Organ donation

National organ donor memorial in Naarden , Netherlands: “De Klim”, climbing

In the case of an organ donation , human organs are made available for a transplant by the organ donor . Living donations are common practice for kidneys and liver lobes ; such donations are in the experimental phase for wombs . In addition to the donor's consent, living donations are often subject to further-reaching conditions.

The removal of vital organs such as the heart , lungs , pancreas and small intestine is only carried out after death (Latin post mortem ). The legal requirement for this is usually the clear determination of brain death , in some countries the cardiac death criterion is also necessary. In addition, from a legal point of view, contradiction and consent rules compete .

Tissue donations (e.g. cornea ), blood donations , bone marrow donations (blood stem cell donation) and donations of vascularized tissue complexes (e.g. hand or face transplants) are distinguished from organ donation in the narrower sense .

history

In 1954, for the first time, an identical twin brother donated one of his kidneys to his brother as a living donor (syngeneic transplant). This brother survived eight years. The donor brother himself died more than 56 years later, in 2010. The then chief surgeon Joseph Edward Murray received the 1990 Nobel Prize for Medicine .

The first living donation of a pancreas was made in 1979 by a team led by David Sutherland at the University of Minnesota in Minneapolis .

Living liver donations have been carried out since 1995 . By 2012, over half a million kidneys had been transplanted worldwide.

Medical practice

Organ donation in the narrower sense concerns solid human organs. The situation is different with tissue donation , in which blood components , corneas , heart valves , bone tissue , cartilage tissue , ossicles , skin or tendons are removed.

Organ quality

A number of factors determine the quality of an organ (and thus, in addition to the compatibility of the organ with the recipient, the degree of success of a transplant). The two most important are organ age and certain comorbidities of the donor.

The age of the donor is less relevant than the condition of the organs. The suitability of organs for transplantation should be checked medically on a case-by-case basis.

Contraindications

Organ donation is prohibited if the donor suffers from metastatic cancer, an active and consuming infection, Creutzfeldt-Jakob disease or other prion diseases or a chronic organ dysfunction.

Because an infection with HIV is no longer an absolute contraindication for transplants, deceased HIV-infected people can also be used as donors for HIV-infected potential recipients, although this is sometimes legal - e.g. B. in the United States - is prohibited.

Some contraindications are organ-specific. People infected with hepatitis B or  C are not available for liver donation.

Drug addiction is not an unconditional contraindication to organ donation.

Types of donation

In principle, a distinction can be made between donor organs, which can only be removed from a dead person, and those which can also be transferred through a living donation. As a rule, organs from living donations achieve greater success in transplantation.

A distinction can be made between autologous, allogeneic, syngeneic, xenogenic and alloplastic transplantation. In an autologous transplant, the organ donor and recipient are the same person (e.g. skin graft in the event of a burn). In an allogeneic transplant, the donor and recipient are two different people. Allogeneic transplantation is the most common type of transplant in the world. Syngeneic transplants between identical twins are a special case; here the donor and recipient are genetically identical. Xenogenic transplants take place between representatives of different species. That means organs are transplanted from animals to humans. This also includes inserting pig heart valves into the human heart.

Living donation

With living donation, a living person donates one of their organs or the required cells. These are either paired or segmented organs or organs with a high regenerative capacity.

Basically, a distinction is made between living donations from close blood relatives and "foreign donors" who are usually not in personal contact with the recipient, so-called living unrelated donors (LURD) . The transplant successes usually do not differ significantly or at least not significantly from one another.

Kidneys and liver are donated by living people . Parts of the pancreas , intestines and lungs have also been transplanted after living donations.

The uterus can now also be temporarily transplanted for the birth of a child .

kidney

The living kidney donation is the most common form of living donation, since this organ in the body is present in pairs and thus the donor does not lose his kidney function. Live donor kidney transplants show significantly greater success than cadaveric kidney transplants. Women donate between two and eight times more often than men. Less invasive laparoscopic types of harvesting led to more frequent serious complications in the early days of the 21st century, but are now as safe as conventional open surgical interventions, but lead to a somewhat longer warm ischemia period without any previously demonstrable consequences for the organ quality Has. Both types of intervention therefore play a legitimate role in clinical practice. Perioperative mortality is around 0.02 to 0.05%; the long-term mortality of kidney donors is not higher than that of comparable age cohorts .

liver

Another organ in which living donations are playing an increasing role is the regenerative liver, only part of which can be donated.

Post-mortem donation

Post mortem, hearts , limbs (e.g. hand transplants ) and the face are also harvested for transplantation. There were first attempts with uterine donations in Saudi Arabia and Turkey; Such a program is also under way in Sweden. Organs for transplantation are usually removed when brain death is proven. In some countries, mostly as an alternative, organs are also removed after cardiac death , mainly kidneys and, more rarely, livers. Until the preparations for the removal operation have been completed, the donor's body will be treated as part of the organ-protective intensive therapy.

Before brain death criteria developed at Harvard University in 1968 gained wide acceptance, cardiac death was the premise of most post-mortem organ donations. Thereafter, brain death became by far the most common pre-exploration diagnosis in most transplant medicine states. Only in countries like Japan, which do not recognize brain death, cardiac death remained the standard criterion for post-mortem organ removal. Only because of the worsening of the organ shortage, in some other countries (e.g. USA, Netherlands) since the 1990s, there has been an increasing number of withdrawals after an irreversible cardiac arrest without a determination of brain death. In Switzerland and, since the end of 2013, in Austria, brain death must also be determined before removal after an irreversible cardiac arrest. In Germany, organ exploration after cardiac death is prohibited.

Brain death can be determined by clinical examinations in a primarily supratentorial ( cerebral ) lesion (coma, absence of all brainstem reflexes and failure of spontaneous breathing). These observations must be proven over a certain period of time - between four and 72 hours, depending on the jurisdiction and the type of brain damage, with secondary brain damage usually requiring longer periods of time. Alternatively, technical examinations to prove irreversibility are possible and common: either a zero-line EEG for at least 30 minutes, or evoked potentials that have been extinguished on both sides , or proof of the lack of cerebral blood flow by means of Doppler sonography or perfusion scintigraphy. In the case of primarily infratentorial ( brain stem , cerebellar ) lesions, an additional technical examination (EEG or sonography) is often mandatory.

Organ donation usually does not make burial difficult or hinder it .

ethics

A number of ethical positions exist with regard to organ donation.

Organ deficiency

There has been a shortage of donor organs since the beginning of the history of transplants. In order to ensure the balanced distribution of post-mortem donated organs, organizations have been set up to keep donor databases. Here, the donor organs are checked for their medical compatibility with potential recipients and according to other criteria, such as B. Urgency ("sickest-first" principle) and prospect of success (gain in years of life with a certain quality of life) assigned to one or more suitable recipients.

Waiting times for a donor kidney vary depending on the political context. In Germany, for example, they have risen continuously in recent years and were around six to eight years at the beginning of 2005. Potential organ recipients die of their illnesses during the waiting period. Reasons for the long waiting time include: a. the decline in fatal road traffic accidents and the increased general life expectancy , which is leading to an increase in diseases that can only be treated with a transplant. In addition, as technology advances, more and more transplants are considered feasible by medical professionals.

Another reason given for the lack of organs is legal regulations that prevented more numerous donations. For example, the National Ethics Council of Germany points out that only a small percentage of the population even knew about the valid consent regulation and thus filled out an organ donor card . If the situation arises that the donor is brain dead and his organs could be transplanted, doctors would have to ask the relatives for permission while still in the intensive care unit. This is often not done for reasons of piety.

The German Foundation for Organ Transplantation (DSO) counted 637 donors in Germany from January to September 2016. According to the foundation, there were 797 donors throughout 2017; it was the lowest number in 20 years (2007 according to DOS 1313).

The Eurotransplant Foundation named 769 donations for 2017. It only counts donations that are found to be suitable for transplantation after the organ removal and that are actually being transplanted.

Post mortem donations

Postmortem donations raise two specific ethical problems: First, there is the question of the occurrence of death . Then it must be checked who decides under what circumstances whether an organ removal may be carried out. Ultimately, it is important to assess the situation of the bereaved .

Onset of death

In the case of post-mortem donations, the occurrence of death must also be specified. In practice, brain death is the common criterion for organ removal . As an example of many medical professionals involved in transplantation processes, the medical coordinator of the DSO describes brain death as “the safest diagnosis that can be made”. In contrast, parts of the German population doubt the reliability of the diagnosis. They fear that potential donors for the purpose of organ removal will be declared dead too early. Representatives of an ethic embodied by the philosopher Hans Jonas take a more fundamental opposing position : They defend the position that the human person cannot be separated from his body or can only be located in the brain. There are also indications that people in Germany are often wrongly declared to be brain dead.

Decision-making authority

In principle, a distinction is made between four models of post-mortem organ donation:

• Consent regulations

allow post-mortem organ removal only if the deceased has expressly declared during his lifetime - for example with the help of an organ donor card - that he wants to be an organ donor after death. With extended consent regulations , certain persons, mostly surviving dependents, can also consent after the death of the organ donor. No European country today practices the narrow form of consent regulation.

• Opposition rules

With regard to the potential group of donors, contradiction rules (including contradiction solutions ) are broader in which all deceased persons who have not expressly objected to a post-mortem donation during their lifetime are eligible as donors.

Extended objection regulations also give certain surviving dependents the right to act as messengers of the will of the deceased during their lifetime after the death of the potential donor.

• Information regulations

form a special sub-type of the extended opposition rule. For those, the will of the potential donor expressed during their lifetime applies. If this is not known, an organ removal is considered permissible if certain surviving dependents are informed and do not object within a certain period of time.

• Emergency regulations

allow organs to be removed even if there is an objection - whether from the donor or his relatives - in any case.

Situation of relatives

Opponents of organ donation complain that relatives are forced to make a decision by the clinic staff after an accident, although they are still in a state of shock. However, in countries in which certain relatives are given a say under specific conditions, such an approach is mandatory.

Organ trafficking

Organ trafficking is prohibited in most states. Exceptions are Iran and the Philippines, which have institutionalized a regulated organ market . Guyana has no laws against organ trafficking, so there are organ purchases. In addition, Bolivia, Pakistan, Peru and Albania are also frequently mentioned in connection with organ trafficking. In order to prevent organ trafficking in living donations, many organ removal regulations only provide for a certain group of people. These are mostly close relatives or people who may be personally connected to the donor.

politics

The various ethical questions are primarily discussed by two types of groups: On the one hand, there are ideological groups that deal with ethical questions of all kinds and, on the other hand, groups from the health care sector who are confronted with organ donation issues because of their work or because of their own concern.

Philosophical groupings

Christianity

The Christian churches refused to donate organs until the 1950s with a view to the mutilation of corpses. Today, most major Christian churches hold the view that the charitable decision to donate organs takes precedence over the corpse's physical integrity. All that is pointed out is the need to treat the dead donor and his relatives with dignity and the voluntary nature of his donation. For this reason, among other things, the model of an objection regulation is viewed critically.

From the point of view of the Roman Catholic Church, the actual death of the donor is an indispensable prerequisite for organ donation. Pope John Paul II has named inadmissible conditions for organ removal in connection with the forms of euthanasia: “They could occur, for example, if, in order to have more organs available for transplants, the removal of these organs without them to respect objective and reasonable criteria for the determination of the death of the donor. ”Pope Benedict XVI. has made it clear that if there is no certainty, the principle of caution must prevail. Only under these conditions can organ donation be seen as an act of charity. The required death condition corresponds to the Catechism of the Catholic Church KKK 2296 and the Compendium 476.

In 1990 the German Bishops' Conference and the Council of the Evangelical Church in Germany brought out their first joint publication, "Organ Transplantations". It says on page 10f: “Death of the brain, like death of the heart, means the death of a person. With brain death, a person lacks the irreplaceable and irrecoverable physical basis for his spiritual existence in this world. The human spirit, unique among all living beings, is physically bound exclusively to the brain. A brain-dead person can never again make, process and answer an observation or perception, never again form a thought, pursue and express it, never again feel and show an emotion, never again decide anything. ... So brain death means something crucially different than just remaining unconsciousness, which alone does not make up human death. ”The final sentence of this joint declaration reads:“ From a Christian point of view, the willingness to donate organs after death is a sign of charity and Solidarity with the sick and disabled. "

On April 27, 2015, the German Bishops' Conference published the working aid “Brain death and organ donation”. It says on page 6: “According to the current state of science, the brain death criterion in the sense of whole brain death - if it is properly applied in practice - represents the best and safest criterion for determining the death of a person, so that potential organ donors can rightly assume that at the time of organ removal they are really dead and not just dying. ... The decision to donate one's own organs post-mortem represents a generous act of charity, which as such should remain free from all social pressure. "

On the day of organ donation in 2020, which only took place virtually due to the coronavirus pandemic , an article appeared in the Catholic Sunday newspaper with quotes from two popes on organ donation: Pope Benedict XVI. In 2008 she called a “special form of charity”. In 2019, Pope Francis called it an "expression of universal brotherhood".

Judaism

In Jewish ethics, the strict prohibition against mutilating a corpse speaks against organ donation. On the other hand, the duty to save a person's life takes precedence over almost all other commandments in Judaism. That is why organ transplantation is advocated in progressive Judaism and, if a specific recipient needs the organ, also in Orthodox Judaism. (The religious affiliation of the donor and recipient is not considered relevant.)

Islam

The strongest argument in the Qur'an for organ donation is found in sura 5:32: "And if someone keeps [a person] alive, it is as if he kept all people alive." On the basis that organ donation lives save, all other theological reasons that would speak against organ donation can be overridden. On the other hand, it can be objected that kidney donations are not life-saving due to the possibility of dialysis and that Islam attaches great importance to the sanctity of the body. Likewise, “ Allah's Foresight ” is highly valued and so the salvation of the doomed may thwart Allah's plans.

In 1966, the Egyptian Grand Mufti issued the first fatwa that allowed organ donation. Since 1986 at a conference of Islamic legal scholars in Amman, brain death was equated with cardiac death in a fatwa, propaganda campaigns for post-mortem organ donation have been carried out in a number of primarily Islamic countries.

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

The willingness to donate among Muslims in Germany is assessed by doctors as very low, while it is higher in Islamic countries. According to some Islamic legal scholars, organ donation from a non-Muslim to a Muslim is possible, but not the other way around. The very high probability in Germany that the organ will go to a non-Muslim could partly explain the low willingness to donate. However, some legal scholars take a different view and consider transplants to be possible even to non-Muslims.

Confucianism

Due to the respect for parents ( filial piety ) there are reservations against organ donation, both when relatives decide whether the organs of the deceased parents should be released for donation, but above all, according to Confucius, the body is a gift from the parents, so that their Children have a duty to keep it intact. On the other hand, there is encouragement from Confucian scholars for organ donation on the basis of charity as one of the five central virtues of Confucianism.

taoism

According to Taoism, organ donations are rejected for several reasons. On the one hand, organ donation is seen as acting against the natural course of things ( wu wei ), on the other hand, an operation disrupts the natural flow of qi s of the body and is unnatural, and ultimately death is only viewed as a different form of life, so that organ removal violates the integrity of the body in this afterlife.

In favor of organ donation, however, would be that the body is only a vessel of the spirit and that an organ donation therefore has no influence on the principles of dao and de as the essence of life, and that a donation is natural as an expression of self-sacrifice in order to save another life.

Anthroposophy

Since organ transplantation can lead to the removal of a large number of organs from the human body, which the donor did not intend, postmortem organ removal is viewed very critically by representatives of anthroposophy . From the perspective of anthroposophic medicine , the criterion of brain death is also very doubtful. Consent to organ donation is therefore not recommended. In contrast, the living donation of organs is viewed positively.

Economy

Because there is no free organ trade, organ donations can only be economically assessed according to their benefit in comparison to substitution services such as dialysis in relation to kidney donations. This shows that kidney transplants are significantly cheaper than comparable dialysis in the long term and with average organ survival. For the United States, this is estimated to be a saving of US $ 94,000 per kidney donated, which does not include the value of quality-adjusted lifetime gained . Even with very conservative estimates, this value is around US $ 50,000 (€ 42,205) per year of organ survival with a current half-life of around ten years. On the other hand, even with live kidney donations, there are no more than about US $ 20,000 in direct costs and a very small, unquantified health risk for the donor.

From a utilitarian point of view, the non-utilization of transplantable organs from corpses means the routine destruction of a very valuable resource. In order to remedy the shortage of organs, it is therefore discussed to offer selective incentives for registration for post-mortem organ donation.

practice

Regional transplant networks: E urotransplant S candiatransplant B alttransplant




Organ donation practices are largely national, although there may be sub-national practices in countries with strong constituent states (e.g. Canada or Switzerland). There are also international organ donation distribution organizations, such as Eurotransplant , Scandiatransplant and Balttransplant in Europe . In Latin America, Grupo Punta Cana tries to coordinate organ transplants internationally.

overview

The following table gives an overview of the global situation of the existing regulations for organ donation.

	State / Country	regulation	Enactment	Death criterion	Donor rate
					post mortem	Living donations
E.	E urotransplant countries
E.	Germany	Consent regulation	1997 (2012)	∅	15.8	09.2
E.	Austria	Objection regulation	1982	∅	23.3	07.3
E.	Belgium	Objection regulation	1986	∅ ♠	20.5	07.6
E.	Netherlands	Objection regulation	2018	∅ ♠	13.7	28.7
E.	Luxembourg	Objection regulation	1982	∅	06.0	00
E.	Croatia	Objection regulation	1989 (2000)	∅	30.7	05.0
E.	Slovenia	Objection regulation	1996 (2000)	∅	20.5	00
E.	Hungary	Objection regulation	1972	∅	15.9	04.3
S.	S candiatransplant countries
S.	Denmark	Consent regulation	1990	∅	05.6	18.2
S.	Finland	Objection regulation	1985	∅	17.0	02.0
S.	Iceland	Consent regulation	1991	∅	10.0	16.2
S.	Norway	Objection regulation	1973	∅	20.8	16.9
S.	Sweden	Information regulation	1996	∅	12.6	18.7
B.	B old transplant countries
B.	Estonia	Objection regulation	2002	∅	25.4	03.1
B.	Latvia	Objection regulation		∅	14.8	00.9
B.	Lithuania	Consent regulation		∅	10.9	02.4
	Rest of Western European countries
	Switzerland	Consent regulation	2007	∅	12.6	14.7
	Liechtenstein	Information regulation	2012	∅
	Spain	Objection regulation	1979	∅	32.0	05.5
	Portugal	Objection regulation	1993	∅	30.2	04.8
	France	Objection regulation	1976 (1994)	∅	23.8	04.6
	Ireland	Consent regulation	-	∅	12.6	05.0
	Italy	Objection regulation	1967 (1999)	∅ ♠	21.6	03.2
	United Kingdom	Consent regulation	1961 (1989)	∅	16.4	17.0
	Rest of southern and eastern European countries
	Turkey	Information regulation	1979	∅	03.6	34.3
	Albania	no		∅
	Bulgaria	Objection regulation	1996	∅	02.7	01.9
	Georgia			∅		01.8
	Greece	Consent regulation		∅	03.9	02.4
	Kosovo	no		∅
	Malta	Consent regulation	-	∅	22.5	07.5
	Moldova			∅	00	00
	North Macedonia		1995 (2008)	∅	00	06.0
	Poland	Objection regulation	1990	∅	13.3	01.8
	Romania	Consent regulation	1998	∅	03.3	04.6
	Russia	Objection regulation	1992 (2007)	∅	02.6	01.4
	Slovakia	Objection regulation	1994	∅	16.8	01.3
	Czech Republic	Objection regulation	1984 (2002)	∅	19.6	01.6
	Ukraine	Consent regulation	1999	∅	00.3	01.9
	Belarus	Objection regulation		∅	08.5
	Cyprus	Objection regulation	1987	∅	04.4	26.7
	Arabic countries
	Algeria	Objection regulation	1990	∅	00.03	02.9
	Bahrain	Objection regulation	1998	∅	04.0
	Brunei			∅	00	11.0
	Qatar	Objection regulation	1997	∅	02.4	01.6
	Jordan			∅		29
	Lebanon	Consent regulation	1983	∅	00.5	16.3
	Morocco	Objection regulation	1998	∅	00	00.3
	Palestine	no	-	∅	00	01.6
	Syria		2003	∅	00	17.0
	Saudi Arabia	Consent regulation	2004	∅	02.7	20.1
	Tunisia	Objection regulation	1991	∅	01.5	10.5
	Rest of Asian countries
	Bangladesh			∅	00.9
	Hong Kong			∅	04.2	06.6
	India	Consent regulation		∅
	Iran		2000	∅	04.1	22.4
	Israel	Objection regulation	1953	∅	08.0	11.0
	Japan	Objection regulation	2010	∅ ♠	00.8
	Malaysia	Consent regulation		∅	00.9	01.2
	America
	United States	Consent regulation	1968 (1987)	∅ ♠	25.0	20.6
	Argentina	Objection regulation	2005	∅	14.5	06.7
	Brazil	Consent regulation	1968 (1997)	∅	09.9	09.3
	Bolivia	Consent regulation	1996	∅	01.4	05.0
	Chile	Objection regulation	2010	∅	05.4	02.6
	Costa Rica	Objection regulation	1994	∅	03.5	20.2
	Dominican Republic	Objection regulation	1998 (2004)	∅	01.1	02.8
	Ecuador	Objection regulation	1994 (2001)	∅	02.5	03.7
	El Salvador	Consent regulation	1994 (2001)	∅	00	05.5
	Guatemala	Consent regulation	1996	∅	06.1	05.2
	Honduras	Consent regulation	1984	∅	00.3	00
	Canada	Consent regulation	1980	∅	14.5	16.1
	Colombia	Objection regulation	1998	∅	12.3	01.5
	Cuba	Consent regulation	1983 (1995)	∅	09.9	00.5
	Mexico	Consent regulation	1984	∅	02.8	16.2
	Nicaragua			∅	00	01.7
	Panama	Objection regulation	1983 (1998)	∅	03.7	03.7
	Paraguay	Objection regulation	2000	∅	04.5	02.8
	Peru	Objection regulation	1974 (2004)	∅	06.0	02.9
	Puerto Rico	Consent regulation	1974	∅
	Uruguay	Consent regulation	1971	∅	14.4	00.9
	Venezuela	Consent regulation	1972 (1992)	∅	03.4	03.2
	Australia and New Zealand
	Australia	Consent regulation	1987	∅	13.5	13.3
	New Zealand	Consent regulation	1964	∅	08.8	15.3

1. ↑ Last amendment to the law in brackets.
2. ↑ ∅ = brain death
   ♠ = cardiac death
3. ↑ Per one million inhabitants. Data for the data collection year 2010.
4. ↑ From 1967 to 1990 an objection regulation was in force.
5. ↑ From 1987 to 1996 a consent regulation was in place.
6. ↑ If the deceased's will is unknown, the attending physician must consult the next of kin regarding the will.
7. ↑ ^{a b c} Practice, there is no explicit legal regulation.
8. ↑ The family can override the deceased's wishes.
9. ↑ Relatives must agree in writing.
10. ↑ From 1978 until after 2004 an objection regulation was in force.
11. ↑ The emergency solution was in effect from 1954 to 1992.
12. ↑ ^{a b c d e f} data from the data collection year 2008.
13. ↑ ^{a b c d e f g h i j k} data for the data collection year 2005.
14. ↑ Data from data collection year 2006 only for kidneys
15. ↑ ^{a b} data for the data collection year 2011.
16. ↑ Data for the data collection year 2009.
17. ↑ Iran has a government-regulated market for living donor organs.
18. ↑ Certain relatives can object to post-mortem organ removal.
19. ↑ Previously consent regulation; Laws introduced in 1983 (1996).
20. ↑ Data for the data collection year 2003.
21. ↑ Start of regulation varies by state; prior to 1980, the following states had approval regimes: Alberta 1967; British Columbia 1974; New Brunswick 1973; Newfoundland 1966; Nova Scotia 1964.
22. ↑ The extended objection rule applies to fatalities caused by violence.

The legal situation is an important factor for the rate of empirical donor populations: States with objection regulations have (under otherwise identical circumstances) a higher proportion of post-mortem donors than those with consent regulations. Other well-known influencing factors on the rate of donation are the proportion of (formally) highly educated people - operationalized as graduates of tertiary school types - and the number of transplant centers per inhabitant as a proxy for the state of the art in transplant medicine. Roman Catholic states also correlate positively with donor rates. The so-called Spanish model , which has been used as a model for many regulations in Latin America, has proven to be particularly successful in terms of the donor quota .

States in the Eurotransplant network

Although the Benelux countries, Germany, Austria, Slovenia, Croatia and Hungary have historically implemented very different donation practices and thus have very different donation volumes, these countries distribute the donor organs that have explanted within their borders together via Eurotransplant .

Germany

The Transplantation Act ( TPG ) forms the legal framework for organ donations in Germany. Tissue donations by the tissue law regulated.

Pursuant to Section 2, Paragraph 2, Clause 3 of the TPG, persons who are capable of giving consent can consent to an organ donation from the age of 16 or declare the transfer of the decision to third parties effective, and object to an organ donation from the age of 14 .

The donation of an organ that cannot form again is possible during lifetime for first- or second-degree relatives , spouses , registered partners , fiancés or people who are personally close to the donor. The interpretation of the legal concept of special personal ties is controversial. Sometimes a biographically grown connection is required. The jurisprudence is satisfied with a prognostic decision. Since the wording of the law does not presuppose an identity of the explanted and the implanted organ, cross-living donation is permitted without a bond between the respective couples. The prospective donor must be informed in writing about the type and scope of the intervention and the possible, also indirect, consequences of organ removal for the donor's health, as well as the expected success of the organ transfer on the recipient and all other circumstances for which he is recognizable his organ donation is carried out by two doctors, one of whom is not allowed to be involved in organ removal. In addition, a life donor must agree to take part in medically recommended follow-up care. A revocation of consent is also effective orally at any time.

A commission formed in accordance with state law must also assess whether there are “substantiated factual indications” that an organ donation would be made under duress or against financial remuneration . The commission includes a doctor who is also not indirectly involved in the transplantation, a person qualified to be a judge and a person experienced in psychological issues.

At the end of 1997, an extended consent regulation was established for the donation of corpses: organs from a dead person may be removed if either the deceased has spoken out in favor of an organ donation during his lifetime or the next of kin consent to the organ removal. The relatives are also bound by the presumed will of the deceased. In 2011, around 35% of organ donors had clearly spoken out in favor of a donation during their lifetime.

The coordination office according to § 11  TPG, the German Organ Transplantation Foundation (DSO), organizes all steps of the organ donation process including the transport of the organs to the recipients. Eurotransplant is responsible for finding a partner for donors and recipients for post-mortem donations . The mediation of the organs takes place according to political and medical aspects.

Legislative reforms

In mid-2012, the Bundestag decided with a large majority and with the consent of the Bundesrat to reform the organ donation regulations. Since November 1, 2012, statutory and private health insurances have been obliged to question all health insured persons aged 16 and over every two years about their attitude towards post-mortem organ donation within the framework of the so-called decision - making system . The electronic health card should be able to be used on a voluntary basis to save the information.

In the wake of the Göttingen organ donation scandal , the Transplantation Act continued to be widely discussed in public.

On April 1, 2019, the Federal Minister of Health Jens Spahn and a number of members of parliament presented the draft for a law "regulating the double contradiction solution in the Transplantation Act" in Germany. An alternative proposal was presented on May 6 by other members of the Bundestag.

On January 16, 2020, the majority of the German parliament voted against an objection solution and a majority for the extended consent solution .

Public discussion

In the run-up to the legal reform, proponents of organ donation, such as the German Medical Association or the National Ethics Council , spoke out in favor of a change to remedy the shortage of donor organs in Germany. In their opinion, a combination of decision-making and objection rules should find their way into legislation.

From February to April 2011, 1165 students from grammar schools in Mainz between the ages of 14 and 20 were questioned about brain death and organ donation. It is noticeable that 63 percent of those questioned are in favor of post-mortem organ donation, but only 11.3% have an organ donor card. Among those who refused to donate organs, 72.4% cited an information deficit as the reason for refusal. Knowledge questions about brain death were sometimes answered incorrectly by more than half of the respondents, which shows that this deficit is not entirely subjective.

Empiricism

Deceased who have been diagnosed with brain death and who have no medical contraindications are potential organ donors. In 2001, 54% of these had an organ donation. In 39% there was no documented will of the deceased and the organ donation was refused by the relatives. Circulatory failure occurred in 4% of the cases. In 2001, 5.2% of the organ donors had an organ donation card and 8.8% had otherwise documented their will, in 78% of the cases the organ donation was legitimized by the relatives.

In 2009, 1,888 potential organ donors were reported. If relatives have already signaled their rejection before the brain death determination, this person has not been reported as a potential organ donor since 2006. In 565 of these cases, the organ donation was rejected in the relatives' interview. In 63 cases, the organ removal was stopped because, for example, a tumor was found. In 24 cases there were other medical reasons, in 19 cases other reasons. There remained 1,217 actual organ donors. That's 64%.

The table gives an overview of organ donations carried out in Germany. In the upper part the post-mortem donations are listed, followed by the living donations. In 2012, two live lung donations were carried out for the first time at the Hannover Medical School in Germany.

organ	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
kidney	1902	1961	1992	1865	1851	1940	1865	2081	1974	2190	2246	2320	2167	2144	2250	2036	1789	1512	1481	1521	1461	1334	1607
heart	479	507	482	441	370	374	348	339	355	366	385	377	369	347	385	362	318	300	294	278	286	251	295
liver	535	549	581	590	589	608	610	700	779	844	917	1042	1007	1039	1114	1040	919	773	763	730	725	674	779
lung	82	94	129	123	123	135	186	194	221	238	236	264	265	254	290	313	339	327	330	270	297	264	338
Pancreas (pancreas)	91	112	147	189	202	176	154	176	174	152	140	131	127	108	155	160	141	119	114	101	94	70	91
Small intestine							6th	6th	5	3	1	6th	10	5	11	6th	5	4th	7th	1	4th	1	3
Total donations	3089	3223	3331	3208	3135	3233	3169	3496	3508	3777	3925	4140	3945	3897	4205	3917	3511	3035	2989	2901	2867	2594	3113
Living donations (kidney and partial liver)	139	303	368	421	436	483	532	479	553	600	605	627	620	660	756	866	844	808	678	690	647	605	690
Total (Germany)	3228	3526	3699	3629	3571	3716	3701	3975	4061	4377	4530	4767	4565	4557	4961	4783	4355	3843	3667	3592	3514	3199	3803
organ	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018

Mass media reception

The topic of organ donation is regularly featured in the German mass media . Current fates are often the trigger for reporting in the local media, the topic is gaining increased attention nationally in the context of the planned news around the day of organ donation .

Reasons for increased media attention were the living kidney donation by top politician Frank-Walter Steinmeier in 2010 and the Göttingen organ donation scandal in 2012 .

In the past, allegations have also been raised against the DSO because of an alleged “self-service mentality” and faulty structure, which could not be refuted even by an investigative commission (Le Ker, Spiegel Online 2012, Kuhrt, Spiegel Online 2012). Not least as a reaction to these scandals and the resulting decline in donor numbers in Germany, the so-called “organ donation reform” came into force on November 1, 2012 (see “Law regulating decision-making solutions”).

GDR

In the GDR , organ removal was regulated from July 4, 1975 by the regulation on organ transplants .

The regulation introduced the objection regime. This means that "the removal of organs from the deceased for transplantation purposes [...] was permitted if the deceased did not make any other provisions during his lifetime". As today, the doctors' involvement in the transplant was excluded if they had previously been involved in establishing the death. The determination of death itself was done by a "collective of doctors that had to prepare a protocol about this".

A living donation was also regulated by the ordinance. The donor was allowed to make consent conditional on transplanting the organ to a specific person.

On August 5, 1987, the regulation for better material security for the donor was reorganized; the new version came into force on October 1, 1987. The regulation became obsolete by the Unification Treaty on October 3, 1990.

Austria

In Austria the objection regulation applies. The Hospitals Act has provided the legal basis for this since 1982 .

The Austrian transplant law also applies to foreigners regardless of their place of origin. That is why the Austrian Federal Institute for Health Care, as the central objection body, also plans to include foreigners in the (non-) donor files.

Belgium

Belgium has been practicing an extended contradiction solution for post-mortem donations since 1986.

Netherlands

Until 1998 there was no specific law for organ donation in the Netherlands and so an extended consent solution was regulated via the 1869 law on the handling of corpses.

In 1998, following a referendum, an extended consent solution for corpse donations was introduced, in which the next of kin may impute the unknown will of the deceased. At the same time, the state started a campaign for inclusion in an organ donation register. In order to remedy the shortage of organs, since the 1980s, in addition to brain deaths, heart deaths have been increasingly considered as organ donors.

The fake show De Grote Donorshow, produced for the Dutch public, attracted a lot of international attention. On the show, three patients waiting for an organ donation allegedly played about the kidneys of a donor. The program polarized the public beyond the borders of the Netherlands.

Denmark

The first (post-mortem) kidney donation was made in Denmark in 1964.

Although the first Danish transplant law did not provide a clear answer to the question of the death criterion, first respiratory arrest was absolutely necessary for post-mortem organ removal. Since 1990, brain death has been recognized as part of organ donation. A consent regulation applies which, if the donor does not consent, allows the relatives to make a decision instead of them during their lifetime. Since 1990, it has been possible to enter the consent to donate organs post mortem in the Danish organ donor register during one's lifetime , whereby since 2000 different types of consent or rejection can be registered. Only seven percent of the mostly online registrants fundamentally refuse to donate organs.

Switzerland

The Swiss Transplantation Act passed in 2004 came into force on July 1, 2007. The law is based on a corresponding constitutional article in the federal constitution. Switzerland is one of the last countries in Europe to have introduced a transplant law. A partial revision of the law has been underway since 2008.

The law provides for the extended consent solution. Patients must therefore have expressly declared their willingness to donate before their death. If there is no such expression of will, the relatives decide.

Before the Transplantation Act was passed, there was no uniform regulation of transplant medicine by the federal government and the cantons had the relevant legislative competence. However, the cantonal regulations were inconsistent, so that in 1995 two motions called for a statutory regulation at the federal level. Before the law was introduced, a federal decree on the control of blood, blood products and transplants was passed in 1996.

The federal popular initiative "Promote organ donation - save lives", which calls for the introduction of the objection regulation, came about in April 2019. In the same year a nationwide referendum was announced if the initiative is not withdrawn on the basis of a counter-proposal.

Spain

Spain has a particularly successful organ donation program that produces the world's highest donation rates. In 2017 there were 46.9 donors for every million inhabitants. This program - sometimes called the Spanish model - has had a major impact on Latin American countries and is currently used as the model for Nicaragua.

The Spanish population has a very positive view of post-mortem donations: around 80 to 85 percent of Spaniards said they would be willing to have organs removed after death.

Portugal

In Portugal, until a person has not expressed their objection to organ donation, they are deemed to have consented to post-mortem donation. Before the organs are removed, a discussion takes place with the family to find out the will of the deceased.

Turkey

There is an extended consent solution for post-mortem donations in Turkey. In the case of living donations, it is unusual that in addition to the donor's consent, the spouses of the donor and recipient must also be informed.

Southeast Europe

In 2011, a study of 36 patients from Kosovo, Macedonia, and Albania who had undergone unregulated transplants in Pakistan reported a very poor success rate.

In Serbia in 1990 and 1992 two contradicting regulations were enshrined in law; This unclear legal situation hinders organ donation.

Successor states of the Soviet Union

The Soviet Union had an extremely liberal practice of handling corpses. As early as 1932 a law was passed in the Ukrainian Soviet Republic for the removal of eyes from the deceased for the purpose of transplantation; From 1937 the Ministry of Health was able to issue ordinances on organ removal. From 1954, organs could also be removed against the will of relatives.

After the collapse of the Soviet Union, the extended contradiction solution was introduced in Russia. In the Ukraine - one of the strongholds of illegal organ trafficking - a restrictive extended consent solution has been practiced since 1999, in which the closest relatives have to agree to the removal of organs.

United States

A consent regime has been introduced in the USA. The list of those waiting for a donor organ at the beginning of 2015 contained around 123,000 names. Organ donation is only possible with the consent of the family and the donor himself.

Arab world

In countries in the Arab world, there are usually explicit laws or guidelines in force that regulate organ donation. What all these regulations have in common with living donations is the donor's informed consent, which can be revoked at any time, and a ban on financial incentives. In addition, the provisions differ as follows:

Egypt

In Egypt, a legislative project is supposed to regulate living donation in order to prevent illegal transplants and organ trafficking.

Algeria

The religious justification for organ donation required in Algeria was established in 1985. The vast majority of kidney donations have been made by living donations, which may be made by healthy adult donors without remuneration, provided that this would not endanger their lives. In accordance with Article 16 of Law 90-17, an extended de jure contradiction solution has been established for post-mortem donations since July 1990 . In this case, brain death is de facto certified by a medical commission after two zero EEGs every four hours. If the deceased's wish is unknown, a psychiatrist, a psychologist and an imam advise the next of kin on the decision to release the organs.

Bahrain

Bahrain allows living donations as long as both the donor and recipient agree in writing and, from a medical point of view, nothing speaks against a transplant. An extended objection rule applies to corpse donations, whereby if the deceased does not object during his lifetime, the next of kin must agree to an organ removal.

Jordan

The first successful kidney transplant in an Arab state was carried out in Amman in 1972 after a cardiac death donation. Today Jordan has one of the highest living kidney donation rates in the world.

Qatar

Qatar practices a very restrictive extended objection regulation, whereby if the deceased between the ages of 18 and 70 does not have a written will, all first and second degree relatives must consent to an organ removal. Reproductive organs are excluded from the removal.

Under these circumstances, around a third of Qatar's resident population was ready to donate organs in 2005.

Lebanon

All constituent religious communities in Lebanon have a positive view of organ donation.

Morocco

Morocco only allows living donations between directly related adults and spouses of several years. Post mortem , defined as brain death, there is an extended contradiction rule in which spouses, parents and children can effectively object to organ removal in the order of decreasing importance if the deceased's will is not documented.

Saudi Arabia

In Saudi Arabia, cardiac or brain death is a prerequisite for post-mortem organ removal. An extended consent regulation applies. If the deceased's will is unknown, the deceased's heirs decide, who may be advised by a “persuasion committee”. Living donations are only allowed for blood relatives.

Sudan

In Sudan, living donations should come from the closest family members, with minors, especially women, only being considered as donors in emergencies. If donations from relatives are not possible, a committee will decide whether a third-party donation is permitted. De jure , an extended consent solution is in effect for post-mortem donations.

Syria

Syria only allows living donations for adult blood relatives and underage twin siblings. Unlike in many other jurisdictions, post-mortem donations do not have to be made anonymously.

Tunisia

Tunisia allows living donations for sane people over the age of 20. An extended contradiction rule applies post mortem : surviving dependents can object to an organ removal if the deceased did not consent to a donation during his lifetime, which has been entered on the identity card since 1999. The legal guardians decide for deceased minors. Donations of reproductive organs are prohibited.

India

So far, around 21,000 kidneys have been donated in India since 1971 and 329 livers since 1995.

The legal framework for post-mortem donations is an extended consent regulation, under which the next of kin may decide on organ donation if the will of someone over the age of 18 is unknown. For those who died before their 18th birthday, the parents decide; if the body is not claimed by relatives within 48 hours, the head of the institution where the deceased passed away may make a decision. Living donations are generally only allowed among close relatives; LURD transplants require a decision by an independent committee.

Iran

Iran has set up a regulated organ market for Iranian citizens for living LURD donations. According to a law from the year 2000, organs may only be removed post mortem with the consent of the family, who must either confirm the deceased's will or, if this is unknown, should be in accordance with the presumed interest of the deceased.

Israel

Since January 2010, people who have themselves agreed to an organ donation with a donor passport have been given preference over a possible recipient who was judged the same as to the urgency level of a donation but who does not have identification.

Japan

Post-mortem organ donations are significantly less common in Japan than in most Western countries. There are initially cultural reasons for this: the heart tends to take precedence over the brain, and the violation of the integrity of the body meets with rejection. In addition, there is an organ donation case from 1968, which led to long-lasting discussions and distrust with regard to the criterion of brain death.

The Act on Organ Donation, which came into force in 1997, required donors to give their written consent; the family's consent was also required. As a consequence, the heart donation rate in Japan was strikingly low with 81 organ donations in twelve years.

An amendment to the law came into force in July 2010. Organs from the dead may now be removed if the family of the deceased does not expressly oppose it. In addition, the minimum donor age of 15 years has been deleted without replacement. In 2010, 13 percent of Japanese hospitals were able to perform organ removal from an adolescent. The aim was to increase this number to 39 percent by the end of the year.

The first organ donation without the donor's written consent was made on August 9, 2010.

Mongolia

In Mongolia, the first living kidney donation was made in 2006 by an identical twin sister of the recipient; since then only living donations from close relatives have been made.

Philippines

Since 2002, the Philippines has been one of the few countries to allow live kidney donations for people who do not come from the personal environment of the donor, for a special allowance totaling around ₱ 275,000 (the equivalent of around € 4,787) and statutory health insurance for a period of ten years , with roughly double the amount of money being tolerated in practice. Although the law expressly excludes the sale of organs, so-called organ tourism has emerged in the course of these regulations, so that organ donations to foreigners have been prohibited since 2009. In general, under these circumstances, the results from these third-party donations have proven to be medically below average for the recipient and socio-economically not beneficial for the donor.

Post-mortem donations require the approval of the next of kin; If the potential organ donor has died as a result of violence, the attending physician or the clinic director can decide on organ removal if the next of kin cannot be reached within 48 hours.

Developing countries

Organ trafficking is sometimes carried out in developing countries without statutory regulations . In this case, however, one can no longer speak of organ donation (on a voluntary basis).

Guyana

In Guyana , only living donations are made.

Nigeria

Organ donations have been accepted in Nigeria since 2003. Studies from the states of Lagos and Ọṣun suggest that around a third of the population would be willing to donate organs, with the rural population showing less willingness to donate, mainly for educational reasons.

Conceptual problem

The term organ donation was a candidate for the unword of the year in 1997 . The jury justified this with a "perversion" of the donation concept .

literature

• Ulrike Baureithel, Anna Bergmann: Heartless Death - The Dilemma of Organ Donation. Klett-Cotta Verlag, Stuttgart 1999, ISBN 3-608-91958-9 . ( Science book of the year 2000 )
• Vera Kalitzkus: Your death, my life. Why we find organ donation right and still shy away from it. Suhrkamp medizinHuman, Frankfurt 2009, ISBN 978-3-518-46114-3 .
• Klaus Schäfer ː 25 x 25 years given 25 transplant recipients report on at least 25 years of their 2nd life. Books on Demand 2015, ISBN 978-3734785337
• Klaus Schäferː YES, My commitment to organ donation. Pallotti 2016 ISBN 978-3876140353
• Eberhard J. Wormer : Organ donation. Life saving transplant . Lingen Verlag, Cologne 2010, ISBN 978-3-941118-50-8 .
• Peter Krause and other authors: Organ donation: yes and no. (= Flensburger Hefte. No. 115). 2012, ISBN 978-3-935679-72-5 .
• Stephan M. Probst (ed.): Brain death and organ donation from an intercultural perspective. Berlin / Leipzig: Hentrich & Hentrich 2019. ISBN 978-3-95565-292-0 .

Web links

Wikiquote: Organ Donation  Quotes

Wiktionary: Organ donation  - explanations of meanings, word origins, synonyms, translations

• Transplantinfo - the transplant portal of the Swiss Federal Office of Public Health
• Federal Association for Health Information and Consumer Protection
• The ten most common mistakes Philip Harms in Focus Online January 4, 2019

Individual evidence

1. ↑ Nicola Siegmund-Schultze: Amendment of the Transplantation Act: loophole in the regulation of tissue complexes . In: Dtsch Arztebl . tape 109 , no. 21 , 2012, p. A-1072 / B-921 / C-913 ( aerzteblatt.de [accessed November 8, 2012]).
2. ↑ The need for hand and face transplants is increasing . Aerzteblatt.de; Retrieved November 8, 2012.
3. ↑ David Batty: World's first organ donor dies aged 79. In: The Guardian. December 30, 2010, accessed July 26, 2012 . 
4. ↑ DD Sutherland, FC Goetz, JS Najarian: Living-related donor segmental pancreatectomy for transplantation . In: Transplantation proceedings . tape 12 , 4 Suppl 2, December 1980, ISSN  0041-1345 , pp. 19-25 , PMID 6784307 .
5. ^ Owen S. Surman, Martin Hertl: Liver donation: donor safety comes first . In: The Lancet . tape 362 , no. 9385 , August 30, 2003, ISSN  0140-6736 , p. 674-675 .
6. ↑ FAQ on the age limit on the BZgA website for organ donation; accessed on October 9, 2015.
7. ↑ BJ Boyarsky, EC Hall, AL Singer, RA Montgomery, KA Gebo, DL Segev: Estimating the Potential Pool of HIV-Infected Deceased Organ Donors in the United States . In: American Journal of Transplantation . tape 11 , no. 6 , 2011, ISSN  1600-6143 , p. 1209-1217 , doi : 10.1111 / j.1600-6143.2011.03506.x .
8. ↑ BJ Boyarsky, EC Hall, AL Singer, RA Montgomery, KA Gebo, DL Segev: Estimating the Potential Pool of HIV-Infected Deceased Organ Donors in the United States . In: American Journal of Transplantation . tape 11 , no. 6 , 2011, ISSN  1600-6143 , p. 1211 , doi : 10.1111 / j.1600-6143.2011.03506.x .
9. ^ Lisa Tambornino: Organ transplantation. German Reference Center for Ethics in the Biosciences, January 2013.
10. ↑ Christine Westerhaus: First birth from the womb of a dead donor. Retrieved December 6, 2018 . 
11. ^ Günter Kirste: On the status of living organ donation . In: Federal Health Gazette - Health Research - Health Protection . tape 45 , no. 10 , October 1, 2002, ISSN  1436-9990 , p. 771 , doi : 10.1007 / s00103-002-0481-5 .
12. ^ Neda Khalifeh, Walter H. Hörl: Gender and living donor kidney transplantation . In: Wiener Medical Wochenschrift . tape 161 , no. 5-6 , March 2011, ISSN  0043-5341 , p. 125 , doi : 10.1007 / s10354-011-0895-5 ( springerlink.com [accessed June 11, 2012]).
13. ↑ Ole Øyen, Marit Andersen, Lars Mathisen, Gunnvald Kvarstein, Bjørn Edwin, Pål-Dag Line, Tim Scholz, Per F. Pfeffer: Laparoscopic versus Open Living-Donor Nephrectomy: Experiences from a Prospective, Randomized, Single-Center Study Focusing on Donor Safety . In: transplant . tape 79 , no. 9 , 2005, ISSN  0041-1337 .
14. ^ Colin H Wilson, Aliu Sanni, David A Rix, Naeem A Soomro: Laparoscopic versus open nephrectomy for live kidney donors . In: Cochrane database of systematic reviews (online) . No. 11 , 2011, ISSN  1469-493X , p. CD006124 , doi : 10.1002 / 14651858.CD006124.pub2 , PMID 22071829 .
15. ↑ Karolin Thiel, Christian Thiel, Martin Schenk, Ruth Ladurner, Silvio Nadalin, Nils Heyne, Alfred Königsrainer, Wolfgang Steurer: Is the conventional donor nephrectomy for living kidney donation still appropriate ? In: Wiener Klinische Wochenschrift . tape 124 , no. 1-2 , November 30, 2011, ISSN  0043-5325 , p. 39-44 , doi : 10.1007 / s00508-011-0094-9 ( springerlink.com [accessed June 11, 2012]).
16. ↑ DL Segev, AD Muzaale, BS Caffo, SH Mehta, AL Singer, SE Taranto, MA McBride, RA Montgomery: Perioperative Mortality and Long-term Survival Following Live Kidney Donation . In: JAMA . tape 303 , no. 10 , March 9, 2010, ISSN  0098-7484 , p. 959-966 , doi : 10.1001 / jama.2010.237 ( ama-assn.org [accessed June 11, 2012]).
17. ^ Doctors hopeful for uterus transplant. In: Hürriyet Daily News. January 31, 2012, archived from the original on April 4, 2015 ; Retrieved June 30, 2012 . 
18. ↑ Madeleine Sahlman: Klart för omstritt livmodersprojekt. In: Göteborgs-Posten. May 19, 2012, accessed June 30, 2012 . 
19. ^ Robert Steinbrook: Organ Donation after Cardiac Death . In: N Engl J Med . tape 357 , no. 3 , 2007, ISSN  0028-4793 , p. 209-213 , doi : 10.1056 / NEJMp078066 .
20. ↑ ^{a b} Dirk EM Van Raemdonck, Filip R. Rega, Arne P. Neyrinck, Nicole Jannis, Geert M. Verleden, Toni E. Lerut: Non-heart-beating donors . In: Seminars in Thoracic and Cardiovascular Surgery . tape 16 , no. 4 , 2004, ISSN  1043-0679 , p. 310 , doi : 10.1053 / j.semtcvs.2004.09.014 .
21. ↑ ^{a b} M. A. Bos: Ethical and Legal Issues in Non-Heart-Beating Organ Donation . In: Transplantation Proceedings . tape 37 , no. 2 , March 2005, ISSN  0041-1345 , p. 574 , doi : 10.1016 / j.transproceed.2004.12.197 .
22. ^ ^{A b} Nicola Siegmund-Schultze, Vera Zylka-Menhorn: Non-Heart-Beating-Donors: “Herztote” organ donors . In: Deutsches Ärzteblatt . tape 105 , no. 16 , 2008, p. A832 ( aerzteblatt.de [PDF]).
23. ↑ Markus Christen, Sohaila Bastami, Martina Gloor, Tanja Krones: Resolving Some, But Not All Informed Consent Issues in DCDD - the Swiss Experiences . In: American Journal of Bioethics . tape 15 , no. 8 , 2015, p. 29–31 , doi : 10.1080 / 15265161.2015.1045095 .
24. ^ Raymond L. Horton, Patricia J. Horton: Knowledge regarding organ donation: Identifying and overcoming barriers to organ donation . In: Social Science & Medicine . tape 31 , no. 7 , 1990, ISSN  0277-9536 , pp. 791-800 , doi : 10.1016 / 0277-9536 (90) 90174-Q .
25. ↑ Mona Motakef: Hey big donors! Organ donation between biopolitics and pop culture . In: culture & gender . tape 6 , July 2010, p. 9 f . ( ruhr-uni-bochum.de [PDF; accessed on July 5, 2012]).
26. ^ Paul Michielsen: Presumed consent to organ donation: 10 years' experience in Belgium . In: Journal of the Royal Society of Medicine . tape 89 , no. December 12 , 1996, ISSN  0141-0768 , pp. 664 f ., PMID 9014874 .
27. ↑ Anna Bergmann: Organ Donation - Deadly Dilemma or Ethical Duty? In: From Politics and Contemporary History 2011. - Introduction, 2nd paragraph , accessed on June 6, 2012.
28. ↑ Number of organ donors continues to decrease in 2016 , augsburger-allgemeine.de, accessed on November 7, 2016.
29. ↑ Organ donor numbers at the lowest level for 20 years  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. , faz.net, January 13, 2018.  
30. ↑ Fewer than 800 organ donors in the past year , faz.net, January 13, 2018.
31. ↑ Sabine Moos: Brain death - the safest diagnosis that can be made . In: Hessisches Ärzteblatt . tape 63 , no. 11 , 2002, ISSN  0171-9661 , p. 630 ( laekh.de [PDF; accessed June 25, 2012]).
32. ↑ Report on the situation of transplant medicine in Germany ten years after the Transplantation Act came into force. (PDF; 12.9 MB). Printed matter 16/13740 of the German Bundestag, June 30, 2009, p. 32, accessed on June 6, 2012.
33. ↑ Sabine Müller: How dead are brain dead? Old question - new answers. May 9, 2011, accessed June 25, 2012 . 
34. ↑ Christina Berndt: Doctors often wrongly declare patients to be brain dead. Retrieved April 22, 2020 . 
35. ↑ Vera Kalitzkus: Your death, my life . Suhrkamp, ​​Frankfurt 2009, ISBN 978-3-518-46114-3 , p. 68 .
36. ↑ ^{a b c} Ralf L. Schild: Organ donation in Europe . In: Deutsches Ärzteblatt . tape 94 , no. 37 , September 12, 1997, pp. A-2323 .
37. ↑ Vanessa Narine: Commercial influence creating worrying trend in… Human Organs Trade. In: Guyana Chronicle. November 18, 2013, accessed March 3, 2015 . 
38. ↑ Mona Motakef: Hey big donors! Organ donation between biopolitics and pop culture . In: culture & gender . tape 6 , July 2010, p. 8 ( ruhr-uni-bochum.de [PDF; accessed on July 5, 2012]).
39. ↑ Wilhelm Korff , Lutwin Beck , Paul Mikat (Ed.): Lexicon of Bioethics . Volume 2, Gütersloh 2000, ISBN 3-579-00264-3 , pp. 813-815.
40. ↑ Encyclical Evangelium vitae No. 64
41. ↑ XVI Benedict: Address «A gift for life. Reflections on the Problem of Organ Donation »of November 7, 2008 to the participants in the International Congress of the Pontifical Academy for Life
42. ^ Council of the EKD and DBK: Joint texts 1. Organ transplantation declaration of the German Bishops' Conference and the Council of the EKD Bonn / Hanover 1990.
43. ↑ http://www.dbk-shop.de/media/files_public/fwmsuermds/DBK_1241.pdf  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. Accessed August 1, 2015.  
44. ↑ Neue Bildpost / Katholische SonntagsZeitung No. 23/2020 (06./07.06.2020) According to: http://www.organspende-wiki.de/pdf/TdO2020.pdf Accessed on June 6, 2020.
45. ↑ Organ Donation Day. Accessed June 6, 2020 (German). 
46. ↑ Jonathan A. Romain, Walter Homolka: Progressives Judentum . Munich 1999.
47. ^ ^{A b c} Adnan Sharif: Organ Donation and Islam - Challenges and Opportunities . In: transplant . tape 94 , no. 5 , July 2012, ISSN  0041-1337 , p. 2 , doi : 10.1097 / TP.0b013e31825f4474 ( wkhealth.com [accessed August 14, 2012]).
48. ^ Adnan Sharif: Organ Donation and Islam - Challenges and Opportunities . In: transplant . tape 94 , no. 5 , July 2012, ISSN  0041-1337 , p. 1 , doi : 10.1097 / TP.0b013e31825f4474 ( wkhealth.com [accessed August 14, 2012]).
49. ↑ Abdel Moneim Hassaballah: Mini Symposium. Definition of death, organ donation and interruption of treatment of Islam . In: Nephrology Dialysis Transplantation . tape 11 , no. June 6 , 1996, ISSN  0931-0509 , pp. 964-965 , PMID 8671951 .
50. ↑ ^{a b} Thomas Eich, Johannes Grundmann: Muslim legal opinions on brain death, organ transplantation and life. (PDF; 122 kB)
51. ↑ M. Oliver, A. Ahmed, & Woywodt, A. (2012). Donating in good faith or getting into trouble Religion and organ donation revisited. World Journal of Transplantation, 2 (5), 69-73. doi: 10.5500 / wjt.v2.i5.69 , p. 71.
52. ↑ ^{a b c} Michael Cheng-Tek Tai: An Asian Perspective on Organ Transplantation . In: Tzu Chi Medical Journal . Vol. 21, No. 1 , March 2009, p. 91 ( com.tw [PDF]).
53. ↑ Flensburg Hefte No. 116: On the essence of organs. Spiritual Background of Organ Transplantation. Flensburg 2012, ISBN 978-3-935679-74-9 ; Flensburg booklet No. 115: Organ donation - yes and no. Flensburg 2012, ISBN 978-3-935679-72-5 .
54. ↑ Arthur J Matas, Mark Schnitzler: Payment for living donor (vendor) kidneys: a cost-effectiveness analysis . In: American Journal of Transplantation . tape 4 , no. 2 , February 2004, ISSN  1600-6135 , p. 216-221 , PMID 14974942 .
55. ↑ ^{a b} R. S. Gaston, GM Danovitch, RA Epstein, JP Kahn, AJ Matas, MA Schnitzler: Limiting Financial Disincentives in Live Organ Donation: A Rational Solution to the Kidney Shortage . In: American Journal of Transplantation . tape 6 , no. November 11 , 2006, ISSN  1600-6135 , p. 2550 , doi : 10.1111 / j.1600-6143.2006.01492.x .
56. ^ Alberto Abadie, Sebastien Gay: The impact of presumed consent legislation on cadaveric organ donation: A cross-country study . In: Journal of Health Economics . tape 25 , no. 4 , July 2006, ISSN  0167-6296 , p. 600 , doi : 10.1016 / j.jhealeco.2006.01.003 .
57. ^ Alberto Abadie, Sebastien Gay: The impact of presumed consent legislation on cadaveric organ donation: A cross-country study . In: Journal of Health Economics . tape 25 , no. 4 , July 2006, ISSN  0167-6296 , p. 601 , doi : 10.1016 / j.jhealeco.2006.01.003 .
58. ↑ ^{a b} R. Mizraji, I. Alvarez, RI Palacios, C. Fajardo, C. Berrios, F. Morales, E. Luna, C. Milanés, M. Andrade, E. Duque, F. Giron, J. Alfonso, S. Herra, C. Soratti, R. Ibar, VD Garcia: Organ Donation in Latin America . In: Transplantation Proceedings . tape 39 , no. 2 , March 2007, ISSN  0041-1345 , p. 333 , doi : 10.1016 / j.transproceed.2007.01.017 .
59. ↑ ^{a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad} Alberto Abadie, Sebastien Gay: The impact of presumed consent legislation on cadaveric organ donation: A cross -country study . In: Journal of Health Economics . tape 25 , no. 4 , July 2006, ISSN  0167-6296 , p. 617 ff ., doi : 10.1016 / j.jhealeco.2006.01.003 .
60. ↑ ^{a b c d e f g h i j k l m n o p q r} International Figures on Organ Donation and Transplantation Activity. Year 2010. In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 33 ( ont.es [PDF]).
61. ↑ ^{a b c d e f g h i j k l m n o p q} International Figures on Organ Donation and Transplantation Activity. Year 2010. In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 32 ( ont.es [PDF]).
62. ↑ Objection instead of consent: The Netherlands make all adults an organ donor . ISSN  0174-4909 ( faz.net [accessed April 26, 2019]).
63. ↑ ^{a b c d e f g h i j k l m n o p q r} International Figures on Organ Donation and Transplantation Activity. Year 2010. In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 34 ( ont.es [PDF]).
64. ↑ ^{a b c d e f g h i j k l m n o p} Conseil de l'Europe: International Data on Organ Donation and Transplantation Activity, Waiting List and Family Refusals. Year 2010 . In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 35 .
65. ↑ Sigurbergur Kárason, Runólfur Jóhannsson, Kristín Gunnarsdóttir, Páll Ásmundsson, Kristinn Sigvaldason: Líffæragjafir á Íslandi 1992–2002 . In: Læknablaðið . tape 91 , no. 5 , 2005, ISSN  0023-7213 , p. 418 ( laeknabladid.is ).
66. ↑ ^{a b c d e f g h i j k l m n o p q r} International Figures on Organ Donation and Transplantation Activity. Year 2010. In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 36 .
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70. ^ A. Kleindienst, WF Haupt, G. Hildebrandt: Brain Death and Organ Donation in Germany: Analysis of Procurement in a Neurosurgical Unit and Review of Press Reports . In: Acta Neurochirurgica . tape 141 , no. 6 , June 15, 1999, ISSN  0001-6268 , p. 644 , doi : 10.1007 / s007010050354 .
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72. ↑ Amanda M. Rosenblum, Lucy D. Horvat, Laura A. Siminoff, Versha Prakash, Janice Beitel, Amit X. Garg: The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations . In: Nephrology Dialysis Transplantation . tape 27 , no. 6 , November 25, 2011, ISSN  0931-0509 , p. 2534 , doi : 10.1093 / ndt / gfr619 .
73. ^ A. Kleindienst, WF Haupt, G. Hildebrandt: Brain Death and Organ Donation in Germany: Analysis of Procurement in a Neurosurgical Unit and Review of Press Reports . In: Acta Neurochirurgica . tape 141 , no. 6 , June 15, 1999, ISSN  0001-6268 , p. 644 , doi : 10.1007 / s007010050354 .
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78. ↑ Российская Федерация: Закон РФ от 22 декабря 1992 г. N 4180-I "О трансплантации органов и (или) тканей человека" (с изменениями и дополнениями) ( Memento from December 3, 2013 in the Internet archive .
79. ↑ ^{a b c d e f} Martí Manyalich, Alessandro Nanni Costa, Gloria Paez: IRODaT 2008 International Donation and Transplantation Activity . In: Organs, Tissues & Cells . tape 12 , no. 2 , 2009, p. 85 ( europeantransplantcoordinators.org [PDF]). IRODaT 2008 International Donation and Transplantation Activity ( Memento from July 5, 2010 in the Internet Archive )
80. ↑ ^{a b} Andriy Tkach: Dark Matter. In: The Ukrainian Week. October 28, 2011, accessed June 22, 2012 . 
81. ↑ А. Шецко: Some legal issues of the transplantation in the Republic of Belarus, 2011. (PDF) Retrieved June 29, 2012 (English). 
82. ↑ Transplant Procurement Management: IRODaT: Europe: Belarus. Retrieved July 6, 2012 . 
83. ^ ^{A b c} Fouad N. Boustany: Ethics and law in biomedicine and genetics an overview of national regulations in the Arab states . UNESCO Cairo Office, Cairo 2011, ISBN 978-92-3104211-9 , Report of Mapping Bioethics Regulations in 17 States in the Arab Region, p. 43 f . ( unesco.org [PDF]).
84. ^ ^{A b} République Algérienne: Loi n ° 90-17 du 31 july 1990 modifiant et complétant la loi n ° 85-05 du 16 février 1985 relative à la protection et à la romotion de la santé . In: Journal Officiel de la République Algérienne . tape 35 , August 15, 1990, pp. 971–973 (East Frisian, cnomedecins-dz.com [PDF; accessed June 28, 2012]). Loi n ° 90-17 du 31 juillet 1990 modifiant et complétant la loi n ° 85-05 du 16 février 1985 relative à la protection et à la romotion de la santé ( Memento of the original from 8 November 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
85. ↑ ^{a b c d e f g h i j} Fouad N. Boustany: Ethics and law in biomedicine and genetics an overview of national regulations in the Arab states . UNESCO Cairo Office, Cairo 2011, ISBN 978-92-3104211-9 , Report of Mapping Bioethics Regulations in 17 States in the Arab Region, p. 45 ( unesco.org [PDF]).
86. ↑ Ahmed Al Arrayed, Mohammed Al Tantawi, Emam Fareed, Faiza Haider, George Abouna: Renal Transplant is an Established and Successful Treatment for End-Stage renal Failure in Bahrain . In: Bahrain Medical Bulletin . tape 22 , no. 2 , 2000, pp. 5 ( bahrainmedicalbulletin.com [PDF]).
87. ↑ ^{a b c d e f} Ariadna Sanz, Reginaldo C. Boni, Angelo Ghirardini, Alessandro Nanni Costa, Marti Manyalich: IRODaT: 2005 donation and transplantation preliminary figures . In: Organs, Tissues & Cells . tape 1 , 2006, p. 10 ( europeantransplantcoordinators.org [PDF]). IRODaT: 2005 donation and transplantation preliminary figures ( Memento of the original dated December 3, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
88. ^ ^{A b c} Fouad N. Boustany: Ethics and law in biomedicine and genetics an overview of national regulations in the Arab states . UNESCO Cairo Office, Cairo 2011, ISBN 978-92-3104211-9 , Report of Mapping Bioethics Regulations in 17 States in the Arab Region, p. 41 f . ( unesco.org [PDF]).
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91. ↑ Lucy Diane Horvat, Salimah Z Shariff, Amit X Garg: Global trends in the rates of living kidney donation . In: Kidney International . tape 75 , no. 10 , February 18, 2009, ISSN  0085-2538 , p. 1090 .
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96. ↑ ^{a b c d e f g h i j k} A. Bagheri: Organ Transplantation Laws in Asian Countries: A Comparative Study . In: Transplantation Proceedings . tape 37 , no. December 10 , 2005, ISSN  0041-1345 , p. 4160 , doi : 10.1016 / j.transproceed.2005.11.016 ( elsevier.com [accessed July 19, 2012]).
97. ↑ scot.org.sa ( Memento of May 29, 2012 in the Internet Archive )
98. ↑ Saudi Center for Organ Transplantation: Annual Report 2011. ( Memento from December 3, 2013 in the Internet Archive ) Saudi Center for Organ Transplantation, Riyadh, p. 2, 62. (PDF in ZIP)
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101. ↑ Transplant Procurement Management: IRODaT: Asia: Bangladesh. Retrieved July 6, 2012 . 
102. ↑ ^{a b} Transplant Procurement Management: IRODaT: Asia: Iran. Retrieved July 6, 2012 . 
103. ↑ Frank van Gelder, Marti Manyalich, Alessandro Nanni Costa, Gloria Paez: 2009 International donation and transplantation activity. IRODaT preliminary data . In: Organs, Tissues & Cells . tape 13 , no. 1 , p. 6 ( organsandtissues.net [accessed June 19, 2012]).
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105. ↑ ^{a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj} R. Mizraji, I. Alvarez, RI Palacios, C. Fajardo, C. Berrios, F. Morales, E. Luna, C. Milanés, M. Andrade, E. Duque, F. Giron, J. Alfonso, S. Herra, C. Soratti, R. Ibar, VD Garcia: Organ Donation in Latin America . In: Transplantation Proceedings . tape 39 , no. 2 , March 2007, ISSN  0041-1345 , p. 334 , doi : 10.1016 / j.transproceed.2007.01.017 .
106. ↑ ^{a b c d e f g h i j k l m n o p q} Conseil de l'Europe: International Data on Organ Donation and Transplantation Activity, Waiting List and Family Refusals. Year 2010 . In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 37 .
107. ↑ ^{a b} J. Domínguez, JL Rojas: Presumed consent legislation failed to improve organ donation in Chile . In: Transplantation Proceedings . tape 45 , no. 4 , May 2013, ISSN  1873-2623 , p. 1316-1317 , doi : 10.1016 / j.transproceed.2013.01.008 , PMID 23726561 .
108. ^ Blanca Miranda: International Data on Organ Donation and Transplantation Activity, Waiting List and Family Refusals. Year 2005 . In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 11 , no. 1 , September 2006, p. 28 ( coe.int [PDF]).
109. ↑ Transplant Procurement Management: IRODaT: America: El Salvador. Retrieved July 6, 2012 . 
110. ↑ ^{a b c d e f g h i j k l m n o} Conseil de l'Europe: International Data on Organ Donation and Transplantation Activity, Waiting List and Family Refusals. Year 2010 . In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 16 , no. 1 , 2011, ISSN  2171-4118 , p. 38 .
111. ↑ ^{a b} Blanca Miranda: International Data on Organ Donation and Transplantation Activity, Waiting List and Family Refusals. Year 2005 . In: Rafael Matesanz (Ed.): Newsletter Transplant . tape 11 , no. 1 , September 2006, p. 29 ( coe.int [PDF]).
112. ^ ^{A b} Ana Cusumano, Guillermo Garcia Garcia, Carlota Gonzalez Bedat: The Latin American Dialysis and Transplant Registry: report 2006 . In: Ethnicity & Disease . tape 19 , 1 Suppl 1, 2009, ISSN  1049-510X , p. S1-S4 , PMID 19484864 .
113. ^ ^{A b c} Ronald W. Gimbel, Martin A Strosberg, Susan E Lehrman, Eugenijus Gefenas, Frank Taft: Presumed consent and other predictors of cadaveric organ donation in Europe . In: Progress in transplantation (Aliso Viejo, Calif.) . tape 13 , no. 1 , March 2003, ISSN  1526-9248 , p. 17-23 , PMID 12688644 .
114. ↑ Summary of the article "Aspects of Crossover Transplants" (Medizinrecht 2006, 94 ff)
115. ↑ Alexandra Hesse, Patricia Waage: Organ donation and transplantation in Germany. Annual report 2011. (PDF) 2012, ISBN 978-3-936550-94-8 , p. 14.
116. ↑ Broad majority for new regulation: Bundestag resolves reform of organ donation ( memento of May 25, 2012 in the Internet Archive ) at tagesschau.de, May 25, 2012 (accessed on May 26, 2012).
117. ↑ Organ donation: New transplantation law passes Federal Council at Spiegel Online , June 15, 2012 (accessed on June 15, 2012).
118. ↑ Federal Ministry of Health: Press release on July 25, 2012. (PDF; 46 kB) (No longer available online.) Archived from the original on November 17, 2012 ; Retrieved November 5, 2012 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
119. ^ "Süddeutsche Zeitung: Collection of articles on the organ donation scandal" at sueddeutsche.de (accessed on July 11, 2013)
120. ^ E [va] R [ichter-Kuhlmann]: Organ donation. Bundestag wants to deliberate in early June. In: Deutsches Ärzteblatt. Volume 116, No. 21, (May) 2019, p. B 856.
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122. ↑ National Ethics Council: Increasing the number of organ donations - A pressing problem in transplant medicine in Germany. Opinion. April 24, 2007 ( online, PDF, 165 kB ( memento of the original dated February 5, 2018 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF)); Document accessed June 4, 2007. 
123. ↑ J. Rey, V. Grass et al. a .: Willingness to donate organs in Germany. In: German Medical Weekly. 137 (3), 2012, pp. 69-73.
124. ^ Robert Koch Institute : Organ Transplantation and Organ Donation; Issue 17 of the series “Federal Health Reporting”; Text online
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126. ↑ Veronika Thomas: Parents donate lungs for their child from the city of Hanover. In: Hannoversche Allgemeine. September 10, 2012, accessed September 11, 2012 . 
127. ↑ Steinmeier's kidney donation was successful . In: spiegel.de from August 25, 2010.
128. ↑ www.verfassungen.de Ordinance on the implementation of organ transplants ; Web page accessed June 4, 2007.
129. ↑ Section 4 (1) of the Ordinance on Organ Transplantation
130. ↑ Section 9 (1) of the Ordinance on Organ Transplants
131. ↑ Federal Law Gazette No. 273/1982 .
132. ↑ website of the ÖRD ; Website accessed October 28, 2015.
133. ^ Paul Michielsen: Presumed consent to organ donation: 10 years' experience in Belgium . In: Journal of the Royal Society of Medicine . tape 89 , no. December 12 , 1996, ISSN  0141-0768 , pp. 663 , PMID 9014874 .
134. ↑ P. Michielsen: Presumed consent to organ donation: 10 years' experience in Belgium . In: Journal of the Royal Society of Medicine . tape 89 , no. December 12 , 1996, ISSN  0141-0768 , pp. 665 , PMID 9014874 .
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136. ↑ Etiske Råd: Organdonation: etiske overvejelser og anbefalinger. Det Etiske Råd, Copenhagen 2008, ISBN 978-87-91112-78-2 , p. 34 .
137. ↑ Etiske Råd: Organdonation: etiske overvejelser og anbefalinger. Det Etiske Råd, Copenhagen 2008, ISBN 978-87-91112-78-2 , p. 61 .
138. ↑ Etiske Råd: Organdonation: etiske overvejelser og anbefalinger. Det Etiske Råd, Copenhagen 2008, ISBN 978-87-91112-78-2 , p. 53 .
139. ↑ Etiske Råd: Organdonation: etiske overvejelser og anbefalinger. Det Etiske Råd, Copenhagen 2008, ISBN 978-87-91112-78-2 , p. 49 .
140. ↑ ^{a b} Etiske Råd: Organdonation: etiske overvejelser og anbefalinger. Det Etiske Råd, Copenhagen 2008, ISBN 978-87-91112-78-2 , p. 71 .
141. ↑ Page no longer available , search in web archives: Article 119a of the Federal Constitution. Federal Office of Public Health; Retrieved June 4, 2007.
142. ↑ Page no longer available , search in web archives: Federal Office of Public Health : Stages of the partial revision.
143. ↑ Fact sheet - Transplantation Act: Questions and Answers. (PDF) bag.admin.ch accessed on June 4, 2007; archived at timetravel.mementoweb.org. Marco Andrea Frei: The extended consent solution according to Art. 8 Transplantation Act. Schulthess Verlag, Zurich 2012, ISBN 978-3-7255-6708-9 .
144. ↑ Page no longer available , search in web archives: Federal Office of Public Health : Earlier regulations; Retrieved June 4, 2007.
145. ↑ Federal Chancellery BK: Federal popular initiative 'Promote organ donation - save lives'. Retrieved August 6, 2019 . 
146. ↑ Barbara Frauchiger: Organ Donation in Switzerland - Do you want to donate your organs? Please decide! In: srf.ch . December 19, 2019, accessed December 19, 2019 . 
147. ↑ Federal Office of Public Health: Federal Council wants to introduce the contradiction solution for organ donation. In: bag.admin.ch . Retrieved March 14, 2020 . 
148. ^ ^{A b} A. García López, MP Gómez: Organizational Model for a National System of Donation and Transplantation from Deceased Donors in Nicaragua . In: Transplantation Proceedings . tape 43 , no. 9 , November 2011, ISSN  0041-1345 , p. 3310-3311 , doi : 10.1016 / j.transproceed.2011.09.087 .
149. ^ ^{A b} A. Ríos, C. Conesa, P. Ramírez, J. Sánchez, E. Sánchez, F. Ramos, P. Parrilla: Information Requested About Organ Donation in Primary Health Care Centers . In: Transplantation Proceedings . tape 38 , no. 8 , October 2006, p. 2367 , doi : 10.1016 / j.transproceed.2006.08.046 .
150. ↑ Average number of post-mortem organ donors in selected countries worldwide in 2017 (donors per million inhabitants). In: de.statista.com. 2019, accessed March 25, 2019 .  
151. ↑ dondorganes.fr ( Memento of the original from October 7, 2010 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. [archive] 
152. ↑ ^{a b} A. Bagheri: Organ Transplantation Laws in Asian Countries: A Comparative Study . In: Transplantation Proceedings . tape 37 , no. 10 , December 2005, p. 4161 , doi : 10.1016 / j.transproceed.2005.11.016 .
153. ↑ About Eurotransplant - In Brief | Eurotransplant. Retrieved January 2, 2019 . 
154. ↑ Ninoslav Ivanovski, Jelka Masin, Irena Rambabova ‐ Busljetic, Vlado Pusevski, Saso Dohcev: The outcome of commercial kidney transplant tourism in Pakistan . In: Clinical Transplantation . tape 25 , no. 1 , 2011, ISSN  1399-0012 , p. 171–173 , doi : 10.1111 / j.1399-0012.2010.01299.x ( wiley.com [accessed January 15, 2019]).
155. ↑ Milivoje Vuković, Nebojša Moljević, Nenad Katanić, Dragan Krivokuća, Vesna Vuković, Zoran Milošević: Cadaveric organ transplantation and religion . In: Medicinski pregled . tape 63 , no. 7-8 , 2010, pp. 577 ( ceon.rs [PDF; accessed July 3, 2012]).
156. ↑ Р. Т. Нигматуллин, Н.В. Чернов: Правовые аспекты трансплантации тканей . In: Регенеративная Хирургия . tape 1 , 2003, p. 1 ( reg-surgery.ru [PDF; accessed June 20, 2012]).
157. ↑ OPTN data ( memento of the original from January 25, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , January 9, 2015. 
158. ↑ D. Orentlicher: Presumed Consent to Organ Donation: Its Rise and Fall in the United States. In: Rutgers Law Review. 61, 2, January 1, 2009, p. 295.
159. ↑ ^{a b c d} Fouad N. Boustany: Ethics and law in biomedicine and genetics an overview of national regulations in the Arab states . UNESCO Cairo Office, Cairo 2011, ISBN 978-92-3104211-9 , Report of Mapping Bioethics Regulations in 17 States in the Arab Region, p. 41 ( unesco.org [PDF]).
160. ^ Egypt: vers une loi sur la greffe d'organe [archive].
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162. ↑ ^{a b c} E. M. Si-ahmed: The First Two Cadaveric Renal Transplantations in Blida, Algeria . In: Transplantation Proceedings . tape 43 , no. 9 , November 2011, ISSN  0041-1345 , p. 3431-3432 , doi : 10.1016 / j.transproceed.2011.09.050 .
163. ^ W. Faraj, H. Fakih, D. Mukherji, M. Khalife: Organ Donation After Cardiac Death in the Middle East . In: Transplantation Proceedings . tape 42 , no. 3 , April 2010, ISSN  0041-1345 , p. 713 , doi : 10.1016 / j.transproceed.2010.02.058 .
164. ↑ H. El-Shoubaki, A. Bener: Public knowledge and attitudes toward organ donation and transplantation: a cross-cultural study . In: Transplantation proceedings . tape 37 , no. 5 , June 2005, ISSN  0041-1345 , p. 1996 , doi : 10.1016 / j.transproceed.2005.03.014 , PMID 15964321 .
165. ^ Indian Transplant Registry: Objectives of the National Transplant Registry. Retrieved July 21, 2012 . 
166. ↑ J. Lavee, T. Ashkenazi, G. Gurman, D. Steinberg: A new law for allocation of donor organs [archive] in Israel. In: Lancet. 375, 2010, pp. 1131-1133.
167. ↑ Mona Newsome Wicks: Brain Death and Transplantation: The Japanese. April 25, 2000, accessed April 17, 2013 . 
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171. ^ Rebecca Empson: Collaborators Collaborating: Counterparts in Anthropological Knowledge and International Research Relations . Ed .: Konrad Monica. Berghahn Books, New York 2012, ISBN 978-0-85745-480-5 , Transacting Knowledge, Transplanting Organs: Collaborative Scientific Partnerships in Mongolia, p. 89 .
172. ↑ Benita S. Padilla: Regulated compensation for kidney donors in the Philippines . In: Current Opinion in Organ Transplantation . tape 14 , no. 2 , April 2009, ISSN  1087-2418 , p. 121 ( lww.com [accessed July 9, 2012]).
173. ↑ ^{a b} Benita S. Padilla: Regulated compensation for kidney donors in the Philippines . In: Current Opinion in Organ Transplantation . tape 14 , no. 2 , April 2009, ISSN  1087-2418 , p. 121 f . ( lww.com [accessed July 9, 2012]).
174. ↑ Arneh Babakhani, Stephen R. Guy, Edward M. Falta, Eric A. Elster, Tarun R. Jindal, Rahul M. Jindal: Surgeons bring RRT to patients in Guyana. In: Bulletin of the American College of Surgeons. June 1, 2013, accessed March 3, 2015 . 
175. ↑ Olumuyiwa O. Odusanya, Christopher O. Ladipo: Organ Donation: Knowledge, Attitudes, and Practice in Lagos, Nigeria . In: Artificial Organs . tape 30 , no. 8 , 2006, ISSN  1525-1594 , pp. 626 , doi : 10.1111 / j.1525-1594.2006.00272.x .
176. ↑ Olumuyiwa O. Odusanya, Christopher O. Ladipo: Organ Donation: Knowledge, Attitudes, and Practice in Lagos, Nigeria . In: Artificial Organs . tape 30 , no. 8 , 2006, ISSN  1525-1594 , pp. 626-629 , doi : 10.1111 / j.1525-1594.2006.00272.x .
177. ↑ HS Aghanwa, Akinsola, DO Akinola, ROA Makanjuola: Attitudes toward kidney donation . In: Journal of the National Medical Association . tape 95 , no. 8 , August 2003, ISSN  0027-9684 , p. 729 , PMID 12934871 .
178. ↑ Die Unwort von 1991 bis 1999. ( Memento of the original from March 25, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. on: unwortdesjahres.net 

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