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Germany

Avoid more organ transplant scandals

Our institution is launching an international transdisciplinary initiative to improve the lamentable state of solid-organ transplantation in Germany and to help fulfil society's obligations towards millions of organ donors and recipients worldwide (see go.nature.com/z5b7uo).

The mortality rate following liver transplantation has risen alarmingly across the country over the past few years. The survival rate after one year is only 72% in Germany, which is 20% lower than in the United States and the United Kingdom, even though Germany has more transplant centres and fewer organ donors per capita (see go.nature.com/pgmrpn; in German). Such scandals are leading to a steady decline in altruistic organ donations, with an 18% drop in the first quarter of this year compared with the same period in 2012.

The situation largely reflects the weak regulation of organ transplantation in Germany, especially by comparison with other countries such as the Netherlands and Denmark (C. Metz and N. Hoppe Eur. J. Health Law 20, 113–116; 2013). Proposals to rectify this include setting up an independent institute of transplantation medicine that has regulative and standard-setting powers (see go.nature.com/yzl4km; in German).

A lack of good prognostic models compounds the likelihood of transplantation failure. Such models would allow clinical urgency to be weighed against transplantation outcome. We are therefore planning systematic multicentre trials to evaluate the prognostic value of liver-allocation scores.

Our initiative also aims to address the dearth of quality-management systems that are properly founded on comprehensive, evidence-based data and on precise methodology that considers patients' needs and expectations.

The early results are promising. We intend to publish regular updates to provide essential information to the transplantation community and to ensure openness to the public.

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Correspondence to Harald Schrem.

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Schrem, H., Kaltenborn, A. Avoid more organ transplant scandals. Nature 498, 37 (2013). https://doi.org/10.1038/498037b

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