"He's always with me," says Peter Fricke, pointing to his heart, which he received from an unknown donor more than 30 years ago.
"Maybe he's standing behind me right now and nudges me when I talk nonsense."
Fricke says he was never interested in whether the donor was a man or a woman."What matters is that they did something great. I am infinitely grateful for the 32 years of life given to me."He recalls Dec 27, 1990, the day he received his new heart. Fricke now celebrates it as his second birthday.
He was 35 at the time, a father of three young girls, and had been waiting for months for a donor.
As he lay in Vinzenz Hospital in the German city of Hanover, a nurse came in, the day after Christmas. She said, "Mr Fricke, here we go. They've found a heart for you. We're going to the medical school now."
What he first saw when he woke up were white sheets, making him wonder whether he was in heaven.
"But then the same nurse came around the corner, and that's when I knew I had made it!"Fricke recovered from the operation quickly, as fast as he became ill in the first place, with myocarditis, or a heart muscle inflammation.
He now takes medicine each day and is classified as severely disabled. A former soldier, the transplant didn't stop him from working for another 17 years at his former employer, an insurance company, Fricke says, looking back as he sits in his garden near Hanover.
Now 67, he retired when he was no longer able to continue due to "a burnout" that he says was probably triggered by his daughter Julia also needing a heart transplant.
"I blamed myself for not having our daughters examined after my heart disease."But it isn't clear whether Julia's case could have been detected earlier. Her doctors say her heart was damaged by the birth of her son in July 2004, when she was 20.
She returned to her training as a nurse two months later but was constantly tired and exhausted, short of breath, with a resting pulse of 140.
Doctors found that her heart was greatly enlarged, and her mitral valve, one of the four in the heart, was not closing properly.
When told she would need a new heart in the next decade, Julia says, "I immediately thought about my funeral." The thought of how long her father had had to wait for a new organ immediately crossed her mind, she recalls.
Her father, meanwhile, had started to work in the field, and just stepped down from chairing the board of Germany's Federal Association of Organ Transplant Patients, to become honorary chairperson.
In late August, 8,524 people were on the Eurotransplant waiting list for a donor organ, of whom 685 needed a new heart.
The non-profit foundation coordinates the procurement of donor organs in eight European countries.
However, the German Organ Donation Foundation (DSO) reported a dramatic fall in the number of organ donations in the first quarter of 2022 compared to the same period last year. That is partly due to the soaring workload in hospitals due to increased staff absences because of Covid-19 cases, the DSO says.
Meanwhile Germany has fewer donors than other European countries, according to the Society for Thoracic and Cardiovascular Surgery (DGTHG).
Legally, people's organs can only be given to others after their deaths if the person has explicitly stated this as their wish, or if their relatives allow.
Other countries have opt-out laws that assume the consent of the deceased unless they state otherwise.
Julia, now 38, also wound up having to wait for a new heart. She was put on the waiting list in March 2006 and finally a new organ was found in November 2007.
The operation went smoothly but she was sad that she could not continue her training as a nurse, a disappointment she still feels keenly.
"I was a single parent. What do you do to avoid having to go on welfare?" she says.
She found work at a restaurant, working 200 hours a month at times, then later worked night shifts at a facility for the mentally ill.For heart transplant patients, the first year is the hardest.
Once it's over, many patients live long lives with their new hearts. However, nearly five years later, Julia's body rejected her new heart.
"It was clearly the stress," her father says.Very few heart transplant patients need a second organ. Some 3% of hearts worldwide are donated to patients in need of a further transplant, says heart surgeon Jan Gummert, who heads the Heart and Diabetes Centre North Rhine-Westphalia (HDZ) in Bad Oeynhausen, Germany.
Last year, 329 hearts were transplanted in Germany, with the HDZ being the largest centre.
For Julia, the rejection of her new heart nearly killed her. Aged 27 at the time, she was admitted to intensive care.
It was a traumatic time, says her father.
"We went there on Sunday, when the doctor told us: If we don't find a heart for Julia by Tuesday, we won't be able to keep her. That was the worst thing for us."The next day, a doctor told his wife, "The miracle of Hanover: we have found a heart for Julia!"
It was transplanted on the night of her 28th birthday in June 2012.
The second heart has now been working away for more than a decade. The recovery process was tough, Julia says. It was hard to relearn how to walk, as she weighed 100kg due to water retention.
"When I finally made it downstairs at the hospital and drank my first cappuccino, I swore to myself that I would now enjoy every cappuccino in my life," says Julia, who now works part time at her sister's nail studio.Julia was determined to keep enjoying life. Just months after being discharged from hospital, she went hiking in Bavaria with her son and her boyfriend and his two sons.
Sometimes, when it's quiet in the evening and she is alone, she says she communicates with the donor of her third heart.
Overall, her illness has made her calm, Julia says. Unlike her boyfriend, she doesn't get upset when the teenagers' rooms are messy, for example.
"My goal before the first transplant was to see my son start school. Now he's 18 and maybe I'll see grandchildren someday," she says. – dpa