Organtransplantation ohne „Hirntod”-Konzept?

Abstract.

Definition of the problem:Truog’s critique of the ”brain death” concept outlines inconsistencies well understood in the U.S. ethical debate, while he is one of the first to suggest returning to the traditional, coherent concept of death, thus breaking with the ”dead-donorrule.” The German transplantation law of 1996 endorses equating ”brain death” with death. A defeated draft, however, had acknowledged that irreversible total brain failure is a death-near state with a zero prognosis; organ harvesting, then, was to be allowed only in case of prior personal consent. The politically effective objection against this concept was its admitted violation of the dead-donorrule and thus its (incorrectly) alleged precedent potential for legalising active euthanasia. Truog’s suggestion to justify organ explantation on the grounds of ”consent and nonmaleficence” would have fuelled German counter-critics had they known it. The problem is how to justify organ harvesting after breaking the dead-donorrule. Arguments: With the allegation that ”imminent death” and ”irreversible coma” allow concluding that there is ”no harm,” Truog ironically returns to the weak arguments traditionally used to support the ”brain death” concept. His suggestion opens the door to a wide array of eligible organ donors (and, indeed, to a precedential case for active euthanasia). The euphemistic tradition of the ”brain death” concept, perhaps a prominent reason for public scepticism towards transplantation, will be perpetuated unless it is acknowledged that the interference of organ explantation with the donor’s dying process does as such constitute ”harm” to this individual. Organ harvesting, then, requires prior personal consent and needs to be clearly differentiable from any act of ”killing” if it is to be compatible with the law, acceptable to surgeons and not a precedent for active euthanasia. A close look at the actual procedure reveals that consent has invariably the effect of prolonging, not shortening the factual life span of the person in whom irreversible total brain failure has been diagnosed. This peculiarity distinguishes organ explantation from all other forms of terminating a person’s life and is not congruent with the ethical and legal notion of ”killing”. Conclusion: Breaking the dead-donorrule by allowing for the donor to give prior personal consent to organ explantation as a procedure that is going to interfere with his or her dying can be justified, informed consent provided, without setting foot on a slippery slope.

Zusammenfassung.

Truog hat eine brillante Zuspitzung der US-amerikanischen Kritik am „Hirntod”-Kriterium vorgelegt; sein kaum begründeter Vorschlag, Organtransplantationen durch (stellvertretende) Zustimmung bei Menschen mit „irreversibler Bewusstlosigkeit” und „unmittelbar bevorstehendem Tod” zu legitimieren, hält einer kritischen Überprüfung jedoch nicht stand und scheint denen in Deutschland recht zu geben, die im Rahmen der Transplantationsgesetzgebung (1996) mit Blick auf den (gescheiterten) alternativen Gesetzentwurf vor einem Dammbruch zur aktiven Euthanasie warnten. Dieser Aufsatz kritisiert Truogs Vorschlag und zeigt, warum Organentnahmen bei Menschen mit irreversiblem totalen Hirnversagen gerechtfertigt werden können, wenn zum tragfähigen Todeskriterium des irreversiblen Herz-Kreislauf-Stillstands zurückgekehrt wird, ohne dass ein Präzedenzfall für die aktive Euthanasie entsteht.