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Lebertransplantation mit Lebendspende

Aktuelles, Perspektiven und Stellenwert in Deutschland

Liver transplantation with living donor

Current aspects, perspectives and significance in Germany

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Zusammenfassung

Vor mehr als 20 Jahren wurde die Lebertransplantation mit Lebendspenden in die Klinik eingeführt. Zunächst für Kinder und später auch für erwachsene Empfänger wurden Spezifika dieser Methode insbesondere in Regionen, die nicht über ein postmortales Programm der Lebertransplantation verfügen, entwickelt. Der sensibelste Punkt der Lebendspende, die Gefährdung eines gesunden Verwandten für die Realisierung der Transplantation, ist systemimmanent und stellt sie damit klar hinter die Möglichkeit einer postmortalen Organspende. Nach weltweiter anfänglicher Euphorie ist sie im neuen Jahrtausend in der westlichen Welt zahlenmäßig deutlich zurückgegangen. Insbesondere in den Ländern Asiens wurde intensiv an der Optimierung gearbeitet, sodass die Sicherheit für den Spender und die Ergebnisqualität für den Empfänger in großen Patientenserien überzeugend gezeigt werden konnten. Der bis heute bestehende eklatante Spenderorganmangel und die Möglichkeit durch die Lebendspende individuell ein optimales (Teil-)Organ zu allozieren, haben die Diskussion über die weitere Profilierung der Lebendspende auch bei uns wieder aktualisiert. Mit der Novelle des deutschen Transplantationsgesetzes im Sommer 2012 wurde eine Reihe versicherungsrechtlicher Voraussetzungen für Lebendspender fixiert. Aktueller Stand und Perspektiven werden hier vorgestellt.

Abstract

More than 20 years ago living donor liver transplantation was introduced into clinical practice. Specifics of this method were developed initially for children and later on for adults particularly in regions where a liver transplantation program using deceased donors was not readily available. The most sensitive aspect of living donation, namely the danger to a healthy relative in order to perform the transplantation is immanent in the system and, thus, it is definitively a secondary option as compared to deceased organ donation. Following worldwide initial euphoria the numbers have markedly decreased in the western world since the start of the new millennium. In Asian countries in particular, much work has been done to optimize the procedure so that the donor safety and the outcome quality for the recipient have been impressively demonstrated in large patient populations. There is still a severe donor organ shortage and the option to allocate an optimal (partial) organ on an individual basis by living donation has given new impact to the discussion about a further rise in the profile of living donations here as well. The new version of the German transplantation legislation implemented in summer 2012 requires a number of conditions with respect to insurance for living donors. The current state and perspectives are presented here.

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  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    U. Settmacher, A. Bauschke, C. Malessa, H. Scheuerlein, J. Zanow & F. Rauchfuß

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  1. U. Settmacher
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  2. A. Bauschke
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  3. C. Malessa
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  4. H. Scheuerlein
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  6. F. Rauchfuß
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Correspondence to U. Settmacher.

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Settmacher, U., Bauschke, A., Malessa, C. et al. Lebertransplantation mit Lebendspende. Chirurg 84, 398–408 (2013). https://doi.org/10.1007/s00104-012-2414-7

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