Rommel Wolf, Schmidt Hartmut H J
Klinik für Klinische und Experimentelle Transplantationshepatologie, Universitätsklinikum Münster.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2010 May;45(5):348-54. doi: 10.1055/s-0030-1253569. Epub 2010 May 7.
Organ transplantation is the therapeutic option of choice in organ failure and distinct types of cancer. For more than two decades organ transplantation had no legal framework in Germany. Multiple ethical and judicial considerations as well as the complexity of medical and organizational management but also the fears of possible organ donors lead to the enacting of German Transplantation Act (Transplantationsgesetz, TPG) in 1997. The TPG defines controlled brain death and the extended consent as requirements for explantation. This means, the organ donor must have approved the donation of his organs before. This approval can be writtenly documented or approved by the nearest relatives or the closest confidents. It is also possible to denominate an assignee (alt.: to authorize another person) during life time. Living organ donations are also legalized in the TPG. Precondition for any organ donation is the brain death of the organ donor. The diagnostic requirements for brain death are specifically mentioned by guidelines of the German Federal Medical Association (Bundesärztekammer). The major problem today is willingness to organ donation in the German population. There is an eminent deficiency of organ donations in Germany. Therefore local hospitals, regional Transplantation Centres, the supraregional German Foundation for Organ transplantation have to act closely in concert based on the directives of TPG. After successful Transplantation, a life- long immunosuppression is necessary. Nevertheless organ rejections remain still possible. By reason of this and other complications a life-long connection to a responsible Transplantation Centre is necessary for the transplanted patient. Physicians who work at a regional hospital's ICU have to be able to identify possible organ donators. They also should know how to initiate the organizational procedures to provide explantation, rapid procuration, and transportation of the explanted organs based upon to the regulations of TPG.
器官移植是器官衰竭和特定类型癌症的首选治疗方案。二十多年来，德国一直没有器官移植的法律框架。多种伦理和司法考量、医疗及组织管理的复杂性，以及对潜在器官捐赠者的担忧，促使德国在1997年颁布了《德国移植法》（Transplantationsgesetz，TPG）。该法将控制性脑死亡和扩大同意定义为器官摘除的必要条件。这意味着，器官捐赠者必须事先同意捐赠其器官。这种同意可以书面记录，也可以由最近的亲属或最亲近的人批准。在生前指定受让人（另一种说法：授权他人）也是可行的。活体器官捐赠在《德国移植法》中也合法化了。任何器官捐赠的前提条件都是器官捐赠者脑死亡。德国联邦医学协会（Bundesärztekammer）的指南特别提到了脑死亡的诊断要求。如今的主要问题是德国民众对器官捐赠的意愿。德国存在器官捐赠的严重短缺。因此，当地医院、地区移植中心、德国超地区器官移植基金会必须根据《德国移植法》的指令紧密合作。器官移植成功后，需要进行终身免疫抑制。然而，器官排斥仍然有可能发生。鉴于此以及其他并发症，移植患者需要与负责的移植中心建立终身联系。在地区医院重症监护室工作的医生必须能够识别潜在的器官捐赠者。他们还应知道如何根据《德国移植法》的规定启动组织程序，以提供器官摘除、快速获取和运输摘除的器官。
