Die Nierentransplantation in Deutschland: Mindestmengenregelung und Vergleich urologischer und allgemeinchirurgischer Transplantationsprogramme
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Date
2025-10-21
Authors
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Philipps-Universität Marburg
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Abstract
This study analyzes two central organizational aspects of kidney transplanta-tion in Germany: the influence of the medical disciplines of urology and sur-gery, as well as the role of the minimum volume regulation in quality assur-ance. The findings show that both urological and surgical departments achieve comparably good outcomes in kidney transplantation, with no significant dif-ferences in complication rates or graft quality. While surgical departments had a higher immediate kidney function rate in post-mortem transplants, no rele-vant differences were found in living donor transplants. This suggests that structural factors, such as the organization of the center and the composition of the team, play a greater role than the medical discipline itself.
The minimum volume regulation, which requires a higher number of trans-plants per center to ensure better outcomes, is a subject of controversy. While studies show a positive correlation between case numbers and outcomes in complex procedures like radical cystectomy and prostatectomy, data from kid-ney transplantation suggest that smaller centers, performing fewer than 25 transplants per year, can achieve equally good or even better results than larg-er centers. Critics warn that a rigid application of the minimum volume regula-tion may not accurately reflect a center's true quality and could force smaller centers to close, potentially leading to under-provision in certain regions.
In addition to the debate over minimum volumes, there are concerns regarding the low organ donation rate in Germany, which has decreased from 1,851 kid-ney transplants in 2006 to 1,701 in 2021. The main causes for this decline are the low level of public trust in the transplantation system and the underutiliza-tion of donation after circulatory death (DCD), a practice that has helped in-crease donation rates in countries like Spain. Spain is considered a model in this regard, as it has achieved high public acceptance of organ donation through extensive public awareness campaigns.
Technological advancements, such as robot-assisted kidney transplants and the use of artificial intelligence (AI) to optimize organ distribution, offer promis-ing approaches to further improving transplantation outcomes. Ethical issues, such as the introduction of the opt-out system in Germany, could also contrib-ute to increasing the donation rate. The question of social justice in access to transplants is also relevant, as patients from socioeconomically disadvantaged groups may have poorer access to specialized centers.
In conclusion, the study shows that both urology and surgery achieve good results in kidney transplantation, but there is a need for greater consideration of center structures and more monitoring of actual quality assurance data. Technological innovations, legal reforms, and increased public education could help improve the kidney transplantation landscape in Germany and raise the organ donation rate.
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Dates
Created: 2025Issued: 2025-10-21Updated: 2025-10-21
Faculty
Medizin
Language
ger
Data types
DoctoralThesis
Keywords
Nierentransplantation in DeutschlandVergleich urologischer und chirurgischer Transplantationszentren
DFG-subjects
MindestmengenNierentransplantationOrganspende
DDC-Numbers
610
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Beckmann, Jonas Fabian: Die Nierentransplantation in Deutschland: Mindestmengenregelung und Vergleich urologischer und allgemeinchirurgischer Transplantationsprogramme. : Philipps-Universität Marburg 2025-10-21. DOI: https://doi.org/10.17192/z2025.0452.
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This item has been published with the following license: In Copyright