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Organ­spen­de – die ver­schwie­ge­ne Sei­te DIVI

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Hirn­tod—
der neue Tod
bei leben­di­gem Leib

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Seit der Harvard Definition 1968 wird uns im Zusam­men­hang mit Organ­trans­plan­ta­ti­on ein neu­er Tod verordnet.

Schon beim Ver­sa­gen des Gehirns soll der Mensch tot sein, obwohl alle ande­ren Kör­per­funk­tio­nen noch erhal­ten sind. Die Trans­plan­ta­ti­ons­me­di­zi­ner, die Bun­des­ärz­te­kam­mer, aber auch der Staat behaup­ten das.

Kön­nen wir ihnen, die nicht mehr den ster­ben­den Men­schen, son­dern nur des­sen lebens­fri­sche Orga­ne sehen, trauen?

Tat­säch­lich müs­sen trans­plan­ta­ble Orga­ne lebens­frisch sein, also von einem Men­schen stam­men, der noch maschi­nell beatmet wird. Er wird gepflegt, sein Herz schlägt, er ist warm und kann Fie­ber haben. Er bewegt sich spon­tan und reagiert auf Berührung.

Beim Ein­schnitt des Chir­ur­gen in den Kör­per des Organ­spen­ders steigt in vie­len Fäl­len der Blut­druck rasant an. Des­halb bekom­men Spen­der bei der Organ­ent­nah­me immer mus­kel­ent­span­nen­de Mit­tel und Opi­ate. Oft sogar eine Vollnarkose.

Es stellt sich die Fra­ge: wie tot sind „Hirn­to­te“, denen ihre Orga­ne ent­nom­men werden?

Ganz­tot, halb­tot, schein­tot, ster­bend oder noch lebend?

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Heu­te ist man in Harvard weiter

Im April 2018 fand an der Harvard Medi­cal School in Bos­ton eine Inter­na­tio­na­le Hirn­tod-Kon­fe­renz statt, an der Rena­te Grei­nert für KAO teil­ge­nom­men hat. Dort war davon die Rede, dass es der­zeit in den USA eine Kla­ge­wel­le von Ange­hö­ri­gen gibt,  die das Abstel­len der Beatmung nach Hirn­tod­dia­gno­se anfech­ten. Auf­ge­schreckt hat die Wis­sen­schaft der Fall der Jahi McMath, die nach einer for­mal rich­ti­gen Hirn­tod­dia­gno­se zum Zeit­punkt der Kon­fe­renz seit vier­ein­halb Jah­ren im Koma lag und auf Anspra­che reagier­te. Besorgt frag­ten sich die Wis­sen­schaft­ler wie man nun der Öffent­lich­keit ver­mit­teln könn­te, dass – anders wie bis­her offi­zi­ell behaup­tet – der Hirn­tod nicht mit dem Tod des Men­schen gleich­zu­set­zen ist. Ein Paradigmenwechsel.

Am 22. Juni 2018 ist Jahi McMath an inne­ren Blu­tun­gen auf Grund von Nie­ren- und Leber­ver­sa­gen wirk­lich ver­stor­ben, gemäß einer Ver­laut­ba­rung ihres Anwalts. Vier­ein­halb Jah­re nach­dem sie in Kali­for­ni­en auf Grund neu­ro­lo­gi­scher Kri­te­ri­en für tot erklärt wurde.

Der wah­re Tod zeigt sich von selbst und läßt sich nicht von uns definieren.

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Rena­te Grei­nert hat­te Prof. Pichl­mayr damals in Han­no­ver gefragt:
“War­um haben Sie uns nicht dar­über auf­ge­klärt,
was es heißt Organ­spen­der zu sein?”
Das war sei­ne Ant­wort vor Zeugen:

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Wenn wir die Gesell­schaft über die Organ­spen­de auf­klä­ren, bekom­men wir kei­ne Orga­ne mehr.

Prof. Rudolf Pichl­mayr – 1987
Transplantationsmediziner

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Was bei “nor­ma­len” Ope­ra­tio­nen als Schmerz­reaktion des Pati­en­ten gewer­tet wird, wird beim Organ­spen­der wäh­rend der Organ­ent­nah­me als nicht rele­vant ange­se­hen. Denn der Organ­spen­der gilt als “tot”. Beim Auf­schnei­den sei­nes Kör­pers vom Hals bis zum Scham­bein­ kommt es jedoch in vie­len Fäl­len zu Blut­druck‑, Her­z­­fre­quenz- und Adrenalinanstieg.

In Deutsch­land sind bei einer Organ­ent­nah­me nur mus­kel­ent­span­nen­de Prä­pa­ra­te vor­ge­schrie­ben, nicht aber Schmerz­mit­tel oder gar eine Voll­nar­ko­se.

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Selbst ent­schei­den

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In Sachen Organ­spen­de ver­langt der Gesetz­ge­ber von jedem Bür­ger eine Ent­schei­dung.
Wer nicht selbst für sich ent­schei­det und dies auch doku­men­tiert, über den ent­schei­den ande­re, meist die Angehörigen.

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Hirn­tod

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Eine Hirn­tod­dia­gno­se ist kom­plex, weil es Umstän­de gibt, die einen Hirn­tod vor­täu­schen. Zum Bei­spiel eine Unter­küh­lung oder die vor­he­ri­ge Ein­nah­me von Schmerz- und Beru­hi­gungs­mit­teln. Insi­der for­dern des­we­gen schon lan­ge eine zer­ti­fi­zier­te Aus­bil­dung für die fol­gen­rei­che Hirntoddiagnostik.

Nach der Hirn­tod­dia­gnos­tik wird der Toten­schein aus­ge­stellt. Denn der Mensch gilt juris­tisch als Lei­che. Die Kran­ken­kas­se stellt die Zah­lun­gen ein.

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Organ­ent­nah­me

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Was eine Organ­ent­nah­me für den­je­ni­gen bedeu­tet, des­sen Orga­ne explan­tiert wer­den, wis­sen die Wenigs­ten. Des­halb ist es uner­läss­lich sich im Detail mit den Abläu­fen vor und wäh­rend einer Organ­ent­nah­me zu befassen.

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Der ver­ord­ne­te Tod

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Der Hirn­tod ist eine recht­li­che Definition, nach der unge­straft Orga­ne ent­nom­men wer­den kön­nen. Men­schen, mit der Dia­gno­se Hirn­tod zei­gen kei­nes der siche­ren äuße­ren Zei­chen des Todes, dafür aber bis auf die Kom­mu­ni­ka­ti­ons­fä­hig­keit alle Zei­chen des Lebens.

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Vor­aus­set­zung für eine Organ­ent­nah­me ist die Hirntod-Diagnose.

Bevor die­se gestellt wird müs­sen Schmerz- und Beru­hi­gungs­mit­tel abge­setzt wer­den, da die­se die Dia­gno­se ver­fäl­schen kön­nen. Die Hirn­tod-Dia­gno­se ist ein Funk­ti­ons­test bei dem geprüft wird, in wie weit das Gehirn des Pati­en­ten Reak­tio­nen zeigt. Schmerz- und Beru­hi­gungs­mit­tel min­dern die­se Reaktionsfähigkeit.

Das Pro­blem für den Pati­en­ten: bei Hirn­ver­let­zun­gen kön­nen Schmerz- und Beru­hi­gungs­mit­tel the­ra­peu­tisch bedeut­sam sein.

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Spen­de­zen­trier­te
Mass­nah­men?

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[/et_pb_divider][et_pb_cta button_​url=”#” button_text=“Mehr erfah­ren” admin_label=“CTA Spen­de­zen­trier­te Mass­nah­men” _builder_version=“3.16” header_font=”|on||on|” header_text_color=”#ffffff” header_letter_spacing=“1px” header_line_height=“1.2em” body_text_color=”#ffffff” body_font_size=“20” body_letter_spacing=“1px” body_line_height=“1.7” use_background_color=“off” background_size=“initial” background_position=“top_left” background_repeat=“repeat” custom_button=“on” button_text_size=“14” button_text_color=”#ffffff” button_border_width=“0” button_border_radius=“0” button_letter_spacing=“2” button_font=“Open Sans|on||on|” button_icon=”%%3%%” button_icon_color=”#ffffff” text_orientation=“left” background_layout=“light” custom_margin=”||10%|” custom_​margin_​tablet=”” custom_margin_phone=“8%|||” custom_margin_last_edited=“on|phone” custom_padding=”||10%|” custom_​padding_​tablet=”” custom_​padding_​phone=”” custom_padding_last_edited=“on|phone” header_​font_​size_​tablet=”” header_font_size_phone=“18” header_font_size_last_edited=“on|phone” body_​font_​size_​tablet=”” body_font_size_phone=“14” body_font_size_last_edited=“on|desktop” body_​line_​height_​tablet=”” body_​line_​height_​phone=”” body_line_height_last_edited=“on|phone” custom_css_promo_button=“display: none;” use_border_color=“off” border_color=”#ffffff” border_style=“solid” button_text_color_hover=”#ffffff” button_border_radius_hover=“0” button_letter_spacing_hover=“2” button_bg_color_hover=“rgba(255,255,255,0)” button_text_size__hover_enabled=“off” button_one_text_size__hover_enabled=“off” button_two_text_size__hover_enabled=“off” button_text_color__hover_enabled=“on” button_text_color__hover=”#ffffff” button_one_text_color__hover_enabled=“off” button_two_text_color__hover_enabled=“off” button_border_width__hover_enabled=“off” button_one_border_width__hover_enabled=“off” button_two_border_width__hover_enabled=“off” button_border_color__hover_enabled=“off” button_one_border_color__hover_enabled=“off” button_two_border_color__hover_enabled=“off” button_border_radius__hover_enabled=“on” button_border_radius__hover=“0” button_one_border_radius__hover_enabled=“off” button_two_border_radius__hover_enabled=“off” button_letter_spacing__hover_enabled=“on” button_letter_spacing__hover=“2” button_one_letter_spacing__hover_enabled=“off” button_two_letter_spacing__hover_enabled=“off” button_bg_color__hover_enabled=“on” button_bg_color__hover=“rgba(255,255,255,0)” button_one_bg_color__hover_enabled=“off” button_two_bg_color__hover_enabled=“off”]

Wol­len Sie schon vor der Hirn­tod­dia­gno­se unter Umstän­den belas­ten­de Unter­su­chun­gen und Behand­lun­gen über sich erge­hen las­sen – im Inter­es­se des spä­te­ren Empfängers?

Die­se Maß­nah­men hei­ßen auch organ­pro­tek­ti­ve oder spen­de­zen­trier­te Maß­nah­men in der Fach­li­te­ra­tur meist Spenderkonditionierung.

Wenn Sie damit nicht ein­ver­stan­den sind, soll­ten Sie alle die­se Maß­nah­men in Ihrer Pati­en­ten­ver­fü­gung untersagen.

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Wie­der­be­le­bung
für Organ­ent­nah­me?

[/et_pb_text][et_pb_divider color=“#980031” divider_weight=“5px” disabled_on=“off” admin_label=“Working Divi­der” module_class=“workDivider” _builder_version=“3.23.4” height=“5px” custom_css_main_element=“width: 20%;” hide_on_mobile=“off”]

 

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Wol­len Sie, wenn man Sie schon auf­ge­ge­ben hat, eine for­cier­te Inten­siv­me­di­zin über sich erge­hen lassen?

Even­tu­el­le auch eine Wie­der­be­le­bung nur zum Zwe­cke der Organentnahme?

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Inva­si­ve
Mass­nah­men?

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Wol­len Sie dass, wenn man Sie schon auf­ge­ge­ben hat, noch inva­si­ve Maß­nah­men durch­ge­führt werden?

Oder zie­hen Sie es vor in Ruhe und bis zum letz­ten Atem­zug beglei­tet zu sterben?

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Kein Kran­ken­schutz
mehr?

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Wol­len Sie, dass ihre Ange­hö­ri­gen die erheb­li­chen Behand­lungs­kos­ten selbst tra­gen müs­sen? Und zwar dann, wenn sie Zwei­fel an der Dia­gno­se Hirn­tod haben und mit dem sofor­ti­gen Abstel­len der maschi­nel­len Beatmung nicht ein­ver­stan­den sind.

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Wenn Sie kein Organ­spen­der sind und nicht als sol­cher behan­delt wer­den wol­len dann müs­sen Sie dies detail­liert in Ihrer Pati­en­ten­ver­fü­gung dokumentieren.

Dazu soll­ten Sie fol­gen­des fest­le­gen: die Spen­der­kon­di­tio­nie­rung (auch organ­pro­tek­ti­ve oder spen­de­zen­trier­te Maß­nah­men) und die Hirn­tod­dia­gnos­tik sind in jedem Fall zu unter­las­sen. Auf Schmerz- und Beru­hi­gungs­mit­tel wol­len Sie auf kei­nen Fall verzichten.

Ein Behand­lungs­ab­bruch ist auch ohne Hirn­tod­dia­gnos­tik nach Abspra­che mit dem Betreu­er juris­tisch möglich.

Auf die­se Punk­te soll­ten Sie auch in ihrem Organ­spen­de­wi­der­spruch in Ihren Aus­weis­pa­pie­ren hinweisen.

Im Aus­land gilt fast über­all die Wider­spruchs­lö­sung. Das bedeu­tet Sie wer­den zur Organ­spen­de her­an­ge­zo­gen, wenn Sie nicht vor­her schrift­lich widersprechen.

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Wider­spruch
erfor­der­lich

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In fast allen ande­ren Euro­päi­schen Län­dern muss man vor­her einen doku­men­tier­ten Wider­spruch ein­le­gen, wenn man kein Organ­spen­der sein will. In Frank­reich und Öster­reich gibt es hier­zu ein Widerspruchsregister.

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Erwei­ter­te
Ent­nah­me­kri­te­ri­en

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In eini­gen Län­dern darf man nicht nur nach Hirn­tod­dia­gno­se, son­dern auch nach zwei- bis fünf­zehn­mi­nü­ti­gem Herz­still­stand (NHBD – non heart bea­ting donor) Orga­ne ent­neh­men. Fakt ist: selbst die Kri­te­ri­en für die Dia­gno­se des Hirn­to­des unter­schei­den sich von Land zu Land erheb­lich. Wenn Sie in einem Land tot sind, sind Sie es in einem ande­ren noch lan­ge nicht.

Wer das nicht will soll­te sei­nen Wider­spruch dokumentieren.

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Wider­spruch
in Lan­des­spra­che

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Ihr Wider­spruch zur Organ­spen­de muss in der jewei­li­gen Lan­des­spra­che aus­ge­stellt sein. Wer viel unter­wegs ist muss für alle Fäl­le gerüs­tet sein.

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Beglau­big­te
Unter­schrift

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In man­chen Län­dern muss ihre Unter­schrift auf dem Wider­spruch von einer Behör­de beglau­bigt wer­den. In Grie­chen­land sogar notariell.

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Im Zeit­druck, unter Schock und unin­for­miert stim­men vie­le Ange­hö­ri­ge einer Organ­spen­de zu.

Die Hoff­nung, dass aus dem Schlim­men etwas Gutes wird, erfüllt sich meist nicht.

Statt­des­sen pla­gen sich vie­le mit Schuld­ge­füh­len, weil sie ihren Ange­hö­ri­gen in sei­nen letz­ten Stun­den allei­ne gelas­sen haben.

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Organ­ent­nah­me aus Sicht der “Spen­der” und ihrer Angehörigen

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HIRNTOD -
TOD BEI LEBENDIGEM LEIB
Die frag­wür­di­ge Hirn­tod­dia­gno­se
und Organ­ent­nah­me bei Lorenz Meyer

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ORGANSPENDE -
DIE SCHATTENSEITE

Inter­view mit Rena­te Grei­nert zur
Organ­ent­nah­me bei ihrem Sohn Christian

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HIRNTOD UND ORGANSPENDE -
DIE VERSCHWIEGENE SEITE

Ein Film­bei­trag über die Organ­ent­nah­me bei Arnd Focke. Der Fall zeigt exem­pla­risch die Pro­ble­ma­tik der Organspende.

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ORGANSPENDE ? – NEIN.
ER BRAUCHT SEINE ORGANE SELBER

Die ret­ten­de Ant­wort
auf eine unzu­mut­ba­re Frage

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Wei­te­re Videos

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Will ich Organ­spen­der sein oder nicht?

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12 GESICHTSPUKTE
ZUR ORGANTRANSPLANTATION

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1/​12 – Der Fall einer soge­nann­ten “hirn­to­ten” Schwan­ge­ren, die noch mona­te­lang lebte.

2/​12 – Wann darf man Orga­ne entnehmen?

3/​12 – Hirn­tod als Vor­aus­set­zung zur Organentnahme

4/​12 – Lebens­wich­ti­ge Orga­ne nicht erlaubt von Lebenden

5/​12 – Rege­lun­gen ande­rer Län­der bezüg­lich der Organentnahme

6/​12 – Organ­spen­de ein Fall von Nächs­ten­lie­be oder doch ein gro­ßer Irrtum?

7/​12 – Fol­gen der Trans­plan­ta­ti­on für den Organempfänger

8/​12 – Gibt es Alter­na­ti­ven zur soge­nann­ten post­mor­ta­len Organspende?

9/​12 – …Spen­de von Organen/​Geweben…

10/​12 – Die Lebend­spen­de

11/​12 – Gegen­wär­ti­ge Ände­rung des Transplantationsgesetzes

12/​12 – Trans­plan­ta­ti­ons­me­di­zin in Zukunft

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Dr. med. Pao­lo Bava­stro, Fach­arzt für Inne­re Medi­zin und Kar­dio­lo­gie, war bis 2003 Chef­arzt einer Inne­ren Abtei­lung. Seit 30 Jah­ren beschäf­tigt er sich mit Ethik, u.a. Pati­en­ten­ver­fü­gung und Trans­plan­ta­ti­ons­me­di­zin. Rege Vor­trags­tä­tig­keit. Etwa 200 Ver­öf­fent­li­chun­gen, Bücher und Buch­bei­trä­ge. Seit 2002 Inha­ber des Ver­dienst­kreu­zes am Bande.

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Das Hirn­tod­kon­zept wird geschicht­lich und wis­sen­schaft­lich-phä­no­me­no­lo­gisch unter­sucht: es ist in sich wider­sprüch­lich und nicht halt­bar. Men­schen im Hirn­ver­sa­gen sind schwerst-kran­ke, lebende.

Organ­ent­nah­me ist fremd­nüt­zi­ge Tötung eines Ster­ben­den. Die ethi­sche Dimen­si­on die­ser Unge­heu­er­lich­keit wird untersucht.

Wel­che Moda­li­tä­ten regeln die Organspende?

Mit wel­chen Argu­men­ten ver­sucht man den “Hirn­tod” zu verteidigen?

Was bedeu­tet “Organ­spen­de”, was erwar­tet den Spen­der, was den Empfänger?

Es wird mas­siv Wer­bung statt geset­zes­kon­for­mer Auf­klä­rung betrieben!

Was erwar­tet die Angehörigen?

Ist Lebend­spen­de so harmlos?

Wie ist der Zusam­men­hang mit kom­mer­zi­el­ler und kri­mi­nel­ler Organbeschaffung?

Kön­nen Orga­ne vom Tier eine Lösung sein?

Wie müs­sen Struk­tu­ren grund­sätz­lich geän­dert wer­den, um Ver­trau­en wie­der zu schaffen?

Wie muss eine lege artis durch­ge­führ­te Auf­klä­rung für jeden ein­zel­nen poten­zi­el­len Spen­der, vor dem Aus­fül­len eines “Organ­spen­der-Aus­wei­ses”, durch­ge­führt werden?

Die­se und vie­le ande­re im öffent­li­chen Dis­kurs ver­schwie­ge­ne The­men wer­den bespro­chen. Es ist ein kri­ti­sches Buch zu einem aktu­el­len The­ma: es ana­ly­siert die Aspek­te, die bei jeder kor­rek­ten Auf­klä­rung bespro­chen wer­den müssen.

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KAO ist eine Initia­ti­ve gegrün­det von Eltern, die ihre ver­un­glück­ten Kin­der zur Organ­spen­de frei­ge­ge­ben haben, ohne die Hin­ter­grün­de zu die­sem Zeit­punkt genau genug zu ken­nen. Erst nach­dem ihre Kin­der beer­digt waren, haben sie begrif­fen, wozu sie ja gesagt hat­ten. Sie haben begrif­fen, dass leben­de Orga­ne nicht von Men­schen ent­nom­men wer­den kön­nen, die so tot sind, wie sie es sich vor­ge­stellt hatten.

Ihre Ent­schei­dung haben sie daher bit­ter bereut. Durch ihre Zustim­mung waren ihre Kin­der in ihrem Ster­be­pro­zess, in dem sie ihrer beson­de­ren Lie­be bedurf­ten, unge­schützt allein gelas­sen und einer Organ­ent­nah­me über­ant­wor­tet, die hin­ter­her wie das Aus­schlach­ten eines Auto­wracks erschien.

In die­ser Situa­ti­on haben sie sich ent­schlos­sen, durch Auf­klä­rung dazu bei­zu­tra­gen, dass ande­re Eltern unter ähn­li­chen Umstän­den davor bewahrt wer­den, unvor­be­rei­tet wie sie mit der Fra­ge der Organ­spen­de kon­fron­tiert zu werden.

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Was wir fordern

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VON UNS ALLEN

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  • sich im Detail zu infor­mie­ren und für sich selbst zu entscheiden
  • die eige­ne Sterb­lich­keit zu akzeptieren
  • sich abzu­wen­den von einer Medi­zin, die das Ster­ben des einen Pati­en­ten zum ver­meint­li­chen Wohl eines ande­ren benutzt
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VON POLITIK UND JUSTIZ

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  • die enge Zustim­mungs­lö­sung ein­zu­füh­ren, nur so sind Organ­ent­nah­men tragbar
  • den sen­si­blen Bereich Organ­ent­nah­me effek­tiv zu kontrollieren
  • jeden Ver­such zu bekämp­fen, mensch­li­ches Leben als Ver­fü­gungs­mas­se zu behandeln
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VON DER MEDIZIN

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  • anzu­er­ken­nen, dass der “Hirn­tod” kei­ne wis­sen­schaft­li­che, son­dern eine juris­ti­sche Definition ist, um straf­frei Orga­ne ent­neh­men zu können
  • auch Risi­ken und Miss­erfol­ge von Trans­plan­ta­tio­nen darzulegen
  • inten­siv auf­zu­klä­ren über die nie­ren­schä­di­gen­de Wir­kung von frei­ver­käuf­li­chen Schmerz­mit­tel bei unsach­ge­mä­ßer Anwen­dung (ins­be­son­de­re Dosie­rung und Dauer)
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VON DEN KIRCHEN

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  • nicht mit zwei­er­lei Maß zu mes­sen und den Pati­en­ten im Hirn­ver­sa­gen die glei­che Zuwen­dung zu geben wie ande­ren Sterbenden
  • kei­ne Nütz­lich­keits­er­wä­gun­gen zu unterstützen
  • Men­schen nicht ihr Mensch­sein abzu­spre­chen und sie damit zum Recy­cling­gut zu degradieren
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Lau­fend neue Bei­trä­ge und Fach­ar­ti­kel zum

  • Infor­mie­ren
  • Dis­ku­tie­ren
  • Tei­len

Machen Sie mit.

Bewaff­nen Sie sich mit Wissen.

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