Is Germany's organ transplant system in need of an overhaul? It is a question that the country is once again asking after yet another scandal involving doctors fast-tracking patients for organ transplants -- one which could carry significant consequences for the doctors involved.
Prosecutors in Leipzig have opened a criminal investigation following allegations that doctors at the eastern German city's university hospital manipulated data to move their patients up on the list of those waiting for a donor organ. Two senior doctors have thus far been suspended in the scandal, which has seen a total of 38 liver patients between 2010 and 2012 erroneously marked down as dialysis cases in order to rise up the waiting list.
"This is a shocking result for me," said Wolfgang Fleig, chair of medicine at the University of Leipzig. "I strongly believed up until now that our procedures complied with all the rules."
"I cannot put my hand into the fire, and say that no money was involved," he added, but stressed he found it hard to imagine bribery was the motive, since he personally knew the doctors and patients concerned. "Whether or not to give dialysis is simply a tick on the computer," Flieg said.
Whatever the truth behind the situation, it has once again brought under scrutiny the supervision of transplant waiting lists. Several similar scandals came to light in 2012, including at clinics in Göttingen, Munich and Regensburg. There have been concerns that the scandals could reduce the already modest willingness of Germans to sign up as potential organ donors. It has been estimated that a person dies in Germany every eight hours for lack of a donor organ.
While a spokesman for the Ministry of Health insisted that: "There is monitoring, inspection and control mechanisms that work," critics have argued there is not enough government regulation of the lists.
Johannes Singhammer, a member of the Christian Social Union, the Bavarian sister party to Chancellor Angela Merkel's Christian Democrats, called for the current guidelines on organ transplants by the German Medical Association to be enshrined in law. "Only in this way are any sanctions possible," he said.
Currently, responsibility for the organ donation system is split between four bodies: the German Organ Transplant Foundation (responsible for organ donation), Euro Transplant (which distributes the organs), the transplant centers themselves and a commission of the German Medical Association (which draws up the guidelines.)
German Health Minister Daniel Bahr has created an independent commission of doctors, ethicists and lawyers to examine the issue. Many doctors, however, are resistant to what they see as outside interference by non-doctors in a clinical decision.
The president of the German Medical Association, Frank Ulrich Montgomery, told the Berlin daily Tagesspiegel that the German organ transplant system was "probably never so safe and protected against cheating as it is currently," saying the Leipzig cases, while in need of investigation, were exclusively "cases from the past."
Commentators at Germany's leading national newspapers on Thursday do not share that view.
The center-right Frankfurter Allgemeine Zeitung writes:
"The damage done is immense. That is obviously not just true of patients on the waiting list for donated organs who were cheated. That is also true of all patients who see themselves as being literally helpless. And it is true of donors, whose mistrust grows with each case of manipulation. The number of donor organs began dropping last year just as the first cases of deceit became public. Last but not least, such cases also hurt transplant doctors, whose own area of specialization has been plunged into disrepute. And the disappearance of trust in how livers, hearts and kidneys are handled hurts the standing of all doctors. As such, it is all the more in their interest to combat this growing damage to their image."
The center-left Süddeutsche Zeitung writes:
"The organ donation system depends on absolute trust that the donated organs are fairly distributed. Violations have to have consequences. As such, it is all the more tragic that efforts to clear up a case at a Munich clinic have not made progress. It has been known since the spring that patient data there was manipulated (to improve their chances of getting an organ). Several senior clinic officials likely knew about it or should have known about it. Consequences have been lacking."
"In the United States, transplant centers have lost their licenses for much smaller violations. Such a system should be introduced here too."
The left-leaning Die Tageszeitung writes:
"It is very possible that manipulation takes place virtually everywhere. The only questions are how broad that manipulation is, what organs are involved and how perfidious the fraud is. Clearing up these questions depends on how many resources public prosecutors, the German Medical Association, insurance companies and the federal government are willing to make available."
"It would be wrong to condemn organ transplantations per se. For many patients, it remains the only possible and correct therapy. The point is to find new rules for the distribution of organs, to establish adequate quality controls and to reduce competition among transplant centers by closing some of them down."
The conservative Die Welt writes:
"The organ transplant system in Germany is prone to manipulation because it is extremely unsatisfactory when the rules are followed. That has largely to do with the huge gap between demand and supply, between the low number of donated organs and the much higher number of needy patients. The patients themselves suffer the most from this discrepancy. But it has consequences for doctors as well. It is extremely difficult for them to keep encouraging those in need of transplantations to be patient and to see their ongoing suffering."
"Let's be clear: The transplant system is unbearable for all involved. That, not just greed or poor character, is what fuels the deceit. But that also means that the system of self-administration among doctors, clinics and insurance companies is not able to prevent violations. Indeed, a requirement for the success of self-administration is a system that more or less works. But organ distribution does not work, primarily because of the discrepancy between supply and demand. Which is why monitoring duties should be taken away from the doctors themselves and handed to a neutral authority."
-- Matt Tempest
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