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At present, organ donation after so-called irreversible loss of brain function is the only legally permissible form of donation. The introduction of organ donation after cardiovascular arrest could shorten waiting times and increase the number of transplants. This is shown by simulations based on European data.
There has been a considerable shortage of donor organs in Germany for years. In Germany, deceased persons may donate organs if this corresponds to their previously expressed or presumed wishes and death is irreversible. At present, organ donation after so-called irreversible loss of brain function (DBD, donation after brain death) is the only legally permissible form of donation from deceased persons. In many other countries, controlled donation after circulatory death (cDCD) is also regulated and established. In this case, death occurs not as a result of brain failure, but after the therapy is withdrawn in accordance with the patient's wishes. The cessation of therapy (cessation of artificial respiration, cessation of artificial circulatory support) may be desired, for example, because the prospects of therapy are very poor and no further suffering is desired. This leads to failure of the cardiovascular system and, after a certain waiting period following death, organ donation is possible.
A recent study by the Faculty of Medicine at Kiel University in collaboration with the Eurotransplant International Foundation (Leiden, Netherlands) has investigated the potential that an extension of the indication to controlled organ donation after definitive cardiovascular arrest would have for Germany. The study was based on retrospective data from nine European countries as well as simulation-based models for the development of transplant numbers and waiting lists.
The results, which have now been published in the German Ärzteblatt, show that the introduction of HKS donation could significantly increase the number of available donor organs in Germany. However, the effect depends heavily on organisational and legal framework conditions. This effect was particularly pronounced in models modelled on countries such as Spain or Switzerland. Two examples from the model calculations for the year 2023: Under assumptions like those in Switzerland, around 35 per cent more liver transplants and 60 per cent more kidney transplants would have been possible. A scenario similar to that in the Czech Republic would result in an increase of around 10 per cent in liver transplants and around 30 per cent in kidney transplants.
"We conducted this study against the backdrop of the ongoing organ shortage, as Germany is taking a special path in contrast to most of its neighbouring countries by foregoing cDCD donation," explains Dr Friedrich von Samson-Himmelstjerna, research associate at the Faculty of Medicine at Kiel University. Together with Eurotransplant scientist Hans de Ferrante, PhD, he is the first author of the study. Previous discussions have mostly focussed on other solutions to alleviate the organ shortage. "Our results show that controlled organ donation after definitive cardiovascular arrest offers relevant additional potential. It should be given greater prominence in the scientific and social debate," says the doctor and scientist.
Data for the public debate on organ donation
Erwin de Buijzer, Medical Director, Eurotransplant, states: "Whether and how DCD could be regulated in Germany is a social and Politics question that Eurotransplant cannot answer - and the study does not anticipate this decision. However, it provides a data-based foundation for an objective debate and helps to better understand the possible effects. Transparency, quality and patient safety remain the benchmark."
The analyses also show that the impact depends heavily on the respective framework conditions. In some scenarios, such as the Austrian model, there were hardly any improvements. This indicates that the mere introduction of the HKS donation is not enough. Structural factors also play a decisive role. International examples show that increasing organ donation figures are usually accompanied by comprehensive measures, such as improved donor recognition in clinical settings, standardised procedures, targeted training of specialist staff and Public Relations to increase acceptance.
The study aims to broaden the public debate. Currently, the introduction of the opt-out solution is being discussed in particular. This stipulates that every person is considered an organ donor unless they have explicitly objected during their lifetime. "We want to make alternative, effective system options visible. Many people don't realise that organ donation in Germany is linked to a specific determination of death - and that this currently excludes donations after permanent cardiovascular arrest. Whether and how to create legal conditions for this should be discussed openly and objectively," emphasises von Samson-Himmelstjerna.
Background
In Germany, organs may currently only be removed after death if doctors have determined death to be an irreversible loss of all brain functions. Organ donation after permanent cardiovascular arrest is established in many European countries and also in Japan, the United States of America and Australia, for example, where it is carried out under different protocols. Death is determined on the basis of permanent loss of circulatory function. After a defined observation period without resuscitation, the organs can be removed. According to the current legal situation in Germany, this constellation of death is not a basis for organ donation.
Pictures/Materials to download:
http://www.uni-kiel.de/de/pressemitteilungen/2026/058-Friedrich-von-Samson-Himmelstjerna.jpg
Dr Friedrich A. von Samson-Himmelstjerna of the Faculty of Medicine at Kiel University.
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Dr Friedrich A. von Samson-Himmelstjerna
Faculty of Medicine, Kiel University
Friedrich.vonSamson-Himmelstjerna@email.uni-kiel.de
https://di.aerzteblatt.de/int/archive/article?id=249388
Cardiac arrest as an extended indication for organ donation. Dtsch Arztebl Int 2026; 123: 207-12. DOI:10.3238/arztebl.m2026.0004. Samson-Himmelstjerna, F A; de Ferrante, H; Niehus, C B; Strelniece, A; Kakavand, N; Thomsen, SY; Guenther, R; Augsberg, S; Vogelaar, S; de Buijzer, E; Tieken, I; Schmitt, R; Kolbrink, B; Schulte, K
http://www.uni-kiel.de/en/details/news/058-organ-donation-study
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