Göttingen, a medium-sized, mid-German university town of quaint, wooden houses might seem an incongruous place for a real-life medical thriller to play out.
The town’s Georg-August University is almost like a German Ivy League institution. Founded in the seventeenth century by Hanoverian/British king George II, the university constantly places near the top of German higher education ranking tables. Dozens of top German politicians were educated at Georg-August.
Yet this northern summer, the university’s medical clinic was exposed in one of the German Republic’s largest post-war medical flare-ups. An organ donation scandal that began in July at Göttingen’s Uniklinikum has now widened, taking in another clinic in the southern German town of Regensburg.
Police in both towns are investigating at least two head doctors who played god, manipulating patient waiting lists. The doctors apparently decided on who deserved a liver operation. And who had to continue to suffer — or even die from their ailments.
Munich’s Süddeutsche Zeitung (SZ) broke the story around two weeks ago. Its original report mentions one head doctor at the Göttingen clinic, whom the paper said was being investigated by the German Transplantation Association for manipulating liver donation priority rankings.
"The tricks that were used [to manipulate organ donation lists at the clinic]were dreadfully simple: the doctor involved made patients seem sicker on paper than they really were," revealed SZ. More than 20 patients had kidney complaints added to their ailing livers, said the original report.
And because patients involved were made to seem very sick indeed, the system functioned for years. The extent to which patient data was being manipulated only became clear when investigators noticed that urea levels — which spike among patients with kidney complaints — were no higher than normal among many patients with supposed liver and kidney problems admitted for surgery at the clinic.
Days ago, the scandal widened. It’s now emerged that the first doctor concerned moved to Göttingen from the equally picturesque Bavarian town of Regensburg. There, at least 23 patients unjustly received liver transplants between 2004 and 2006, a follow-up in the Munich paper has revealed.
And back in Göttingen, a further doctor is being investigated for his manipulation of patient records in the 1990s, wrote German weekly Stern last week. Concerned colleagues reported the doctor to the hospital in 1995. It remains unclear why the second doctor was not investigated back then.
While the motives of the doctors involved aren’t yet clear, there are early indications that money may have changed hands in exchange for the liver transplants, say German specialist medicine publications.
One of the doctors involved — the former head of transplantation surgery at the Göttingen clinic — "paid a lump sum of around 8700 euros to the German Organ Transplantation Foundation on behalf of a [Russian] organ donation recipient" in 2011, reports ÄrzteZeitung.de a specialist online newspaper for German doctors.
Meanwhile, the second doctor involved — the former head of gastroenterology and endocrinology in Göttingen — may have systematically been favouring Italian patients for treatment during the 1990s.
"Not one patient with an Italian passport received a kidney donation of a total of 181 donor recipients [in Göttingen between 1995 and 1999]. But 23 Italian patients did receive liver transplants, of an overall total of 99," reveals Ärzte Zeitung.
And, with further indications that doctors may have been involved, there are almost uniform calls for state regulation of organ transplantation in the German media. In a commentary, conservative weekly Focus questions whether self-regulation of organ transplantation rankings by doctors should really continue:
"The whole system of organ donation, organ receipt and transplantation surgery must be carefully examined. Whether — all things considered — the system should be left in private hands appears highly doubtful in light of current events."
One in two patients in Germany dies while waiting for an organ transplantation. Their desperation means that mafia-brokered organ transplantation operations continue to find a ready market, an investigation by the print edition of Der Spiegel reported last week.
Those who can’t find a crooked doctor can turn to an organ broker, who "charges around 160,000 euros for a new kidney all up". These brokers then activate a squad of "flying doctors", who bring together organ "donor" and recipient in a third country where the surgery is performed, Spiegel’s investigators assert.
Kazakhstan and Cyprus are currently favoured destinations for performing kidney transplant surgery, reports the weekly magazine.
Illegal organ surgery remains the privilege of a few thousand wealthy recipients. But American and European patients receiving legal, synthetically created body parts may be inadvertently fuelling a morally dubious trade. The human tissue industry is subject to little regulation, a new investigation by the Washington-based International Consortium of Investigative Journalists has found.
Leading European media outlets published the results of a months-long investigation conducted by the organisation in eleven different countries last week. ICIJ asserts that "the good intentions of the tissue industry are in conflict with its impatience to make money using cadavers" in one of its reports, published in French paper Le Monde.
ICIJ claims that regulators almost never track the origins of human tissue used in everything from cornea transplants to knee surgery — unlike legally donated lungs or hearts. And, says their report in Le Monde, while the human tissue industry asserts that it acts in a "responsible manner", many companies won’t answer questions about where the tissue they turn into body parts comes from.
Yet, sadly, tracking tissue back to where it came from turns up "shocking" results, says Le Monde:
"In Ukraine, police think that cadavers stored in a morgue in Nikolaev, an economically depressed ship-building region on the Black Sea, may have fuelled this trade. According to investigators, this business may have left behind dozens of human ‘hulks’ — bodies stripped of all their reusable components."
Police investigations in Nikolaev, like those in Göttingen, are continuing. Complex medical transplant surgery is often literally a matter of life or death for patients. July’s medical transplant scandals are unlikely to be the last case where patients have traded their conscience for a transplant.
ABOUT BEST OF THE REST: It’s a big world out there and plenty of commentators and journalists are writing about it — but not always in English. And not surprisingly, ideas about big events of the day shift when you move away from the Anglosphere. Best of the Rest is a fortnightly NM feature by Berlin-based journalist Charles McPhedran. Charles reads the news in French, German, Spanish and Portuguese and reports on what the rest of the world is saying about the big stories.