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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 29; 335(7621): 634.
PMCID: PMC1995466

German media describe allocation of organs to Saudi patients as unfair

The University Hospital of Kiel, in northern Germany, has been criticised for transplanting livers from cadavers to two Saudi patients, ahead of other, native German patients who had been on the waiting list longer.

The Saudi patients had been meant to receive a transplant from relatives, but they benefited from a recent change in the rules of Eurotransplant, the body that coordinates transplant allocation across seven European countries, propelling them to the top of the waiting list, even though they had only recently arrived in Germany and had a donor relative lined up.

Under the rule change, patients are given scores as to the urgency of their case that are based solely on laboratory blood test results (creatinine and bilirubin concentrations and prothrombin time). The score is given higher priority than the length of time the patient has been waiting for a transplant. The system, known as the model for end stage liver disease (MELD), is used in the United States by the United Network for Organ Sharing.

Eurotransplant, which coordinates transplantations in Germany, Austria, Belgium, Netherlands, Luxembourg, Slovenia, and Croatia, also does not distinguish—when allocating organs—between patients who are long term residents of its member countries and patients who have recently arrived. It has a rule that no more than 5% of organs should go to non-residents but has no means to enforce it.

Criticism of the Kiel hospital began in August, when the television programme Monitor reported that the Saudi patients had been given preference over German patients in return for substantial payments.

The media and official bodies such as the regional doctors' council had been alarmed by an anonymous whistleblower's email. The television programme claimed that because a large number of patients in Germany were dying while waiting for a liver transplant, the transplants given to the Saudi patients seemed to be legally and ethically dubious.

The hospital confirmed that two Saudi patients had received cadaver organs in 2007, although they were originally supposed to receive transplants from living relatives who had accompanied them to the hospital.

Bernd Kremer, the hospital's medical director, said, “According to German law we have to put all patients, including ones expecting organs from a living donor, on a waiting list for a cadaver organ, regardless of whether they are German or come from abroad.”

Until December 2006 waiting time was a major factor taken into consideration when cadaver livers were being allocated to people in the Eurotransplant countries. But then the organisation adopted its new system.

“We were surprised ourselves that patients waiting for a living donation were suddenly offered organs from the Eurotransplant pool—in one case just one day before the planned living donation,” said Bernd Kremer. “The offer had to be accepted.”

The hospital rejects reports of suspected bribery and has filed charges of slander against an unknown person. Hospital representatives also say that important documents supporting their position have been offered to Monitor but have been disregarded. The programme claims that its research into those cases had been thorough and sound.

However, the Kiel official attorney has announced that he has been investigating irregularities in the university hospital's international department, which is responsible for acquiring and billing patients from abroad.

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