Schaub F, Fischer-Fröhlich C-L, Wolf C, Kirste G
Deutsche Stiftung Organtransplantation (DSO), Frankfurt am Main.
Dtsch Med Wochenschr. 2013 Oct;138(43):2189-94. doi: 10.1055/s-0033-1349554. Epub 2013 Sep 18.
According to surveys the majority of the German population has a positive attitude towards organ donation. However, declarations of will concerning this matter are often missing in case of death. Thus, in nearly all cases consent must be obtained from the family of the deceased. Compared with refusal rates of other countries the refusal rate in Germany (approximately 40%) is rather high. The modification of the German Transplantation Legislation in November 2012 supports the voluntary documentation of everyone's decision with regard to organ donation.
Based on 6,617 documented donation requests collected between 2009 and 2011, factors were identified, which--besides personal attitude of morality--could influence the decision about donation.
The decedent's will is often unknown (67.4%) and the family's decision is based on the suspected will of the patient. This resulted in 4097 (61.9%) consents and 2520 (38.1%) refusals. 4669 (70.6%) of these donation-requests were carried out by the physician in charge and 1948 (29.4%) with the assistance of a coordinator from the German foundation for organ transplantation (DSO). Predictive (p<0.001) for consent were the presence of a specially trained coordinator and the timing of the request for organ donation.
There is a big discrepancy between the attitude displayed in surveys and the actual consent rate to organ donation. The major challenge is an improved caregiving for the donor family. Donation requests should be made preferably by trained physicians as well as coordinators. Waiting for the finalized certification of brain death may not be appropriate in all cases.
根据调查，德国大多数民众对器官捐赠持积极态度。然而，在死亡情况下，关于此事的意愿声明往往缺失。因此，几乎在所有情况下都必须征得死者家属的同意。与其他国家的拒绝率相比，德国的拒绝率（约40%）相当高。2012年11月德国移植立法的修订支持对每个人关于器官捐赠的决定进行自愿记录。
基于2009年至2011年期间收集的6617份有记录的捐赠请求，确定了除个人道德态度外可能影响捐赠决定的因素。
死者的意愿通常不明（67.4%），家属的决定基于对患者意愿的推测。这导致了4097例（61.9%）同意和2520例（38.1%）拒绝。这些捐赠请求中有4669例（70.6%）由主管医生执行，1948例（29.4%）在德国器官移植基金会（DSO）协调员的协助下进行。同意捐赠的预测因素（p<0.001）是有经过专门培训的协调员以及器官捐赠请求的时机。
调查中显示的态度与实际器官捐赠同意率之间存在很大差异。主要挑战是改善对捐赠者家属的护理。捐赠请求最好由经过培训的医生和协调员提出。在所有情况下等待脑死亡最终认证可能并不合适。
