Outrage at individual medical practitioners who have come under suspicion of manipulating the donor organ allocation system for their own ends has created a situation in which the system of organ allocation itself has come under public scrutiny.
Together with a panel of six experts the Council examined the process and the criteria by which patients get put onto and moved up waiting lists for donor organs and discussed whether the development of these rules should primarily be a medical task.
Dirk Ludger Stippel of the transplant staff at Cologne’s University Hospital pointed out that the medical criteria for the allocation of organs need to be made more specific. This would require a transplant register with a good database. He called for a broad public debate on the fair regulation of transplantation medicine and pointed out that this would also raise the level of acceptance.
Gertrud Greif-Higer, a psychosomatic specialist at the University Hospital in Mainz, noted critically that the current practice of prioritising urgency over the likelihood of success was forcing patients “to wait until they were so seriously ill that the chances of a successful transplantation were poor”. She also regretted that next to no data were available on patients’ experiences.
Jutta Riemer, Chair of the Association of Liver Transplantees, stressed that there was an urgent need to think about ways of optimizing the system of organ allocation and discussing the ethics involved. She pointed out how hard it was to do justice to individual patients’ circumstances on the basis of the guidelines. There was also a lack of data on the patients’ quality of life and no general agreement on what was meant by the “likelihood of success” criterion.
The Chair of the German Medical Association’s Standing Commission on Organ Transplantation, Hans Lilie, conceded that the German Medical Association “had not received easily subsumable legal concepts” in § 12, section 3, subsection 1 of the Organ Transplant Act, but he doubted that a more exact wording of this regulation could bring about fairer allocation.
From a constitutional perspective, Thorsten Kingreen of Regensburg University criticized as insufficient the terms of reference of the Organ Transplant Act concerning criteria for the allocation of organs and hence also the allocation of survival chances. An allocation system in keeping with democratic and constitutional norms was “a vital political prerequisite, not just for organ allocation, but also for increasing the number of organ donors”.
Micha Werner of the University of Greifswald examined the problem of organ allocation in the light of moral philosophy. He defended the practice of placing more weight on urgency than on probability of success in terms of “a justice ethic based on incalculable individual claims ... that sees urgency as the primary basis of individual claims to donor organs”, although probability of success was not excluded as a secondary criterion.
In summing up the subsequent discussion with the members of the Ethics Council, the Chair of the Council, Christiane Woopen, said it had become clear that a distinction had to be made between the question of access to the waiting list and that of the actual allocation of organs. More data would have to be collected on the situation of the patients, not only from a medical, but also from a psychosocial point of view. In the medical sphere, for example, there was still a lot of scope for further development of guidelines and improved psychological monitoring of patients without requiring additional legislation.
It was also clear, Professor Woopen continued, that the question of a fair system of organ allocation was primarily an ethical question. There was not just ONE criterion for fair allocation but several criteria which had to be combined, defined and weighted in the course of an intensive public debate before being written into law by parliament. Their concrete application would then have to be determined by the medical profession in a second phase.
The programme of the session as well as the papers and contributions to the discussion may be found here (in German).