Legal Justice in Organ Allocation. A Legal Perspective on the Failure of the German Organ Allocation System
The German organ allocation system is out of joint. In July 2012, the medical community as well as the broader public got alarmed by several high-profile transplantation scandals, which meanwhile have resulted in a significant decrease in the number of organ donations. Several physicians at different university hospitals have been accused of altering data related to their patients to make them appear sicker than they actually were in order to place them in front of other patients that were on the waiting list for liver donations. The scandal sheds light on the essential normative nature of prioritization decisions and raises the question of ethical and legal justice in public health. The article argues that the regulatory framework of organ allocation in Germany is not in accordance with the constitutional requirements for a state organized allocation order, which directly affects the most fundamental rights of patients. The lack of legitimacy of the current allocation system, which is essentially determined by guidelines of the German Medical Association, makes it impossible to find a satisfactory legal answer to the problem of individual manipulations of the prioritization process by doctors, who arbitrarily try to advantage their own patients.
Verteilungsgerechtigkeit in der Transplantationsmedizin
Der Beitrag kritisiert die elementaren Defizite des deutschen Transplantationsgesetzes und skizziert verfassungsrechtliche Vorgaben fur eine Neuregelung
Liver Transplantation for Alcoholic Liver Disease in Europe: A Study from the ELTR (European Liver Transplant Registry)
Alcohol‐related liver disease (ALD) is one of the most common indications for liver transplantation (LT). Long‐term outcome after LT for ALD versus other etiologies is still under debate. The aim of this study was to compare outcome after LT of patients with ALD, viral (VIR), and cryptogenic cirrhosis. Donor, graft and recipient ELTR variables were analysed in transplants for alcoholic and nonalcoholic cirrhosis (1988–2005) and were correlated with patient survival. Causes of death and/or graft failure were compared between groups. Nine thousand eight hundred eighty ALD, 10 943 VIR, 1478 ALD + VIR and 2410 cryptogenic (CRYP) liver transplants were evaluated. One, 3, 5 and 10 years graft survival rates after LT in ALD patients were 84%, 78%, 73%, 58%, significantly higher than in VIR and CRYP (p = 0.04, p = 0.05). By multivariate analysis, ALD + VIR (RR 1.14) and viral alone (RR 1.06) were significant risk factors for mortality. De novo tumors, cardiovascular and social causes were causes of death/graft failure in higher percentage in ALD groups versus other etiologies. LT for ALD cirrhosis has a favorable outcome, however, hepatitis C virus co‐infection seems to eliminate this advantage. Screening for de novo tumors and prevention of cardiovascular complications are essential to provide better long‐term results.