Paired kidney donation performed in Germany--a guest post by Ágnes Cseh

 Below is a post written by Ágnes Cseh, about a kidney exchange conducted legally in Germany, in October, after being identified outside of the medical establishment. (The links she supplies are all worth looking into, and Google translate works well enough.)

"The legal basis for a living organ donation in Germany is a relationship or close personal connection between donor and recipient. This well-meant rule implicitly forbids paired kidney donation, because even though recipient and donor are closely related in each of the two pairs participating in a paired donation, the physical graft a patient receives technically comes from the relative of the other recipient.

A cumbersome, but legal way around the regulation is to establish a close personal connection between all four persons involved in a paired donation. Then, an ethical committee might approve of the two transplants separately. This constellation even inspired filmmakers to shoot a fictional movie about such a venture -- the genre is supposed to be comedy. In reality, paired transplants have been performed very sporadically in the past years in Germany.

A new initiative offers a centralized platform for paired kidney donations. It is run by Susanne Reitmaier, an activist fighting for the complete legalization of paired donations and Ágnes Cseh, a researcher specialized in matching theory. They maintain a database of the voluntarily submitted medical data of incompatible recipient-donor pairs. If a possible match among these pairs is found, then the two pairs are put into contact with each other so that they can establish the personal connection required by the law.

The first match in this program was identified in July 2020. After a long journey (see the detailed report in English here and in German here), the transplants were finally performed in October 2021 in Berlin. The ethical committee first rejected their claim, but then approved of the two transplants as one paired donation, not as two separate donations. This might be a milestone in the practice and potentially lead to more standardized procedures in the future.

As time goes by and word gets around, more and more incompatible pairs enter their data into the database. A handful of already identified pairs for paired donations are currently in different stages of the medical and legal process. The first step taken by Charité Berlin encouraged other hospitals to show interest in conducting paired transplants.

Despite of this recent progress, an efficient kidney exchange program would clearly require a law change in Germany. It would be sufficient to modify the current regulation marginally, by stating that the close personal connection is meant for the pairs entering the pool together and not for the matched pairs."

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Here's a link to (and translation of) an op-ed I published in a German newspaper in 2016 urging that the law be amended to allow regular kidney exchange:

German organ transplant law should be amended or reinterpreted to allow kidney exchange: my op-ed in Der Tagesspiegel

And here are all my posts on kidney exchange in Germany.