Well over 6,000 people in Germany are currently waiting for a kidney donation; the average waiting time is 8 years. With an amendment to the Transplantation Act, the possibilities for living donation are now to be expanded; this will be discussed in the Bundestag on Wednesday.
Of the organ transplants performed annually, kidney donation is the most common. A distinction is made between donations from deceased and living donors. Unlike other organs, kidney donation is possible for healthy people without major health risks. Living donation has so far made up a smaller proportion of kidney donations The requirements for this are strict: Only people who are “obviously particularly close to each other” are allowed to donate to each other. As a rule, these are spouses or close relatives. A living donation is only medically possible if it is an immunological match for the intended recipient.
Now the following scenario is conceivable: A person would like to donate a kidney to their partner, but it doesn’t fit. Elsewhere, a donor recipient couple experiences the same thing. In other countries – such as the USA or the Netherlands – so-called cross donations have been successful for years. Using computer algorithms, longer chains with several pairs of donors can also be formed.
In Germany, this option is long overdue, according to experts and patients. Those affected sometimes travel abroad to make a cross donation. The current bill sees an amendment to the Transplantation Act before and after which cross-donations and anonymous donations would be possible – explicitly only for kidneys and anonymously arranged through a placement agency that has yet to be organized. Psychosocial counseling for donors should be mandatory.
Better than dialysis
The director of the Hanover Clinic for Kidney and Hypertension Diseases, Kai Schmidt-Ott, speaks of a “step in the right direction” and expects around 100 additional living donations per year as a result of the new regulation. So far there are around 600. Klemens Budde, senior physician specializing in transplants at the Charité Berlin, also welcomes the planned new regulation. Each additional transplant also shortens the waiting time for everyone else, increases the quality of life and chances of survival for those affected and is also good for the health system. A transplant is cheaper than continued dialysis after just six months.
Silke Schicktanz, director of the Institute for Ethics and History of Medicine in Göttingen, assesses the expanded options for living donation as ethically justifiable. However, she still sees weaknesses in independent advice and information as well as in the question of whether money could subsequently flow between recipients and donors. Overall, experts see no additional risk of commercial abuse of organ donations.
It will probably be a while before cross donations become common practice in Germany. A new regulation must first be decided by the Bundestag after the discussion on Wednesday. It remains to be clarified which body should be responsible for the complex coordination of cross-donations. Given the severe shortage of organ donations For example, the German Society for Nephrology (kidney medicine) is calling for the introduction of the objection solution for Germany due to a possible increase in living donations, according to which, unlike before, anyone who does not want to be a donor after death must actively object. The Federal Council had one on this in November Legislative initiative in the Bundestag introduced.