Die Transplantation solider Organe hat sich längst zu einer Standardtherapie des irreversiblen
Endorganversagens von Herz, Lunge, Leber, Pankreas und Nieren entwickelt. Limitierender
Faktor ist der gravierende Mangel an postmortal gespendeten Organen. Eine Schlüsselrolle
in der Organspende haben die Intensivteams inne. In diesem Beitrag geht es um die
Erkennung potenzieller Organspender, die Therapiezielfindung sowie eine leitlinienbasierte
„organprotektive“ Intensivtherapie.
Abstract
A newly issued policy statement of the German Medical Association considers organ
donation as an integral part of end-of-life intensive care in patients with devastating
brain afflictions. Hence, patients’ wishes towards organ donation and medical suitability
should be evaluated when prognosis is considered futile and goals of treatment need
to be reconsidered. Continuation of intensive care treatment towards the (mandatory)
diagnosis of “brain death” and subsequently towards organ donation has to be legitimatized
by patients’ explicit wishes (organ donor card, advanced directive) or by surrogate
decisions makers. Intensive care facilitating organ donation should be goal-directed
and follow established guidelines. Thus, a potential recovery of transplantable organs
is supported by appropriate intensive care treatment. Decisions to employ extended
intensive care options (like extracorporeal circulatory support or cardiopulmonary
resuscitation) in potential organ donors should be carefully outbalanced with patients’
wishes, organ donation being considered an achievable goal and even potential frictions
in medical teams.
Schlüsselwörter
Organspende - Intensivtherapie - Entscheidungsfindung
Key words
organ donation - intensive care - end-of-life decision making