In Germany, brain death is a prerequisite for the removal of donor organs. The FDP wants to change that – and give the green light for donations much more often. But critics think this is half-baked.
Should cardiac death instead of brain death be enough in the future to allow doctors to remove livers, lungs or other organs from potential organ donors? With this initiative, the FDP is drawing attention to itself in the Bundestag – and is receiving far more than just positive reactions.
How is organ donation regulated today?
The most important requirements for organ donation are consent and that the deceased person has been diagnosed with irreversible loss of all brain functions – brain death. The Federal Center for Health Education further emphasizes: “If these requirements are met, doctors check in individual cases whether the state of health allows organ donation.”
What is brain death?
Important parts of the brain no longer work and its functionality is lost forever. Brain death refers to the condition in which a person’s death has clearly occurred according to neurological criteria and the brain no longer exercises its control function. The cardiovascular system can only be maintained artificially with the help of intensive care measures. Without artificial ventilation, brain death would quickly be followed by cardiovascular arrest. Brain death is a rare phenomenon and can only be diagnosed in an intensive care unit.
What does the FDP want?
Expand the definition of death as a prerequisite for organ donation. In the future, cardiovascular arrest should also be the basis for self-determined organ removal. A corresponding position paper from legal and health politicians was discussed in the group. Potential donors should then be able to record their wishes in the organ donation register or on organ donation cards using an additional, optional field explicitly provided for this purpose.
How does the FDP justify its initiative?
This could increase the number of donors, said right-wing politician Katrin Helling-Plahr to “Welt”. The parliamentary group’s health policy spokesman and doctor Andrew Ullmann told the newspaper: “From a medical perspective, there is no gold standard in explaining death.” Death after a prolonged cardiac arrest is equivalent to brain death. “A key difference, however, is that cardiac death is easier but still certain to determine.” The effort involved in determining brain death is immense and thus limits the number of potential donors from the outset.
What do critics say?
The German Foundation for Patient Protection accuses the FDP of trying to get votes on the issue of brain death. But the topic is far too differentiated for that, said board member Eugen Brysch of the dpa. “Brain death and cardiac death after an untreated cardiac arrest are not the same. But that is exactly what the FDP initiative suggests.” Cardiac arrest is not irreversible, as is the case with brain death.
What is important to Karl Lauterbach?
The Federal Minister of Health Karl Lauterbach (SPD) wants the contradiction to be resolved in organ donation, unlike today. Consent to a decision is deemed to have been made if the person concerned does not explicitly object. Today the decision-making solution applies: Organ or tissue removal may only take place if the deceased consented to it during their lifetime or if their next of kin give their consent after death.
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Is the diagnosis of cardiac arrest just as certain?
Brain death is irreversible, truly irreversible. People in cardiac arrest can sometimes be resuscitated. But when the heart doesn’t beat, the brain doesn’t get oxygen, and after three to five minutes, brain cells begin to die. Brain death will occur at some point – how long this takes depends on many factors, such as age.
An important question is: How long should the cardiac arrest last so that the organs can be removed? The FDP is not making any proposals on this. That’s why the Society for Cardiology explains: “Unfortunately, at this point in time, we don’t know enough about the FDP’s proposal to be able to comment on it in a well-founded manner.” As soon as more is known about the position paper, the heart experts want to study it intensively.
How would death be determined?
Last year, the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi) explained in a position paper how organ donation could proceed after a controlled cardiac arrest: A hopelessly ill patient must have previously declared that he does not want to be resuscitated. The therapy is no longer curative but palliative, so it is no longer about healing but about relief. Intensive care measures will be discontinued.
Once cardiac arrest has been detected, there is an observation period, the so-called no-touch time, during which the patient is not touched. Divi speaks of five minutes, in other countries the wait is longer. Death is then determined, often with additional tests, and the organs are removed.
Why the call for more organ donations?
More organs such as kidneys, livers and hearts for seriously ill patients have been urgently needed for years. Last year, 965 people gave up one or more organs for others after their death, according to the coordinating German Organ Transplantation Foundation. At the same time, 8,400 people were on waiting lists. In order for donations to even be considered, two specialists must independently determine that a deceased person is brain dead.
Does the FDP initiative also receive support?
Yes. The German Transplantation Society emphasizes that donation after death due to cardiac arrest and subsequent brain death is already established in many neighboring countries – “and has led to a significant increase in the donor pool there.” “In hardly any other European country is the disproportion between donor organs and patients who urgently need a new organ as great as in Germany,” said President Utz Settmacher.
Long-tested alternatives should be introduced – these include so-called DCD donation (donation after circulatory death), organ donation after a primary cardiovascular arrest and subsequent brain death. Almost all neighboring countries allow such donations.
Information about organ donation Data and facts about resuscitation Divi: organ donation and organ transplants
Source: Stern
I have been working in the news industry for over 6 years, first as a reporter and now as an editor. I have covered politics extensively, and my work has appeared in major newspapers and online news outlets around the world. In addition to my writing, I also contribute regularly to 24 Hours World.
