Sidebar: Wary of war and distrustful of transplants, Germans not ready to embrace American ‘gift’

By Matthew D. LaPlante
The Salt Lake Tribune
October 15, 2006

OBERSTEIN, Germany — Kai Nehammer sprints down a stark, white corridor, a basket of pamphlets swinging back and forth before him.

He has invited 400 people, mostly staff members of Oberstein General Hospital, to a presentation on organ transplantation - to begin promptly at 4 p.m.

It's 4:05 as Nehammer steps into a nearly empty lecture hall.

"We'll give everyone some time," he says optimistically, sweat beading on his bald head.

In Germany, where organ transplantation is as socially sensitive a topic as abortion in the United States, Nehammer's job is a difficult one.

He gave up his medical practice to join Deutsche Stiftung Organtransplantation, which coordinates all transplants in Germany, because he wanted to help save lives. But on most days, he's more salesman than doctor. Much of his time is spent on the autobahn, his large frame hulked into a compact Ford, speeding from hospital to hospital in hopes of increasing support for his cause among doctors.

It's a hard sell. More than half of the nation's physicians refuse to cooperate with the DSO.

On this day in Oberstein, about an hour's drive east of his office on the French border, just a handful of doctors show for the lecture, arriving late and sitting in a cluster near the door. Twenty minutes in, two have fallen asleep.

In all, fewer than a dozen people attend. Those who do include several nursing students and an aging couple, both organ recipients, here to lend moral support.

And this, Nehammer wryly notes, is a hospital with which he has a good working relationship.

Because Nehammer found such little interest among German doctors, he was touched when, in 2002, physicians at a U.S. Army medical base in Landstuhl, Germany, called.

"We hadn't approached them. They just called one day to tell us that they had a patient at their hospital who might be able to donate organs," Nehammer recalls.

The next year, the United States invaded Iraq. As casualties began flowing into Landstuhl, more calls followed.

"The excellent cooperation we now have with Landstuhl really grew up beside the Iraq war," Nehammer says. "This is not something we would have wished for, but it is something that we are pleased to accept."

It wasn't exactly a windfall. More than 12,000 Germans are waiting for organs. Landstuhl may have seen more than 5,000 wounded troops since the beginning of the Iraq war, but the hospital's staff is good at keeping those patients alive. Just 35 have died there, according to Defense Department records.

Yet nearly a third of those have been organ donors, according to Raymond Fang, a U.S. doctor who oversees the program. DSO officials estimate they have received 21 organs from Landstuhl donors.

Those numbers make Landstuhl one of the most active donor hospitals in all of Germany. In 2005, the U.S. military medical center provided more organs than 198 of the 206 hospitals in the DSO's central donor region, according to the agency's annual report.

Some German hospitals are trying to better their own records, but "changing perceptions is a slow process," says Karen Rexroth, a doctor in Germany's southwest Rhineland Palatinate.

Over the past five years, Germans have donated organs at a rate lower than any other member nation of the Eurotransplant International Foundation. Neighboring Belgians donate nearly twice as often, and the Dutch are three times as likely to provide organs, according to Eurotransplant records. The reasons are vast and complicated, but likely stem from the nation's nefarious history with medical experimentation and post-reunification distrust of the country's socialized medical system, said Linda Hogle, who has studied German attitudes on transplantation.

Germans simply do not trust their government to decide who should live and who should die, the University of Wisconsin professor said.

"For Germans, the question of who has the right to do what with an individual's body is a very real one," she said.

And a very contentious one. Families who consent to organ donation are sometimes accused of profiting by selling the organs on the black market. One presidential candidate saw his popularity plummet after suggesting ways to make obtaining organs easier. And German doctors who perform transplants have been threatened and had their homes picketed.

Rolf Jaksties is hoping to make a difference in the way Germans look at the issue. The 51-year-old, one of 300 Germans to receive a new heart in 2003, has started a support group for those, like him, who find themselves on the wrong end of social perception simply because they wanted to live.

Jaksties believes that, left in the shadows, Germany's organ donation program will continue to languish. "So when I am asked, I tell everybody," he says. "I will answer all questions. I am here because someone was so generous to me."

Jaksties received his heart months after the beginning of the war in Iraq — a time when Landstuhl's cooperation with the DSO was beginning to gain momentum — but like all other recipients, he doesn't know from whom his heart came. "Only, I think, it must have come from someone who was a great person," he says.

Despite Jaksties' calls for more openness, German transplant officials fret about exposure — especially in regards to the arrangement they keep with Landstuhl.

There is, they acknowledge, an uneasy irony to the program: Germans are virulently against the war in Iraq. Along with France, Germany was a leader in the anti-war movement during United Nations debate in 2002. And recent polls show German opinion has only grown more negative.

"We do not pretend that this does not complicate things," said Dietmar Mauer, a supervisor in the DSO's regional office in Mainz.

Mauer would prefer the Landstuhl agreement were kept a secret, for fear of derailing the program. "We are trying to save lives, but some people would not understand this," he said.

He worries Americans, not recognizing most organs must be transplanted within hours — too short a time for a trans-Atlantic flight — might feel Germans are wrongly benefiting from U.S. war losses. And he worries Germans — proud, staunchly against the Iraq war and dubious of organ transplantation — might conclude those on their nation's transplant waiting list don't need "tainted" organs.

Bringing attention to the relationship, he said, "could be disastrous to our program."

Nehammer, meanwhile, continues to schlep the nation's transplantation program to wary doctors. And success continues to be elusive. Shortly after coordinating the transplantation of Utahn Tim Boyce's organs, for instance, he spent six months without handling a single case.

"This is the reality in Germany," he said. "For us, each organ is very precious and very important."