Organ protective intensive therapy

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The organ-protective intensive therapy or donor conditioning is the intensive medical treatment of a brain-dead patient whose organs for the purpose of a possible transplant to be preserved in good condition. For this purpose, the potential organ donor is largely monitored, treated and cared for like any other intensive care patient until the organ is removed or the therapy is discontinued. The intensive therapy of the organ donor is also the preferred intensive therapy of the later organ recipient.

Monitoring, therapy and care

The goal of treatment during this phase is to ensure optimal graft function at the time of explantation . Other intensive care principles, such as ensuring dignified care and empathic care for relatives, is very similar to the care of other patients in the intensive care unit . However, unlike intensive care patients with a prospect of recovery, there is no physiotherapy . The implementation of preventive measures (e.g. for pressure ulcer prophylaxis ) takes a back seat when it endangers circulatory stability.

Psychological stress on those involved

Relatives

Relatives are often unsettled about the organ donor that has been declared dead, as their observations do not agree with their ideas about death and the dead. The brain-dead is intuitively perceived as alive: the visible signs of death such as death spots and muscle rigidity are missing, on the other hand the patient is supplied with blood and feels warm, movements of the extremities and trunk can be observed in isolated cases ( Lazarus phenomenon ). The definition of brain death may therefore be questioned and the question asked whether a dying process is possibly artificially prolonged. Relatives often find it difficult to choose the right time to say goodbye, as nothing has externally changed in the patient after the brain death was determined. In addition, they hardly find the necessary peace and quiet in an intensive care unit, since the treatment that is tailored to organ preservation requires constant activity on the part of the staff: the organ donor receives intensive care, receives medication and infusions and is monitored by devices. But the treatment no longer serves the patient himself, but the unknown organ recipient or recipients. The time that elapses from the diagnosis of the brain death to the removal of the organs is perceived as stressful by everyone involved.

Supervising team

Organ-protective intensive therapy is complex and means a human, organizational and professional challenge. Intensive care unit staff often have a generally positive attitude towards organ donation, but according to surveys they feel exposed to a high level of emotional stress in practice. This burden arises above all when a trusting atmosphere has developed in the brain-dead patient and through the care of the existentially affected relatives, who are often completely overwhelmed by the acute situation. In particular, the caring nurses act as contacts and advisors for relatives.

Nursing care for an organ donor poses a challenge to the individual's view of the prevailing ethics . Conflicts of conscience can arise if at the same time care is neglected for patients who still have a chance of survival. A study at the University Hospital Regensburg (2005) showed that “the stated psychological stress does not decrease with increasing professional experience, but tends to increase.” The conclusion of the study is that there is no “routine effect”, but information deficits are perceived expresses the desire for more training and education.

literature

  • Vera Kalitzkus: Your death, my life. Why we find organ donation right and still shy away from it. Suhrkamp medizinHuman, Frankfurt 2009; ISBN 978-3-518-46114-3
  • Theda Rehbock: Human dignity in the intensive care unit - is that even possible? In: Practice book ethics in intensive care medicine. (Ed. Fred Salomon), Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin 2009 ISBN 978-3-941468-03-0

Web links

Individual evidence

  1. ^ W. Pothmann, B. Füllekrug: Donor conditioning in intensive care medicine ; 2nd Edition; Editor: H. Van Aken; G. Thieme Verlag, Stuttgart, 2007
  2. ^ Marco Greeting, Michael Bernhard, Markus A. Weigand: Intensive Therapy of Organ Donors ; Intensive care medicine up2date; 06/2010; doi : 10.1055 / s-0029-1243979 ; VNR 2760512010047432007
  3. ↑ J. Haslinger: Organ donor: The patient with a difference - How much care does an organ donor need? ; 2008. From: www.medicom.cc , accessed June 25, 2012
  4. ↑ A. Zieger: Medical Knowledge and Interpretation in 'Relationship Medicine' - Consequences for Transplant Medicine and Society. In: Manzei, A., & W. Schneider (Hrsg.): Transplantationsmedizin. Cultural knowledge and social practice. Agenda Verlag, Münster 2006, pp. 157–181; online: PDF ( Memento of the original from July 10, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. P. 4, accessed June 7, 2012 @1@ 2Template: Webachiv / IABot / www.subventionsberater.de
  5. ^ Christiane Puschner: Organ donation - on the donor's side. P. 25 dgpalliativmedizin.de, accessed on August 24, 2016
  6. ↑ Haslinger 2008
  7. ↑ Vera Kalitzkus: Your death, my life. Why we find organ donation right and still shy away from it. Suhrkamp medizinHuman, Frankfurt 2009; Pp. 131-132
  8. ↑ Th. Bein et al .: Determination of brain death and care of the organ donor: A challenge for intensive care medicine. German Ärztebl 2005; 102 (5): A-278 / B-226 / C-213