[Allocation principles and the organization of tissue donation: ethical challenges and possible influence on the willingness to donate from the perspective of multidisciplinary experts].

Abstract

Due to the shortage of tissues and organs, numerous patients suffer from a reduced quality of life or even die. In political measures to increase the donation rate, tissue donation is often subsumed to organ donation, despite considerable differences: For example, unlike organs, tissue transplants can be stored for up to five years and allocated internationally. Similarly, industrially processed tissue preparations can be sold commercially, whereas organs are subject to a trade ban. Tissue donation also differs from centrally organized organ donation in terms of decentralized organization. As the associated ethical challenges and possible influence on the willingness to donate have only been insufficiently investigated to date, these are the focus of this exploratory expert survey.We conducted qualitative interviews with 14 experts who are involved in the tissue donation process in different positions. In addition, we interviewed medical ethicists, lawyers and scientists. We evaluated the interviews with a structuring content analysis according to Mayring and performed a frequency analysis. In reporting, we followed the standards for qualitative studies.Altruism and the medical necessity of transplantation were cited as legitimation of tissue donation. Therefore, most experts were in favor of a commercial ban for all tissues. In case of a commercial use of tissues, a negative effect on the donation rate was feared. According to most experts, neither the possible commercial use of tissue transplants nor the decentralized organization of tissue donation or the international allocation of transplants are discussed in conversations with relatives, although some experts assume that they could have an impact on the willingness to donate. Furthermore, the general population is not sufficiently informed about the characteristics of tissue donation.The characteristics of tissue donation can influence the willingness to donate. At the same time, they are discussed neither in conversations with relatives nor in public communication. If the present results are confirmed in further studies, in the sense of an informed decision both in in discussions with relatives as well as in public communication, transparency must be created about the decision-relevant aspects.