What is organ transplantation, here kidney transplantation?

The only way for kidney patients to avoid dialysis (blood washing) is through organ transplantation. One organ is enough for this, i.e. a kidney.

Organ transplants in Germany occur through two ways (which are defined/managed by state-supported bodies such as the BäK and the DSO):

1. Living organ transplant (Here the donor is a healthy person, i.e. a living donor. This person may only donate one kidney or part of the liver.)
2. Postmortem organ removal after brain death (up to nine organs/tissues are removed from a brain-dead person).

The kidney donation may come from a living donor (legal text on living donation). A person has two kidneys and may/can donate one of these to a close relative, if self-determined.

To do this, the blood group, blood cross sample for typing (HLA antigens) between donor and recipient must correspond to the allocation or organ transplant criteria and the donor must be “healthy”.

Another method of living donation is CROSS-OVER LIVING DONATION

“Postmortem organ removal” (also called waiting list transplantation) is only possible from a brain-dead person in a hospital intensive care unit. (Definition: brain death)

For this to happen, the blood group and blood cross sample of the brain dead person must also meet certain criteria and of course this brain dead person must also have had healthy organs.

Up to 7-9 organs/tissues are then removed from this, for a maximum of 7-9 sick people: heart, lungs, liver, 2x kidneys, pancreas, intestines, cornea and parts of skin/tissue.

The organ recipient and the organ donor are then prepared for the operation and pre- and post-operative care according to predefined criteria.

Until the transplant (kidney waiting patients are put on a list and wait up to 11 years for a kidney transplant), the organ recipient is subject to preliminary examinations.

The organ recipient, in this case the kidney patient, is previously prepared for the kidney transplant through certain examinations.

These investigations include

1. Examination of surgical operability:

• cardiovascular check-ups,
• Abdominal check-ups and
• Vascular check-ups.

2. Exclude sources of infection

• Blood laboratory tests

If these were positive (no infection, surgical operation possible) (because these are very lengthy in Germany and sometimes expire quickly before the first round has been completed, as the condition is very pronounced), the operation date for the living donation is worked towards and set.

With “post-mortem organ donation”, kidney patients are first placed on a waiting list marked “T”. T for “transplantable” if all tests are positive. If the examinations do not meet the requirements of the rules set by the respective medical associations, the entry is set to “NT“, for “not transplantable“. There is another entry with “HU“. This is set in urgent cases (e.g. danger to life) and means “high urgent“.

These prioritizations (NT,T,HU) are passed on to Eurotransplant by the transplant centers, depending on the assessment of the transplant doctor.

The waiting list transplants are organized and handled by two foundations, led by EUROTRANSPLANT and DSO.

Living donor transplants are organized and carried out by the clinic or hospital carrying out the operation.

Because the waiting list for organ recipients is very long, a waiting list determined by the German Medical Association (or associated societies with their guidelines, in this case the German Society for the Advance Care of the German nephrology Society DGfN, with their NTX manual for evaluation before kidney transplantation) according to criteria and factors regarding who may and should be on the list and how urgently, the wait in Germany is 8-11 years for a redeeming donor organ, in this case a kidney transplant. Due to the organ shortage caused by the decision-making regulations of the German Transplantation Act, this creates long waiting times in Germany, which are painful for the waiting patients and have social consequences, and which are unparalleled anywhere else in the world.

An example from 2021-2023 (two-year waiting period, only for the readmission of a waiting patient, or listing with Eurotransplant for a postmortem organ donation!)

During this time, you will continue to receive dialysis (this is where the comorbidities in these patients develop) and you will have to undergo the preliminary examinations again every year or every two years (depending on age), according to the rules defined by the Medical Association’s guidelines (with a very strong understanding of due diligence), unless you are removed from the list and are deemed “not transplantable”, i.e. “NT”.

These rules, which lead to a waiting patient being deemed “NT,” are so extensive in Germany (consider that rules are set that tinker with examination methods that are penalized after signs of tumor onset even though there is no suspicion!) that so many patients are waiting on the waiting list due to a lack of donor organs due to legal unrealities in the transplantation system that patients are then declared “NT” ineligible for transplant during this long period. No other European country does something like this! What’s wrong here?

You can do it here, for example. read:

Waiting list placement at organspende-info.de

Is this what health policy wants? Organ donation – laws that increase numbers are intentionally kept inactive and the objection regulation is denied. Words on this information platform are: “prospect of success” and “necessity”, word combinations from the economics lesson. Since the numbers are so low, are you trying to tighten the rules and limit them to the likelihood of success and necessity? What an injustice! No other country has such expressions in their state information platforms for organ donation!

The Wartepatient

Living kidney donation

Postmortem donation