[PPT] - Germanys Campaign I have nothing to disclose. to Increase Organ PowerPoint Presentation

SLIDE 1

9/30/2016 1

Germany‘s Campaign to Increase Organ Donation

Christiane Kugler, PhD

Witten University, Department of Health, and Hannover Medical School, Hannover, Thoracic Transplant Program, Germany

UCSF Transplant 2016: Building Bridges to Excellence San Francisco, September 29-30, 2016

I have nothing to disclose.

Outline

1. Current condition of organ allocation and

transplantation

2. Organ donation decrease
3. Organ donation campaigns

Outline

1. Current condition of organ allocation

and transplantation

2. Organ donation decrease
3. Organ donation campaigns

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Current Condition

Eurotransplant Collaborative Framework

To date, eight countries cooperate within

Eurotransplant

– Austria, Belgium, Croatia, Germany, Hungary, Luxemburg, the Netherlands and Slovenia – Total population 135 Mill. Inhabitants

Int’l collaborative framework includes all

transplant centers, tissue-typing laboratories and hospitals where organ donations take place

Eurotransplant. org

Current Condition

Eurotransplant Collaborative Framework

One central waiting list
'Pooling' donor organs depending on

population and allocation of collaborative countries

Eurotransplant. org

Current Condition

Eurotransplant. org

Current Condition

Eurotransplant Collaborative Framework Organ balance…

necessary condition for cooperation -

ensuring that the exchange of organs between countries remains reasonably in balance and

to compensate for the differences in

donor ratio and

for the effect of different criteria for

allowing patients on the waiting list

Eurotransplant. org

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Concepts and Systems of organ donation

Legal Prerequisites

Presumed Consent

Organ donation is automatically considered in patients

diagnosed brain dead, unless they have specifically registered their wish not willing to donate

In some countries, doctors will still ask permission from

relatives Informed Consent

Voluntary system of organ donation, whereby relatives give

permission at the time of death, usually in the knowledge that the potential donor had expressed a wish to become a donor

Concepts and Systems of organ donation

Legal Prerequisites

Informed Consent

Voluntary system of organ donation, whereby relatives give

permission at the time of death, usually in the knowledge that the potential donor had expressed a wish to become a donor

Donor Card

Country Donor's legal situation Austria Presumed consent Belgium Presumed consent Croatia Presumed consent Germany Informed consent Hungary Presumed consent Luxemburg Presumed consent The Netherlands Informed consent Slovenia Presumed consent

Legal Prerequisites

Legal constitution differs within the countries of Eurotransplant region

Eurotransplant. org

German Organ Transplantation Foundation (DSO)… …is an incorporated foundation according to civil law in Germany … after the German Transplant Law was passed in 1997, the DSO was officially assigned the role of

rgan procurement agency by a contract which
utlined its responsibilities in coordinating the organ

donation procedure …promote and support for organ donation and transplantation

Current Condition

www.dso.de

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Outline

1. Current condition of organ allocation and

transplantation

2. Organ donation decrease
3. Organ donation campaigns

Organ Donation Decrease

Series of Organ Transplantation Scandals

July 2012: media report on manipulation of listing status of patients

for liver tx, two physicians under investigation at the university clinics Goettingen

August 2012: one of the two physicians under investigation in

Goettingen may have performed manipulation to fast-track patients for liver tx at university hospital in Regensburg

January 2013: media report on manipulation of listing status of

patients for tx, university hospital Munich (TUM), Leipzig

August 2014: report to the authorities of false manipulations related

to transplant wait list procedures at the heart center in Berlin

dpa

Organ Donation Decrease

Federal Responses to Organ Transplantation Scandals

July 2012: Physicians under investigation are suspended
June 2013: Federal Parliament changes transplantation act in order

to allow sanctioning of manipulations and fraud related to transplant wait list procedures

August 2013: start of lawsuit against head physician from university

clinic Goettingen

August 2013 - onwards: audits of independent experts of archived

patient documentations in all transplant centers

dpa

Organ Donation Decrease

Public Responses to Organ Transplantation Scandals

dso.de

37% decrease

f deceased
rgan donors

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Organ Donation Decrease

Consequences of Organ Transplantation Scandals

Published statistics available provide limited

information to compare pre- versus post-scandal conditions

dso.de

Organ Donation Decrease

Consequences of Organ Transplantation Scandals

More than 10,000 pts on the waitlist

(Eurotransplant, 09.2016)

Current donor shortage of donor organs

results in the death of 1,000 pts on the waitlist every year

(Kaiser et al.,2016)

dso.de

Organ Donation Decrease

Consequences of Organ Transplantation Scandals

Drop in donor numbers
2012-2011: 13% (Stafford, 2013)
Drop in transplantations performed
2015: overall 3,777 transplants performed

dso.de

Organ Donation Decrease

Consequences of Organ Transplantation Scandals

Drop in donor numbers
2012-2011: 13% (Stafford, 2013)
Drop in transplantations performed
2015: overall 3,777 transplants performed

dso.de

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Organ Donation Decrease

Consequences of Organ Transplantation Scandals – huge interest from the media

dso.de; Spiegel-online.de

Decrease per region; comparison organ donations 2013 versus mean status 2000-2012

Organ Donation Decrease

Consequences of Organ Transplantation Scandals – huge interest from the media

Hoisl, et al., The Anesthesiologist 2015

Print media – over-

regional distribution 1.5 Mill exemplars

216 articles within 12mts

Organ Donation Decrease

Consequences of Organ Transplantation Scandals – huge interest from the media

Hoisl, et al., The Anaestesiast 2015

Content analysis of 216 articles

Most categories (63.8%) placed negative

evaluative opinion (e.g. loss of confidence, enrichment of persons involved, fraud, misconduct, rejection of brain death and disturbing the peace of the dead)

Minority of 36.2% of news articles tried to

convey objective information (e.g. problems, and consequences of organ shortage)

Outline

1. Current condition of organ allocation and

transplantation

2. Organ donation decrease
3. Organ donation campaigns

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Organ Donation Campaigns

Public Promotion in a wide Range of Activities - First wave in 2014

Since 2014 a wide range of public education and

information activities are underway including – National multi-media campaigns – Advertising – Research activities to better understand specific needs

Organ Donation Campaigns

1st wave-

Public Promotion in a wide Range of Activities

DSO performed an analysis of 1,284 donation requests,

including the outcome – 38% of donations based on expected will – 23% consent from relatives – 12% carried a donor card

DSO.de

Organ Donation Campaigns

1st wave-

Public Promotion in a wide Range of Activities Campaign between June- December 2014

Advertisements in newspapers and magazines
10,000 Large-scale poster walls, and 13,000 city light

posters with a reach of 44.18 Mill. people, and 7.78 Mill. young adults

DSO.de

“I decide”

Organ Donation Campaigns

1st wave-

Public Promotion in a wide Range of Activities

DSO.de

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Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities

In 2016, second wave of public education and information

activities including – National multi-media campaigns – Advertising – Research activities

DSO.de

Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities

June 1, 2016 Press release

Preliminary findings from a second nation-wide

representative survey on “beliefs, knowledge, and behavior with respect to organ- and tissue donation in German citizens in 2016”

with 4,003 participants in the age

range 14-75 years

Pressestelle BMG Bund, 2016

Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities

June 1, 2016 Press release

54% feel well informed (2013: 44%)
81% report on having a “positive attitude” on tissue- and
rgan donation” (2010: 79%)
32% carry a donor card (2010: 25%)

Pressestelle BMG Bund, 2016

Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities Brochure

Uses “known faces” like actors,

Comedians, moderators, sports men

“Organ donation?! –

I have made my decision”

DSO.de

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Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities Internet campaign

Advertisements
Video clip
Organ donation “stories”
Online organ donation “magazine”
Interviews

Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities Day of Organ Transplantation

Advertisements
Video clip
Organ donation “stories”
Online organ donation “magazine”
Interviews

Organ Donation Campaigns

2nd wave-

Public Promotion in a wide Range of Activities Organ “Godparent” Award

Faces
Organ donation “stories”
Interviews

Organ Donation Campaigns

Research Activities-
Survey on organ donation attitudes among

5,291 participants

Majority of 65.2% was willing to organ

donation postmortem

40.1% held a donor card

Uhlig et al., 2015

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Organ Donation Campaigns

Research Activities-

Uhlig et al., 2015

Organ Donation Campaigns

Research Activities-

Uhlig et al., 2015

Organ Donation Campaigns

Research Activities-

Uhlig et al., 2015

Multiple answer categories possible

Summary

Transplant scandals decreased organ donation

and transplantation rates in Germany

Media have an important influence on the

decision-making process of the public

Multi-media campaigns and adjusted regulations

led to…

higher public awareness
more positive attitudes
higher rates of donor card holders
Small increases in transplant rates

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