Hoffmann Olaf Martin, Dinse Corinna, Masuhr Florian
Klinik für Neurologie, Alexianer St. Josefs-Krankenhaus Potsdam, Allee nach Sanssouci 7, 14471, Potsdam, Deutschland.
Klinik für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland.
Anaesthesist. 2021 Jul;70(7):563-572. doi: 10.1007/s00101-020-00904-5. Epub 2020 Dec 18.
In Germany, postmortem organ donation requires a diagnosis of irreversible brain death (BD) in strict compliance with the guidelines of the German Medical Association.
Identification of factors that have a limiting effect on the initiation and execution of BD diagnostics. Identification of potential for improvement.
Anonymous survey of transplantation officials in hospitals in Berlin, Brandenburg and Mecklenburg-Western Pomerania.
There is considerable heterogeneity with respect to the frequency of BD diagnostics and hospital-specific procedures, including the use of an existing consultation service. The local availability of qualified doctors and of suitable ancillary diagnostic tests has a structurally limiting effect. This is especially true for pediatric patients. Potential for improvement was seen in the identification of affected patients, the motivation of staff and the role of transplantation officials.
According to the recently amended German Transplantation Act, a centrally organized consultation service for BD diagnostics must be implemented as soon as 2021. Recommendations can be derived from the present survey and from the experience of the regionally established consultation service. In addition to neurological and neurosurgical expertise, qualified pediatricians and mobile ancillary instrumental diagnostics should also be provided. Expert advice from neurointensive care physicians should be available at an early stage in order to identify potentially affected patients. The highly variable participation of hospitals in organ donation, despite the availability of an expert diagnostic service free of charge, points to an important role of additional factors, some of which may be nonmedical in nature.
在德国，尸检器官捐赠要求严格按照德国医学协会的指南诊断为不可逆脑死亡（BD）。
确定对BD诊断的启动和实施具有限制作用的因素。确定改进潜力。
对柏林、勃兰登堡和梅克伦堡-前波美拉尼亚医院的移植官员进行匿名调查。
在BD诊断频率和医院特定程序方面存在相当大的异质性，包括现有咨询服务的使用情况。合格医生和合适辅助诊断测试的本地可用性具有结构性限制作用。儿科患者尤其如此。在受影响患者的识别、工作人员的积极性和移植官员的作用方面存在改进潜力。
根据最近修订的德国《移植法》，最迟在2021年必须实施一项针对BD诊断的中央组织咨询服务。可以从本次调查以及地区性咨询服务的经验中得出建议。除了神经科和神经外科专业知识外，还应提供合格的儿科医生和移动辅助仪器诊断。神经重症监护医生的专家建议应尽早提供，以便识别可能受影响的患者。尽管有免费的专家诊断服务，但医院在器官捐赠方面的参与程度差异很大，这表明其他因素起着重要作用，其中一些因素可能是非医学性质的。
