In Germany, it is prohibited by law to donate organs to strangers. In many neighboring countries, such as the Netherlands, Austria, and Switzerland, organ donations to strangers are legal. The German ban may prevent a large number of life-saving organ transplants and deprive patients and donors of more choice. That’s why the ban should be lifted.
More than 7,300 patients are currently waiting for a kidney transplant in Germany, and some 400 patients who had waited in vain for a suitable kidney died in Germany in 2017. Under German law donating organs while the donor is alive is strictly limited to first or second-degree relatives, spouses, registered partners, engaged couples, and others who are obviously close to the donor personally.
That means that patients in need of an organ must rely on the willingness of their close relatives to donate. But that’s not all. Patients also need Mother Nature to decide whether they and their relatives have matching blood groups. If the stars don’t align – i.e., if a patient cannot find a relative who is both willing to donate and has the same blood group – the ailing person can only hope to receive an organ from the long waiting list of Eurotransplant.
In many other countries, such as Great Britain, Spain, the Netherlands, Austria or Switzerland, the situation is different. In these countries, not only those close to the patient but also strangers may donate organs.
Matching to save lives
This regulation has a greater effect on the number of successful transplantations than one might expect. The opportunity to donate an organ to strangers allows incompatible donor-recipient pairs to exchange kidneys with other incompatible pairs.
Let’s say you want to donate a kidney to your brother, but your blood groups do not match. Somebody you don’t know, Hans, wants to donate a kidney to his sister, but their blood groups don’t match either. But Hans’s blood happens to be compatible with your brother’s, and your blood matches that of Hans’s sister. So you arrange a cross-over: Your brothers gets Hans’s kidney and survives; Hans’s sister gets your kidney and also survives. Nobody loses, everybody gains.
Through such crossover-donations, many additional donor-recipient pairs can be found. The Nobel Prize laureate in Economics, Alvin Roth, has developed a mechanism for matching incompatible patient-donor pairs with other pairs for this purpose. Roth and his colleagues developed databases for such matching in the U.S., where they have been used successfully for years now.
If two compatible pairs are found, four surgeries are performed simultaneously. The simultaneity of the operations prevents any one of the donors from behaving opportunistically. Otherwise a donor could promise to donate an organ, wait until his relative has received an organ, and then refuse the donation.
But what if you can’t find two matching pairs for a simultaneous operation? You can still save lives, by building a so-called “chain” of donors and recipients. Some altruistic person usually initiates the process by donating a kidney, say. This kidney goes to a patient, who has a relative who in turn donates one of his kidneys to another stranger. That stranger has a friend who also donates. And so forth.
Donor chains are a second-best option to matching pairs, but they still work better than you might think. The longest chain comprised 30 recipients and 30 donors.
In Europe, the Netherlands pioneered this humane approach. It started allowing crossover donations in 2003. Soon after, a nationwide program was introduced to find matches for crossover kidney donations. The medical data of the donor-recipient pairs registered under this program are compared four times a year with a computer program. In the first four years of the program, more than 45 percent of registered patients received an organ through crossover donations.
Crossover and chain donations save lives. They also help many patients to avoid a painful alternative therapy: dialysis. Patients whose blood flows through a device to be filtered outside their body suffer. For may, a new organ can restore a decent quality of life.
That’s why Germany should follow the Dutch lead and lift the ban on donating organs to strangers. In fact, Germany should go even a step further. The larger the pool of donor-recipient pairs in the database, the more lives can be saved. That’s why Germany should join with the Netherlands and other countries to enable crossover donations across borders.
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