A large variety of cells, tissue, organs, and even organ systems can be transplanted by means of transplantation medicine. Due to the discrepancy between donor body material or organs available and persons in need of a transplant, procedures such as split-liver transplantation are now being used in addition to standard procedures and alternatives such as xenotransplantation and alloplastic transplantation are receiving greater attention. Hence, transplantation medicine and stem cell research are connected, as the cultivation of tissue or organs using cell cultivation processes has great potential.
In Germany, organ or tissue donations and their removal and transfer is regulated by the national Organ Transplantation Act (Transplantationsgesetz, TPG). For the purpose of the removal of organs and tissue in deceased persons, this legislation is based on brain death, which must be determined by two qualified doctors independently of one another and who are prohibited from participating in the transfer of the organs. In addition, consent is given by extension, i.e., an organ of a deceased person may only be removed if prior consent for organ donation has been given either by the deceased person, for example in the form of an organ donor card, or by relatives. Educational campaigns and surveys should promote the willingness to donate. Living donor transplantation is also possible. However, certain requirements must be met. Regenerating organs or tissue may also be donated anonymously, while organs that do not regenerate by themselves (e.g., kidney, parts of the liver) may only be donated to benefit persons who belong to the small group of next of kin. Several administrative bodies are responsible for the removal, allocation, and transfer of organs in a multi-stage process.
Transplantation medicine raises a series of questions which are continually subject to controversial discussion: Is the brain death criterion sufficiently based on scientific evidence and is it appropriate? Should the consent solution be replaced by a dissent solution as practiced in other countries? Should the options for living donations be expanded? How should new forms of transfer, such as xenotransplantation, be assessed? Are organs being allocated and distributed fairly? How should questions about commercialization and organ trade be dealt with?
Marion Albers, 22.07.2014 / Marion.Albers@uni-hamburg.de