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We are pleased with the positive contributions to our study (1), which had the primary goal of understanding why the number of organ donations in Germany has decreased by one third in recent years. However, the decline in this period is only one facet of the problem in Germany: even at its peak, relatively few organs were donated in Germany as compared to international standards (2).

Until now, the low donation rates in Germany were thought to be due to the attitude of the population. This conclusion was suggested by a German Organ Transplantation Foundation (DSO) in-house coordination project, which was carried out between 2010 and 2012. This study concluded that „the below-average donation rates in Germany are by large not due to inadequate reporting of potential donors by hospitals“ (3). Our study, however, shows that the hospitals that participated in the project at that time were not at all representative of the overall situation in Germany. The contact rate in these hospitals was significantly higher than in the nationwide average. In short, the below-average donation rates in the international comparison were already at that time mainly due to insufficient reporting of potential donors. Thus, if the currently existing reporting deficit in the German hospitals were to be consistently rectified, there would be a legitimate hope that organ donation rates in Germany would reach the international level—as our potential analysis shows.

But how can the reporting deficit be addressed effectively? The proposal of Prof. Kribben moves exactly in the right direction. The organ donation activities of each hospital that performs organ removal must be transparent. For example, the rates we describe could be integrated into hospital quality reports. Based on this, it would then be possible to deliberately intervene in hospitals in which there is a deficit in the organ donation process.

In this context, Mr. Koczor’s proposal of introducing an electronic emergency file should also be discussed. With such a file, the patient‘s will would be clearly documented, and it would also be comprehensible in retrospect if no report was made due to a lack of consent.

Now for the current debate about financing: Assuming that there is no reporting deficit, the informed decision making regulation was introduced in 2012. Since then, all persons covered by statutory health insurance—more than 72 million people—have been regularly sent information leaflets and organ donor cards. Just the postage costs alone for this measure exceed many times over the expense reimbursement that the hospitals receive annually for organ donations that were actually performed—which, in 2017, was about four million euros. Against the backdrop of the knowledge presented above, this use of funds should be reconsidered.

Nevertheless, determining the financial framework must not obstruct the view of the decisive problem. The fact that some hospitals do an outstanding job under the current conditions proves that it can work!

DOI: 10.3238/arztebl.2018.0749c

On behalf of the authors:

Dr. med. Kevin Schulte

Prof. Dr. med. Thorsten Feldkamp

Klinik für Nieren- und Hochdruckkrankheiten

Christian-Albrechts-Universität zu Kiel

Kevin.Schulte@uksh.de

Conflict of interest statement

Dr. Schulte declares that no conflict of interest exists.

Prof. Feldkamp has received consultant honoraria from Bristol-Meyers Squibb (BMS), Roche, Novartis, Fresenius, Chiesi, Teva, Noevii, Hexal, and Sanofi, payment for authorship or co-authorship of a publication relating to the topic of this article from Novartis, reimbursement of meeting participation fees, travel and accommodation expenses, and/or lecture honoraria from Biotest, BMS, Astellas, Chiesi, Novartis, Neovii, Roche, Hexal, Fresenius, and Sanofi, and study support (third-party funds) from Chiesi, BMS, Astellas, Novartis, Hexal, and Teva. He is a member of the Renal Transplantation Conference of the University Medical Center Schleswig-Holstein, Campus Kiel.

1.
Schulte K, Borzikowsky C, Rahmel A, Kolibay F, Polze N, Fränkel P, Mikle S, Alders B, Kunzendorf U, Feldkamp T: Decline in organ donation in Germany—a nationwide secondary analysis of all inpatient cases. Dtsch Arztebl Int 2018; 115: 463–8 VOLLTEXT
2.
Weiss J, Elmer A, Mahillo B, et al.: Evolution of deceased organ donation activity vs. efficiency over a 15 year period: an international comparison. Transplantation 2018. doi: 10.1097/TP.0000000000002226. [Epub ahead of print] CrossRef
3.
Blum K: Inhousekoordination bei Organspenden, Abschlussbericht, Deutsches Krankenhausinstitut. www.dki.de/sites/default/files/downloads/inhousekoordination_bei_organspenden.pdf.
1.Schulte K, Borzikowsky C, Rahmel A, Kolibay F, Polze N, Fränkel P, Mikle S, Alders B, Kunzendorf U, Feldkamp T: Decline in organ donation in Germany—a nationwide secondary analysis of all inpatient cases. Dtsch Arztebl Int 2018; 115: 463–8 VOLLTEXT
2.Weiss J, Elmer A, Mahillo B, et al.: Evolution of deceased organ donation activity vs. efficiency over a 15 year period: an international comparison. Transplantation 2018. doi: 10.1097/TP.0000000000002226. [Epub ahead of print] CrossRef
3.Blum K: Inhousekoordination bei Organspenden, Abschlussbericht, Deutsches Krankenhausinstitut. www.dki.de/sites/default/files/downloads/inhousekoordination_bei_organspenden.pdf.

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