Organ transplantation: Patients in Germany hardly benefit from new possibilities in precision medicine

28.09.2023 14:58

Nowhere in Europe does organ donation save so few lives as in Germany. Although tests for assessing the tolerance of organ donations are becoming more and more precise and modern, they do not bring any progress for patients in this country. Because in Germany, patients have to take what they can get - no matter how bad the tolerance is. Why this is the case, what solutions can help and what new possibilities precision medicine offers in organ transplantation were explained by experts at the online press conference of the German Society for Transfusion Medicine and Immunohematology (DGTI) on September 19th.

Around 8,500 people in Germany are on the waiting list for a donor organ. On average, 2.5 of them die every day because the life-saving organ is missing. Professor Dr. med. Rainer Blasczyk, head of the Institute for Transfusion Medicine and Transplant Engineering at the Hannover Medical School and congress president of the 56th annual meeting of the DGTI, warned: “The mortality rates on the waiting lists for liver and lungs are more than twice as compared to other Eurotransplant countries high. And unlike dialysis therapy for kidney failure, there is no replacement therapy for these organs.”

In addition, especially with liver transplantation, the survival rates of the transplanted recipients are lower than in other European countries. “This is because the organ shortage means that only the most seriously ill patients with the worst prognosis can be transplanted,” explained Blasczyk. The conflict between urgency and prospects of success is discussed again and again. Last year in Germany only 869 people donated organs after their death (source: German Organ Transplantation Foundation). Trend: continuing to decline.

Way out: living donation

One way out would be living donation – at least for kidney transplantation. “But this is exactly where the problem continues: the quality of living kidney transplants is not good in Germany because they are associated with a particularly large number of mismatches,” explains Blasczyk. The expert sees the reason for this in the outdated transplant law in Germany, which requires a close relationship (relatives, partners) between donor and recipient. “The focus is on the question of the family relationship and not on the question of which donor kidney is best suited to the recipient,” says the transfusion doctor. A solution could be cross-over donation, which is not permitted in Germany, but is a given in countries with more modern transplant laws. The living donated organs are distributed in such a way that the best possible match for the patient is achieved, so that the new organ is accepted as well as possible by the transplant recipient and rejection is less likely.

Innovative approaches to preventing organ rejection

At this year's DGTI conference, two completely new and multi-award-winning approaches to preventing organ rejection were presented. The first innovation developed invisibility cloaks for organs. Instead of shutting down the recipient's immune system so that it doesn't "turn" against the new organ, the donor organ is genetically modified while it is still outside the body. This means that once it has been inserted into the recipient, it cannot be recognized by the recipient's immune cells and therefore cannot be attacked. “This is a new dimension in organ transplantation,” said the expert.

The second innovation solves the problem of antibody-mediated rejection, which is responsible for the majority of late organ losses. For this purpose, the patient's own immune cells are converted into killer cells through genetic modification. These can precisely eliminate those cells of the immune system that would otherwise form antibodies against the transplant. All other antibody-producing cells are spared, so that the recipient's immune system remains fully functional.

Demand for the introduction of the contradiction solution

Professor Blasczyk: “In order to make progress, transplantation must be constantly rethought. Both procedures have the potential to lead organ transplantation into a new era. However, we need more donor organs. We will only get this if Germany, like other countries, introduces the contradiction solution, according to which everyone is a potential donor after their death if they do not expressly object.”