The review article focusing on this therapeutic approach (1) unequivocally shows the weak international evidence supporting it. Furthermore, the question that arises is that of the legal legitimation of donor-centered, rather than patient-centered, therapy in the temporal context. The authors remind us of the German Medical Association’s guidelines, the German Transplant Act (Transplantationsgesetz, TPG), and of an opinion of the German National Ethics Council, all of which creates the impression of general legal admissibility—but organ-protective therapy has not been sufficiently considered by the legislature or the guideline issuer in a form that is oriented towards the will of the patient. The statement of the German National Ethics Council in particular contains numerous legal concerns regarding donor-centered therapy—especially before and after brain death has been ascertained (“the irreversible, total loss of brain function”) (2).

Whether a box checked next to organ donation on the organ donor pass is sufficient, furthermore, to deduce the purported agreement of the dying (but still alive) or already deceased “brain dead” patient for this therapy is an unconfirmed fiction, not a general assertion, and more than questionable in view of the jurisdiction relating to the concretization of living wills (German Federal Court of Justice, 6. 7. 2016–XII ZB 61/16; for the international discussion on equating brain death and individual death [2, 3]). In case of a therapy-limiting living will, which excludes intensive medical measures when the prognosis is poor, the checked box can hardly be assumed to be priority. In spite of the information for the public that was planned in the context of the decision-making solution according to section 2 of the German Transplant Act, the information brochures of the relevant organizations provide next to nothing regarding organ-specific therapy. And why would that be so? Well-informed patients might reject such an approach, in the same way that study participants decide against organ donation if brain death is not certified by apparatus-based diagnostic evaluation (4).

When deploying a form of “therapy” that is based on weak evidence in a scenario where the patient’s wishes are not clear or presumed to be opposed, one may find oneself of thin ice in terms of the law. Clear information to the public on these aspects and patient-oriented legal specifications in the German Transplant Act might help to strengthen public confidence in transplantation medicine.

DOI: 10.3238/arztebl.2017.0137a

Assessor Prof. Dr. med. Dr. med. habil Markus Parzeller

Institut für Rechtsmedizin,
Universitätsklinikum der Goethe-Universität,
Frankfurt/Main

parzeller@em.uni-frankfurt.de

Barbara Zedler

Institut für Rechtsmedizin,
Universitätsklinikum Gießen/Marburg

Prof. Dr. med. Marcel A. Verhoff

Institut für Rechtsmedizin,
Universitätsklinikum der Goethe-Universität,
Frankfurt/Main

1.
Hahnenkamp K, Böhler K, Wolters H, Wiebe K, Schneider D, Schmidt HHJ: Organ-protective intensive care in organ donors. Dtsch Arztebl Int 2016; 113: 552–8 VOLLTEXT
2.
Deutscher Ethikrat: Hirntod und Entscheidung zur Organspende. Stellungnahme vom 24.2.2015. S. 41 ff.: zu organprotektiven Maßnahmen; S. 71 ff.: zur „Kontroverse über die Hirntodkonzeption“; www.ethikrat.org/dateien/pdf/stellungnahme-hirntod-und-entscheidung-zur-organspende.pdf (last accessed on 5 September 2016).
3.
Markert L, Bockholdt B, Verhoff MA, Heinze S, Parzeller M: Renaissance of criticism on the concept of brain death–the role of legal medicine in the context of the interdisciplinary discussion. Int J Legal Med 2016; 130: 587–95 CrossRef MEDLINE
4.
Markert L, Ackermann H, Verhoff MA, Parzeller M: Der (Hirn-)Tod und seine Feststellung. Rechtsmedizin 2016; 26: 264–72 CrossRef
1.Hahnenkamp K, Böhler K, Wolters H, Wiebe K, Schneider D, Schmidt HHJ: Organ-protective intensive care in organ donors. Dtsch Arztebl Int 2016; 113: 552–8 VOLLTEXT
2. Deutscher Ethikrat: Hirntod und Entscheidung zur Organspende. Stellungnahme vom 24.2.2015. S. 41 ff.: zu organprotektiven Maßnahmen; S. 71 ff.: zur „Kontroverse über die Hirntodkonzeption“; www.ethikrat.org/dateien/pdf/stellungnahme-hirntod-und-entscheidung-zur-organspende.pdf (last accessed on 5 September 2016).
3. Markert L, Bockholdt B, Verhoff MA, Heinze S, Parzeller M: Renaissance of criticism on the concept of brain death–the role of legal medicine in the context of the interdisciplinary discussion. Int J Legal Med 2016; 130: 587–95 CrossRef MEDLINE
4. Markert L, Ackermann H, Verhoff MA, Parzeller M: Der (Hirn-)Tod und seine Feststellung. Rechtsmedizin 2016; 26: 264–72 CrossRef

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