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Doctors newspaper online, 24.09.2019
Hearing on Health Committee on Wednesday
Contradiction or decision-making solution? In the near future, the Bundestag wants to determine to what extent the organ donation needs to be redefined. Associations and experts will be heard first this Wednesday.
By Thomas Hommel
© Petra Steuer / JOKER / picture alliance
BERLIN. It is an unsolved problem of the sad kind: Around 10,000 people in Germany are waiting for a donor organ. About every third person dies because the right organ is missing. Now the legislature wants to take countermeasures and regulate organ donation.
There are three drafts to discuss. Everyone is in agreement to increase the number of organ donations. But the way is described differently: So sets a group of deputies to Green Party leader Annalena Baerbock on a strengthening of the willingness to decide to donate organs. For this purpose, citizens should be given the opportunity via an online register to document the decision, to change it at any time and to withdraw it.
The submission of an organ donation statement should also be possible in identity cards. Family doctors should advise patients and encourage them to register. The effort is to be reimbursed to physicians extra budgetary.
Decision or Opposition?
A second group around Minister of Health Jens Spahn (CDU) and the SPD health expert Professor Karl Lauterbach, on the other hand, strives for the double contradiction solution: every citizen is therefore considered as organ or tissue donor, as long as he has not contradicted during his lifetime. If the next of kin is not aware of any conflicting will, organ harvesting is considered permissible.
In the course of the new regulation, this group also wants to have a register created in which citizens enter their declaration. Both drafts also envisage education and information campaigns in the population.
A third motion by the AfD faction finally suggests a solution of trust. An increase in donor numbers requires confidence in the system created for this.
BÄK for Double Opposition Solution
The arguments for and against the drafts are also reflected in the opinions of the associations and experts, which will be heard in the health committee on Wednesday. The German Medical Association, which pleads for the double resolution solution, emphasizes that could be expected of almost every citizen after the legally regulated education by the health insurance, "to deal with questions of organ and tissue donation and binding for or to decide against a donation ".
The contradiction solution violates neither against the human dignity nor against the freedom of belief or world view, so the BÄK. The right to decide for themselves remains "essentially untouched". No one is forced to disclose the reasons for his decision.
The representatives of the big churches see that differently. The contradiction solution is afflicted with "considerable legal and ethical concerns," emphasize the Council of the Evangelical Church of Germany and the Commissariat of German Bishops. The organ donation decision must remain voluntary.
Church representatives plead for voluntariness
There are good reasons for the organ donation, the church representatives said. Nevertheless: "There is no moral obligation to donate his organs posthumously." For this reason, a legal duty could "certainly not".
In order to increase the number of organ donations "sustainably", organizational aspects in the transplantation procedure should be improved. The transplantation law passed in the spring sets "exactly here" and should therefore be consistently implemented.
The central cause of the low organ donation rate is a recognition or reporting deficit of potential organ donors in hospitals.
Professor Ulrich Kunzendorf, Director of the Department of Internal Medicine IV, University Hospital Schleswig-Holstein Campus Kiel
Similarly argued the board of the German Foundation for Patient Protection, Eugen Brysch. Silence is not an agreement. The right of self-determination is so severely restricted by the draft contradictory as would otherwise be "inconceivable" in data and consumer protection or in medical law.
When do patients feel compelled to donate?
People may feel compelled to donate organs or worry that a contradiction will not be found, even if there is a register for it. Thus, the confidence crisis, in which the donation of organs in Germany, "further aggravated," warns Brysch.
The association "Leben Donate!" Emphasizes that a paradigm shift in the regulation of organ donation is long overdue. The contradiction solves this. In all countries in which this rule applies, the organ donation figures are much better than in Germany, according to the statement of the association, the well-known supporters such as the President of the German Society of Surgery, Professor Matthias Anthuber, or former Federal Labor Minister Norbert Blüm (CDU).
The decision-making solution should be rejected because it is not clear at all that this could lead to improvements in organ donation. Addressing the citizen every ten years when applying for the identity card only postpones the problem rather than remedying it.
Relatives do not decide!
Peter Dabrock, professor of systematic theology at the University of Erlangen, accuses the representatives of the double contradiction solution against label fraud. One should only speak of a double contradiction rule "if, beyond the consent of the potential organ donor during his lifetime, the relatives would be given the opportunity to make independent decisions". Only then terminologically give the adjective "double" meaning.
This option is denied, however. On the other hand, Dabrock categorizes the draft decision-making solution as a "factually meaningful reform initiative sensitive to fundamental rights and the establishment of its practical concordance". You also put the "lever in the right places" on. These included, for example, the low-threshold provision of decision-making options with authorities, a register or the financial improvement of necessary conversations with the doctor.
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