[Decision-making support in Intensive Care to facilitate organ donation : Position paper of the Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care Medicine and Emergency Medicine (DGIIN)]. / Entscheidungshilfe bei erweitertem intensivmedizinischem Behandlungsbedarf auf dem Weg zur Organspende : Positionspapier der Sektion Ethik und der Sektion Organspende und -transplantation der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI) unter Mitarbeit der Sektion Ethik der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN).

BACKGROUND AND CHALLENGE: Injuries, especially traumatic brain injury, or specific illnesses and their respective sequelae can result in the demise of the patients afflicted despite all efforts of modern intensive care medicine. If in principle organ donation is an option after a patient's death, intensive therapeutic measures are regularly required in order to maintain the homeostasis of the organs. These measures, however, cannot benefit the patient afflicted anymore-which in turn might lead to an ethical conflict between dignified palliative care for him/her and expanded intensive treatment to facilitate organ donation for others, especially if the patient has opted for the limitation of life-sustaining therapies in an advance directive. METHOD: The Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) have convened several meetings and a telephone conference and have arrived at a decision-making aid as to the extent of treatment for potential organ donors. This instrument focusses first on the assessment of five individual dimensions regarding organ donation, namely the certitude of a complete and irreversible loss of all brain function, the patient's wishes as to organ donation, his or her wishes as to limiting life-sustaining therapies, the intensity of expanded intensive treatment for organ protection and the odds of its successful attainment. Then, the combination of the individual assessments, as graphically shown in a {Netzdiagramm}, will allow for a judgement as to whether a continuation or possibly an expansion of intensive care measures is ethically justified, questionable or even inappropriate. RESULT: The aid described can help mitigate ethical conflicts as to the extent of intensive care treatment for moribund patients, when organ donation is a medically sound option. NOTE: Gerald Neitzke und Annette Rogge contributed equally to this paper and should be considered co-first authors.

[Organ donation in Germany - when and how? A task for in-house coordinators]. / Organspende in Deutschland - wann und wie? Ein Fall für Transplantationsbeauftragte.

BACKGROUND: Organ donation of deceased is the main prerequisite for solid organ transplantation. The use of hospital-internal, independent staff as so-called "in-house coordinators" are required since 2012 in Germany. OBJECTIVES AND METHODS: Treatment algorithms and therapy recommendations of central organ donation processes based on the tasks and competencies of in-house coordinators who work in close cooperation with intensive care physicians, neurologists, neurosurgeons and the German organ procurement organisation are presented and discussed within the framework of a review. RESULTS: In all patients with acute severe brain damage and unfavorable cerebral prognosis, in the context of end-of-life decisions and especially after brain death diagnosis, the willingness of patients to donate organs is the decisive question. In addition to this difficult question, the detection, evaluation, selection, brain death confirmation, intensive care therapy of a potential donor as well as the organizational management and the accompaniment of relatives are core processes. CONCLUSION: The identification of potential organ donors and their treatment is a task for all emergency and intensive care physicians and in-house coordinators.

[Attitude of intensive care specialists toward deceased organ donation in Germany. Results of a questionnaire at the 12th Congress of the German Interdisciplinary Association for Intensive and Emergency Medicine]. / Einstellung des intensivmedizinischen Fachpersonals zur postmortalen Organspende in Deutschland. Ergebnisse einer Fragebogenerhebung auf dem 12. Kongress der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin.

BACKGROUND: Organ transplantation is the only treatment option for many patients with end-organ failure. Due to lack of transplantable organs, patients already on the waiting list die every day. The number of organ donors in Germany fell in 2012 by 12.8 %, reaching its lowest level since 2002. The medical and nursing personnel in intensive care units have a key role in the recruitment of potential organ donors; therefore, a survey was conducted on this subject. MATERIALS AND METHODS: At the 12th Congress of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) in December 2012, a point prevalence study using a paper-pencil survey was performed. RESULTS: A total of 1045 questionnaires were analyzed. Of respondents, 81 % favor organ donation in the event of their own brain death. The approval rate in the medical profession was 84 % and 75 % of the nursing profession. Only 45.3 % of the participants (47 % physicians, nursing 44 %) had an organ donor card and nearly half (45 %) had already confided their opinion towards organ donation to their family or friends. The main reasons for a lack of acceptance of organ donation was the concept of brain death (40 %), fear of abuse by organ trade (29 %), and the lack of integrity of the body after death (11 %). The particularly intense discussion about organ donation and transplantation in 2012 resulted in a predominantly negative change of attitude in 45 % of respondents. CONCLUSION: The vast majority of the intensive care personnel supports organ donation, but less than half of the respondents have an organ donor card. The reports of irregularities in the organ allocation were scrutinized, but had apparently no significant impact on the individual and collective fundamental donor decision.