Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review.
BACKGROUND
German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation.


METHODS
A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy.


RESULTS
Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns.


CONCLUSION
Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.
['Tackmann|E|E|', 'Dettmer|S|S|']
D001344:Autopsy D003643:Death D005858:Germany D006801:Humans D009426:Netherlands D016377:Organ Transplantation D013030:Spain D009927:Tissue and Organ Procurement D006113:United Kingdom
Europe Organ transplantation Tissue and organ procurement Tissue and organ procurement/organization and administration