitis. But external injuries or accidents can also lead to brain death.
Cardiovascular arrest occurs when the heart stops beating and stops pumping blood throughout the body. Without this blood circulation, the organs, including the brain, can no longer receive oxygen and die. If left untreated, cardiovascular arrest leads to (cardiac) death. Causes of cardiovascular arrest include a heart attack, coronary heart disease, myocarditis or shock.
If brain death is suspected, two experts must independently determine the complete and irreversible failure of the cerebrum, cerebellum and brainstem. In addition, the causes that led to brain death must be clarified. In order to prove that the loss of brain function is irreversible, the examinations must be repeated at intervals in the final step. The diagnosis of brain death can therefore take a few hours to days. The initiator of the application, the health policy spokesman for the FDP parliamentary group and university professor in Würzburg, Andrew Ullmann, describes the effort that doctors would have to make to determine that a patient is brain dead as “immensely high”.
The diagnosis of cardiovascular arrest, on the other hand, is easier, but can still be determined reliably, explained Ullmann to “Welt”. The diagnosis of cardiac arrest is based on clinical signs such as respiratory arrest and pulselessness and is confirmed using a cardiac monitor and electrocardiography (ECG).
According to the medical newspaper, organ donations after a cardiac arrest are already permitted in countries such as Great Britain, Spain, Belgium and the USA. The regulation partly led to an increase in the number of organ donations there.
However, Eugen Brysch, board member of the German Patient Protection Foundation, contradicts the FDP. According to him, the central point of the irreversibility of death in the event of cardiac arrest is not given, he explains to the German Press Agency. “Brain death and cardiac death after an untreated cardiac arrest are not the same. But that is exactly what the FDP initiative suggests.”
Federal Health Minister Karl Lauterbach (SPD) also thinks little of the FDP proposal. “As a doctor and a clear supporter of a contradiction solution, I consider brain death to be the safe method for determining death. With brain death, errors are excluded. In combination with the contradiction solution, we would save many lives,” he wrote on X. With the contradiction solution Consent to a decision is deemed to have been made if the person concerned does not explicitly object.
In Germany the so-called decision solution applies. This means that organs and tissue may only be removed after death if the deceased person consented to this during their lifetime in an organ donor card or in the organ donation register. If there is no decision, the relatives will be asked for a decision.
In this article you will find out how to record your decision in the organ donation register and what needs to be taken into account.
In order to support people’s decision-making, all people insured with German health insurance from the age of 16 receive information materials and the organ donor card free of charge every two years.