Frage für das Forum: Should Residents in Germany automatically become Donors after Death?

Photo taken by Piotr Bodzek, MD [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)%5D
frage für das forum

There is an old saying to start off the forum: If you are born to an American parent, you automtically become an American.  How about when you pass on: Should you automatically become an organ donor?

This is the question that is floating around aggressively in Berlin and is being talked about in hospitals and medical centers in Germany, thanks to German Health Minister Jens Spahn and his most recent proposal.

According to the proposal:

  • The “dual opt-out” donation system would automatically make everyone in Germany a registered organ donor.
  • People could still opt out at any time by putting themselves on a register that says they object to being a donor.
  • Family members could also revoke consent after a person dies.
  • Doctors would be required to consult with the family before removing any organs in the event a person is declared brain-dead.
  • People will be informed multiple times about the new system and the options to opt out.

The proposal comes in response to the sharp decrease in the number of organ donors between 2012 and 2017, combined with the increase in the number of patients who are on the waiting list for an organ donor.  According to a recent study, the number of organ donations carried out in Germany decreased from 1097 in 2012 to only 797 in 2017. Last year alone, some 9,400 people were on the organ transplant waiting list.  Less than 1,000 organ transplantations were carried out, while 2,000 on the waiting list died.

The current system allows for opting in to donations, where people who volunteer receive a donor card and their names are in the data bank. Critics feel that the opt-out clause is the same as forcing people to donate their organs when they die, even though they don’t want to.  Already an alternative proposal is in the works which would require repetitive questioning about donating organs when at the doctor or renewing their personal ID. The belief is that organ donations should be a conscious option that remains voluntary and not obligatory by the state.

While the debate goes to the Bundestag, the German upper parliament, which will be debated and voted upon soon, the question is whether being an automatic donor after death with the clausal to opt-out would make the best sense in the interest of the German population. Or if it makes sense to leave it the option to donate to the person him/herself. Henceforth, a poll has been created for you to vote upon. Feel free to do so and if you want, comment on this issue.

While the author does see many advantages of being an organ donor (he is one himself, plus there’s a success story on that which you can click here to read.), there are some who don’t want to based on past experiences or even religious beliefs. There are two sides to the story on this topic, just as much as two sides to the story on becoming Americans automatically when a child born to American parents is born abroad. It’s a question of listing the facts on both sides of the aisle and deciding based personal feelings towards this subject. 🙂

 

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TED Talk: Poverty- The Lack of Cash Not Character

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While we have been talking about the fall of capitalism and countries in Europe introducing a general income for all, some of us wonder if there is a correlation between poverty and intelligence, or poverty and health. While there have been many (and sometimes important) studies that definitely confirm the latter, there is very little written or even spoken about the former.

That is until a TED-talk session in 2017, where Dutch historian Rutger Bregman, debunks the claim that poverty and intelligence are related. Bregman specializes in the history of economics and society and has done talks and written many pieces in this field. In this TED talk session, Bregman claims that the correlation relating to poverty has more to do with one lacking cash for the basic necessities: food, education, shelter and clothing, and less with the character of the person him-/herself. Even the brightest persons in the world happen to be poor. As a result, he pushes for a national general income for all program to encourage people to have these necessities and not treat them as a luxury. Interestingly enough, it was introduced in the Netherlands in the 1970s and produces surprising results.

Details are in his speech. Watch it and ask yourself if a general income for all would be of advantage to your country’s population and if so, how?

 

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To The Donor in Germany With Many Thanks, Wherever You Are.

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David Weringa (left) and Tim Anderson (right), long time friends with much in common. Photo contributed by David Weringa

I would like to start this Holiday Tribute with a quote about friendship which one should keep in mind: “Friends are there when you least expect it.” That means if you are in dire straits and others turn your back, there will be one or a small set of friends, some whom you haven’t seen in years, who will be right there to help you through the hardest of times.

I would like to share this story to one unknown friend out there, who went the extra mile to save the life of another person in the most dire need. And what is special about this story is that the person who helped him lives in Germany. The person, whose life was saved, lives in the US in the State of Minnesota. Specifically, Fairmont, Minnesota, which is located 50 miles west of the nearest city of Albert Lea in the south-central part of the state.

David Weringa works in the restaurant industry and has for many years. A 1991 graduate of Granada-Huntley-East Chain High School, which is east of Fairmont, David used to be a manager of Brickhouse Pizza in Winnebago before moving to Jackson to take a more rewarding job at Pillar’s Restaurant and Grill (which is now known as Bucksnort’s). Jackson is located 30 miles west of Fairmont. He is a friend of a close friend of mine, Tim Anderson, who also lives in Jackson.  He and I were members of a barbershop quartet while in high school, but graduated one year before I did. (I am a 96er). He and David got to know each other while working at Pillar’s in Jackson and became great friends after that. While Tim was working as a bartender, waiter and assistant manager, David was working as the kitchen manager at the restaurant when he suddenly felt severe pain in his legs in the summer and fall of 2016. After several visits to five different hospitals, including the emergency room, combined with several tests, he was diagnosed with Acute Lymphoblastic Leukemia on November 30th, 2016. Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, pale skin color, fever, easy bleeding or bruising, enlarged lymph nodes, or bone pain. As an acute leukemia, ALL progresses rapidly and is typically fatal within weeks or months, if left untreated. As many as 876,000 people were affected by ALL in 2015; of which, 111,000 of them died from it. ALL affects mostly children between the ages of two and five, as they account for 50% of all cases. Yet a small number of adults have been infected with it as well.

People like David.

After the diagnosis, David was sent to Sanford Hospital in Sioux Falls, South Dakota, where he started chemotherapy. Consisting of eight cycles (1 week in the hospital and two weeks at home), he continued undergoing therapy until 4th of May, 2017. It was not easy for him as he lost 40 pounds in the process, plus he was unable to continue performing his duties at the restaurant he was working; as a consequence, he was forced to resign for health reasons. After the chemotherapy was completed, David was put on maintenance chemo, where doctors could check the progress of the cancer. It was at that point where bone marrow biopsy revealed that the cancer was coming back.  Faced with a life and death situation, the only hope left for him was a bone marrow transplant.

David was referred to the Mayo Clinic in Rochester, one of the world’s leading hospitals when it comes to treatments for very rare diseases, combined with state-of-the-art medical research and technology. There, he underwent another form of chemotherapy called Blinotumomab, which targets the cancer cells. After 28 days, the cancer went into remission, yet the hardest battle was yet to come, and it had to do with the bone marrow.

In November 2017, David returned to the Mayo after having spent much of his time at home, where he received the best news ever: doctors had found a bone marrow match on the donor list! 😀  The person who had donated the marrow was a 27-year old person who was living in Germany at the time of the transplant. There was no further information beyond that, nor was it possible to contact the donor for a year after the transplant,  and afterwards, only that person would be allowed to contact David and others. The bone marrow cells from the German were delivered to Rochester on 29 November, 2017 and transplanted into David one day later, which coincided with the one-year anniversary of his diagnosis.

While the bone marrow transplant was a success, David was not out of the woods just yet.  100 days after the transplant, a biopsy in March 2018 revealed that the cancer cells were back and the bone marrow cells were not ready to fight these cells off. As a consequence, David underwent a new targeted chemo, called Inotuzamab, which was supposed to help the new cells take on and defeat the cancer cells, but had very nasty side-effects- namely high fever, rapid heartbeat, tiredness, infections, and the decrease in number of platelets plus other symptoms. In some cases, it could cause liver failure, which is potentially fatal. In David’s case, he needed transfusions of platelets as the numbers were dreadfully low. The average number of transfusions per week, according to his account, ranged between two and seven times. These platelets serve to clot up the flow of blood in areas where a cut or a bruise happened, in order to stop the bleeding instantly. Persons with a low platelet count can experience prolonged bleeding for up to hours on end. As an example, a person with a nosebleed would need five hours or more to stop the bleeding if the count is too low. Normally it is usually between five and ten minutes if the platelet count is normal.

Finally, in June of this year, after being at the Mayo Clinic in Rochester for over a half a year, David was finally able to go home. He has become healthier and stronger than he was when he entered the clinic prior to the transplant, and his cancer has since been in remission. In the interview, he mentioned that his cancer had been in remission for a total of six times during this ordeal, yet, since having left the clinic, the biopsies he has undergone have revealed that the cancer has not come back. For him it was a victory that could not have been achieved if it hadn’t been for that donor in Germany, who took the time to donate a marrow to save another life, namely his.

Donating organs, blood and the like have not been well received in Germany within the past five years. According to the German Organ Transplantation Foundation (DSO), only 797 organ donations were reported in 2017, making it 9.7 persons per 1 million. This is the lowest number since 2017, and Germany is towards the bottom in European standards, with Spain leading the pack with 46.9 donors per one million. Factors include several scandals and the lack of interest in donating even blood have played a key role in the decline, despite increases in numbers in the states of Bavaria, Hesse and Rhineland-Palatinate, according to local.de. Proposals to have organ donations be obligatory after a person’s passing unless noted by the person himself have been rejected soundly because of privacy reasons, yet there are several advantages of donating organs, blood and the like, especially if one is willing to allow for the transplant in order to save the life of another.  Donor cards exist in Germany, where a person can fill out his personal data and submit it to a donor fund, granting them permission to remove the organs and like once the person passes on. This one is quite useful, if a person is like yours truly and believes that even if the person dies, the organs can still be used in someone else, as long as they are useful and working. Therefore, inspite of the scandals and lack of interest, one should have a look at the option of donating carefully and all the benefits that exist.

 

December 2018:

David still lives in Fairmont.  A lot of things are looking up for him ever since the transplant. He’s about to take on a job at Ambiance Tap House and Grill in town as soon as he’s ready. With the cancer in remission for a half a year at least and his health becoming better, he’s ready to take that step in returning to the job that he loves doing, which is working in a restaurant. It has been well over a year since the donor provided him with that bone marrow that saved his life, and David has been very thankful for that.  While the year clause has long since expired, the donor has yet to contact David to see how he is doing. For there has not been any contact, it is the wish of David to send the word of thanks to that donor, for taking the time needed to donate the marrow and save his life. That is even if that donor still wishes to remain annonymous.

And with that, I would like to end this story with a small token in German: “Vielen Dank, dass Sie diese Mühe gegeben haben, um das Leben eines Menschen wie David retten zu können. Es war das beste Geschenk, das Sie ihm gegeben haben. Dank Ihnen, kann er sein Leben weitermachen und mit vielen Freuden.”  The best present comes when the person least expects it. ❤  🙂

Special Thanks to David Weringa for providing the details to this long story and wishing him all the best.

 

 

Sunset over Flensburg

FlFi Christmas 2018