Draft:Organ Donation Scandal in Germany

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  • Comment: The article needs extensive rewriting. Consider first explaining and summarizing the main ideas of the article and then you can create specific sections below that. KeepItGoingForward (talk) 20:15, 8 May 2025 (UTC)
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Between 2010 and 2012, the German organ transplantation system faced its most significant ethical and regulatory crisis since the introduction of the Transplantationsgesetz (TPG) in 1997. Investigations revealed widespread manipulations in multiple transplant centers involving liver, heart, and lung programs, undermining trust in the allocation system and triggering a profound decline in organ donation rates.[1][2] As mandated by the TPG, the German Medical Association (BÄK), in collaboration with the German Hospital Federation (Deutsche Krankenhausgesellschaft) and the Health Insurance Funds (GKV), established two key oversight bodies: the Monitoring Commission, responsible for supervising the German Procurement Organization (DSO) and donor hospitals, and the Assessment Commission, tasked with auditing Eurotransplant (ET) and transplant center activities. Before the scandal, this governance framework operated on mutual trust and collegiality rather than enforcement. This trust-based system was disrupted by three major controversies: The first, in 2011, involved allegations of nepotism within the DSO; although ultimately dismissed after investigation, it prompted increased governmental reporting requirements. The second—the widely publicized organ allocation scandal—emerged in 2012 following anonymous reports from Göttingen. Intensive audits revealed falsification of laboratory values, manipulation of blood samples, and fabrication of dialysis documentation. Systematic irregularities were confirmed in Göttingen, Munich (TU, rechts der Isar), Münster, and Leipzig, leading to the closure of two liver programs. Thirteen additional centers exhibited documentation deficiencies, while five (Berlin, Hamburg, Hannover, Magdeburg, Würzburg) were free of violations. In July 2013, the TPG was amended to grant the Assessment Commission authority to monitor centers directly and review patient records. These amendments criminalized the falsification of clinical data or laboratory parameters for organ allocation, imposing penalties of up to five years’ imprisonment. The third scandal evolved in 2014 with the investigation of heart and lung transplant centers. Subsequent audits of heart and lung programs in 2014 uncovered similar patterns of manipulation—including falsified drug dosing and HU/LAS listings—at centers in Berlin, Jena, Munich (LMU Großhadern), Heidelberg, Cologne, Hamburg and Leipzig. All findings were publicly disclosed by BÄK, and biennial audits were mandated. Cases of suspected criminal behavior were referred to prosecutorial authorities. This third scandal was particularly serious, since it included the program directors Bruno Meiser (Munich) and Herman Reichenspurner (Hamburg) who had senior positions in ET, BÄK and were members of the auditing and supervision commissions (PÜK).

The manipulations were primarily aimed at accelerating access to scarce organs for selected patients, achieved through falsification of clinical data, retrospective documentation, and intentional guideline violations. These actions, though rarely financially motivated, were driven by medical prestige, inter-center competition, and pressure to maintain high transplant success rates.[3][4].


Transplant Centers Involved[5][6]

Liver Transplantation

University Hospital Göttingen (UMG)

In 2011, allegations of manipulation were made against a senior physician at the UMG. In 2013, he was charged with attempted manslaughter and bodily harm resulting in death but was acquitted in 2015. The Federal Court of Justice confirmed his acquittal in 2017, and in 2019, he received compensation for his time in pre-trial detention.[7]

University Hospital Regensburg

There were indications that Jordanian patients had been illegally placed on the European waiting list. Additionally, there was suspicion that a transplant had been performed in Amman instead of Regensburg. The hospital’s director was temporarily suspended but was later reinstated.[8]

Klinikum rechts der Isar (Technical University of Munich)

Here, 38 violations of transplant regulations were identified. In three cases, there was suspicion of deliberate deception to favor certain patients by manipulating blood samples with urine. Experts criticized the department for lacking both structure and qualified personnel. As a result, the transplant program was shut down in 2013.[9]

University Hospital of Munich (Ludwig Maximilian University – Großhadern Campus)

Seven violations of transplant regulations were found. Four patients received donor livers despite having tumors that were too small to meet transplant criteria. Three additional violations were considered less severe.[10]

University Hospital Leipzig

76 violations of transplant regulations in liver transplantation were identified. Manipulations affected 37 out of 182 transplanted patients. The hospital's medical director was dismissed, and three doctors were investigated for attempted manslaughter and grievous bodily harm, but no charges were filed.[11]

University Hospital Münster

25 violations of transplant regulations were recorded, mainly concerning dialysis data. In several cases, there was no medical indication for the reported dialysis. Documentation was initially insufficient but was later supplemented.[11]

University Hospital Essen

The hospital was criticized for frequently accepting low-quality donor livers and recorded the highest number of liver transplants in Germany. In 2011, nearly 17% of transplant patients died in the hospital.[11]

Heart and Lung Transplantation

Lung Transplantation Program Hamburg (University Medical Center Hamburg-Eppendorf – UKE)

In 2015, 14 out of 25 reviewed cases had falsified blood gas values, with no plausible explanation for the patients’ reported critical condition. Important documents were missing, and original records from the LungenClinic Großhansdorf were never entered into UKE's digital archive and remain untraceable.[12]

Heart Transplantation Program Munich (LMU Munich – Großhadern Campus)

Between 2010 and 2012, 95 heart transplants were performed, of which 64 were reviewed. Violations were found in 20 patients, and in at least 17 cases, these manipulations were deliberate.[13]

Lung Transplantation Program Munich (LMU Munich – Großhadern Campus)

During the same period, 119 lung transplants were performed, 83 of which were reviewed. In 37 cases, false HU (High Urgency) or LAS (Lung Allocation Score) applications were submitted, exaggerating the patients' actual condition. Investigators concluded that systematic manipulation was used to secure HU listings.[13]

Heart Transplantation Program Heidelberg

Between 2010 and 2012, 80 heart transplants were performed, of which 59 were reviewed. Falsified medication dosages were recorded. The irregularities ended in summer 2011, suggesting a particular senior physician may have been responsible.[13]

Heart Transplant Center Cologne-Lindenthal (University Hospital Cologne)

Between 2010 and 2012, 15 heart and heart-lung transplants were performed, all of which were reviewed. Six patients had false medication records to obtain HU listings. Notably, data was altered during re-evaluations to conceal fraud.[13]

Scope and Motivation of Manipulations

These cases highlight serious violations of transplant regulations, ranging from waiting list manipulations and document falsifications to questionable medical decisions. The incentives for these manipulations were not primarily financial but stemmed from: • Medical prestige and authority • Competition among hospitals • Pressure to achieve successful treatment outcomes.[14][15]

The Role of Bruno Meiser and Hermann Reichenspurner

Bruno Meiser held a dual role as Head of the Transplantation Center at LMU Munich (Großhadern) and President of Eurotransplant (ET), the organization responsible for organ allocation across eight European countries. Additionally, he served on the Permanent Committee for Organ Transplantation (StäKO) of the German Medical Association and was a member of its Audit and Supervision Committee (PÜK). This latter position was particularly sensitive, as it provided him with prior insight into audit schedules and in-depth knowledge of ongoing evaluations. Given that the audit commissions relied heavily on data from ET—especially concerning patient registration, waiting lists, and organ allocation—his involvement drew considerable criticism following the transplant scandal at Großhadern, which involved irregularities in liver, heart, and lung transplantation practices (Liver, Heart and Lung).[16] As evidence of systematic violations emerged, many German transplant centers expressed a loss of confidence in Meiser’s leadership and no longer felt adequately represented by him. The composition of the review committees, as outlined in §11(3), sentence 4 of the German Transplantation Act (TPG), indicates that both Bruno Meiser and Hermann Reichenspurner were actively involved in the audits conducted in 2014 and 2015. These audits assessed transplantation activities between 2010 and 2012 at centers in Hamburg and Munich Großhadern. Meiser served in his capacity as Eurotransplant President and head of the Großhadern center, while Reichenspurner, as Director of the Lung Transplantation Program at University Medical Center Hamburg-Eppendorf (UKE), participated as a medical expert advisor[17] Notably, the Großhadern audit preceded the one in Hamburg, raising concerns that the timing and composition of the committees may have influenced the completeness of documentation—especially considering that original records from the cooperating LungenClinic Großhansdorf were reportedly absent from UKE’s files. Despite widespread criticism and mounting pressure, Meiser declined to step down or assume responsibility for the identified violations.[18][19][20]

Reactions and Consequences Legal Reforms

• In 2012, the Transplantation Act (TPG) was reformed to prevent organ allocation manipulations. Mandatory interdisciplinary listing conferences and Nationwide audit cycles, and enhanced documentation standards were implemented. Monitoring of transplant centers was intensified, and comprehensive documentation of organ allocation and transplantation was mandated. [21]

• In 2013, the law was further tightened, making deliberate violations a criminal offense, punishable by up to two years in prison (§19 Abs. 2a TPG).[22]


Impact on Organ Donation Rates[23]

• The scandal caused a dramatic drop in organ donor willingness in Germany.[24]

• Between 2012 and 2017, the number of donors declined by nearly 30%.[25]

• This resulted in longer waiting times for patients and worsened the organ shortage.[18]

Reactions from Medical Societies and Hospitals

• The German Organ Transplantation Foundation (DSO) and the German Medical Association revised organ allocation guidelines.[26]

• The German Transplantation Society (DTG) demanded comprehensive training for transplant doctors and stricter external oversight.[27]

Legal Proceedings

• Despite extensive investigations, no individuals were convicted.[28]

• Many involved doctors were acquitted or never charged, as courts ruled that medical discretion justified their decisions.[29][30]

• The senior surgeon from Göttingen, one of the main suspects, was acquitted in 2015, causing public outrage.[31]

Long-Term Effects

• The scandal reignited the debate on introducing a presumed consent system for organ donation.[32]

• However, Germany retained the opt-in system, requiring explicit donor consent.[33]

• The crisis of trust in the transplant system remains unresolved.[18] as reflected by low donation numbers despite major legal and organizational changes as described.

Conclusion

The organ donation scandal in Germany exposed weaknesses and misconduct in the transplant system. The deliberate manipulation of patient data and the resulting preferential treatment of certain recipients led to both an ethical disaster and a severe crisis of confidence in organ donation and transplantation, which is still ongoing. Despite stricter laws and improved monitoring, the challenge remains to restore public trust while addressing the persistent shortage of donor organs.

References

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  1. ^ B. Nashan, C. Hugo, C. P. Strassburg, H. Arbogast, A. Rahmel, H. Lilie: Transplantation in Germany. In: Transplantation. 2017, doi:10.1097/TP.0000000000001554
  2. ^ B. Nashan, C. Hugo, C. Strassburg, H. Arbogast, A. Rahmel, H. Lilie: The Authors' Reply. In: Transplantation. Band 102, Nr. 2, Feb 2018, S. e83–e84
  3. ^ Markus Pohlmann, Kristina Höly: Manipulationen in der Transplantationsmedizin. Ein Fall von organisationaler Devianz? In: Kölner Zeitschrift für Soziologie und Sozialpsychiatrie. 2017 (69), S. 181–207, doi:10.1007/s11577-017-0436-3
  4. ^ Markus Pohlmann: Der Transplantationsskandal in Deutschland: Eine sozialwissenschaftliche Analyse der Hintergründe. Springer VS, 2018, ISBN 978-3-658-22784-5, S. 155–159.
  5. ^ B. Nashan, C. Hugo, C. P. Strassburg, H. Arbogast, A. Rahmel, H. Lilie: Transplantation in Germany. In: Transplantation. 2017, doi:10.1097/TP.0000000000001554
  6. ^ "Jahresberichte von Prüfungs- und Überwachungskommission". Bundesärztekammer.
  7. ^ "HRRS Dezember 2017: Ast - Die Manipulation der Organallokation (Bespr. zu BGH HRRS 2017 Nr. 968) · hrr-strafrecht.de". www.hrr-strafrecht.de.
  8. ^ "Göttinger Skandalarzt: Mauschelei bei Organspenden in Regensburg | Aktuell | Themen | BR.de". Archived from the original on 29 July 2012.
  9. ^ "Klinikum rechts der Isar - Chefarzt äußert schweren Verdacht". 28 June 2013.
  10. ^ "Organspende-Skandal: Mängel am LMU-Klinikum bestätigt". 12 April 2013.
  11. ^ a b c "Organspende: Unregelmäßigkeiten bei Lebertransplantationen in Münster und Essen". Die Zeit. July 2013.
  12. ^ Buchen, Stefan (15 November 2016). "Organspendeskandal in Hamburg: Ein Winterkorn im weißen Kittel". Die Tageszeitung: taz.
  13. ^ a b c d "Jahresberichte von Prüfungs- und Überwachungskommission".
  14. ^ Markus Pohlmann, Kristina Höly: Manipulationen in der Transplantationsmedizin. Ein Fall von organisationaler Devianz? In: Kölner Zeitschrift für Soziologie und Sozialpsychiatrie. 2017 (69), S. 181–207, doi:10.1007/s11577-017-0436-3
  15. ^ Markus Pohlmann: Der Transplantationsskandal in Deutschland: Eine sozialwissenschaftliche Analyse der Hintergründe. Springer VS, 2018, ISBN 978-3-658-22784-5, S. 155–159.
  16. ^ "Klare Kante zeigen!". October 12, 2016.
  17. ^ Buchen, Stefan (15 November 2016). "Organspendeskandal in Hamburg: Ein Winterkorn im weißen Kittel". Die Tageszeitung: taz.
  18. ^ a b c Asli Zeybek et al. Organ donation in Germany: opt-in vs. opt-out—opinions and voting patterns in the 19th German Bundestag. Front. Transplant. 4:1526238. doi: 10.3389/frtra.2025.1526238
  19. ^ T. Verrel: Manipulationen in der Transplantationsmedizin. Hrsg.: BRJ 01/2020. Bonn 2020 https://www.bonner-rechtsjournal.de/publikationen/regulaere-ausgaben/ausgabe-012020/
  20. ^ T. Verrel: Absolution von Richtlinienverstößen durch Sachverständigengutachten. Hrsg.: MedR. Band 35, 2017, S. 597–601, doi:10.1007/s00350-017-4675-0
  21. ^ B. Nashan, C. Hugo, C. P. Strassburg, H. Arbogast, A. Rahmel, H. Lilie: Transplantation in Germany. In: Transplantation. 2017, doi:10.1097/TP.0000000000001554
  22. ^ https://www.gesetze-im-internet.de/tpg/TPG.pdf.
  23. ^ B. Nashan, C. Hugo, C. P. Strassburg, H. Arbogast, A. Rahmel, H. Lilie: Transplantation in Germany. In: Transplantation. 2017, doi:10.1097/TP.0000000000001554
  24. ^ Ker, Heike Le (24 April 2013). "Zahl der Organspenden geht 2013 weiter zurück". Der Spiegel.
  25. ^ B. Nashan, C. Hugo, C. P. Strassburg, H. Arbogast, A. Rahmel, H. Lilie: Transplantation in Germany. In: Transplantation. 2017, doi:10.1097/TP.0000000000001554
  26. ^ "Richtlinien zur Transplantationsmedizin".
  27. ^ Björn Nashan, Utz Settmacher, Martina Koch. The German Transplant Certification. doi: 10.21037/hbsn-24-36
  28. ^ T. Verrel: Manipulationen in der Transplantationsmedizin. Hrsg.: BRJ 01/2020. Bonn 2020 https://www.bonner-rechtsjournal.de/publikationen/regulaere-ausgaben/ausgabe-012020/
  29. ^ T. Verrel: Manipulationen in der Transplantationsmedizin. Hrsg.: BRJ 01/2020. Bonn 2020 https://www.bonner-rechtsjournal.de/publikationen/regulaere-ausgaben/ausgabe-012020/
  30. ^ T. Verrel: Absolution von Richtlinienverstößen durch Sachverständigengutachten. Hrsg.: MedR. Band 35, 2017, S. 597–601, doi:10.1007/s00350-017-4675-0
  31. ^ Otto, G., Rissing-van Saan, R. Das BGH-Urteil zum Transplantationsskandal aus medizinischer Sicht. MedR 36, 543–548 (2018). https://doi.org/10.1007/s00350-018-5007-8
  32. ^ "Deutscher Bundestag - Organspenden: Mehrheit für die Entscheidungslösung".
  33. ^ "Gesetzliche Regelungen der Organspende".