Endokrinologisches Management bei Patienten mit irreversiblen Hirnfunktionsausfall vor der Organspende

In Deutschland ist die Feststellung des irreversiblen Hirn-Funktionsausfalls (IHA) für eine postmortale Organspende unabdingbare Voraussetzung. Nach Feststellung des IHA finden im Organismus der Verstorbenen multiple Veränderungen, u.a. auf endokrinologischer Ebene, statt. Dieser Beitrag soll einen kurzen Überblick über die postmortalen Veränderungen und die Möglichkeiten der Therapie im Rahmen einer organprotektiven Behandlung vor der Organspende geben.

Abstract

Organ donation is often the only treatment option for patients with severe, life-threatening organ insufficiencies. The precondition for organ donation in Germany is the irreversible loss of brain function (ILB). When ILB occure, multiple changes in the organism take place, including the endocrinological system. Organ-protective therapy includes all essential organ systems and, in addition to differentiated volume and catecholamine therapy, lung-protective ventilation and the maintenance of homeostasis with regard to the acid-base balance, electrolytes and also the endocrinological system. Endocrinological management is of equal importance to hemodynamic management in the context of organ-protective therapy. In some cases, endocrinological changes in severe brain damage also determine the hemodynamic situation. This means that endocrinological dysfunctions must be treated even before an ILB is diagnosed. In the most severe cerebral pathologies and then also with the onset of ILB, multiple pathophysiological changes in the endocrinological system usually take place. These changes then also require specific therapy. The changes are complex and include the dysfunction of the hypothalamic-pituitary axis and the destruction of the vagus nuclei. This results in significant endocrinological changes. This article is intended to provide a brief overview of the post-mortem changes and the possibilities of therapy in the context of organ-protective treatment of endocrinological changes prior to organ donation.

Kernaussagen

• Endokrinologische Veränderungen sind im Rahmen der Organspende von erheblicher Bedeutung. Sie haben potenziell Einfluss auf die Diagnostik des IHA, die organprotektive Therapie in den Spender*innen, sowie auf die Transplantat-Funktion in den Empfänger*innen.

• Die aktuellen Empfehlungen in Deutschland beschränken sich neben dem hämodynamischen Management und dem Aufrechterhalten der Körpertemperatur auf die Gabe von Methyl-Prednisolon und die Therapie eines Diabetes insipidus centralis.

• Ein engmaschiges Monitoring und eine frühe zielgerichtete Therapie sind entscheidend, um weitreichende Konsequenzen in der intensivmedizinischen Betreuung des Organspende-Prozesses zu vermeiden.

• Organspender*innen sollten als schwerkranke Patient*innen in der Intensivtherapie verstanden werden, die eine ebensolche Aufmerksamkeit verdienen wie alle anderen Patient*innen.

• Auch wenn die Datenlage schlecht ist, erscheint eine organprotektive Therapie in diesem Patientenklientel sinnvoll.

Schlüsselwörter

Organspende - endokrines System - Organschutz

Keywords

organ donation - endocrine system - organ protection

Publication History

Article published online:
21 July 2025

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