![]() | Nikolaus Knoepffler |
-
03.07.2025-29.07.2025
Wer ein Leben rettet, rettet eine ganze Welt - zur Bedeutung der Organspende
The central working hypothesis of the book “Wer ein Leben rettet, rettet eine ganze Welt”, i. e. On the question of post-mortem organ donation is: We have a duty of solidarity towards sick people who need an organ, which is linked to human dignity. That is why organs should be available to these patients after our death, so that people whose lives can be saved are actually saved. In legal terms, this means that we should follow in Germany the practice of many countries to introduce opting-out and DCD.
For this reason, the central first working hypothesis is linked to a second hypothesis, according to which the death of a person is established when the whole brain has died. However, this definition is incomplete in the context of the question of post-mortem organ specification and must be supplemented, as there could also be good reasons to understand the time of death as the time at which the heart has stopped beating and the person concerned does not wish to be resuscitated. It should also be asked whether it might be sufficient for parts of the brain that are essential for consciousness to have died in order to declare death in these cases as well, if the persons concerned agreed to such a definition of death during their lifetime. It is very important to proceed with the utmost care.
As a first step, the tension in the understanding of human dignity, which is taken as the fundamental principle of work, must be addressed, namely the extent to which human dignity is associated with duties as well as rights. This is the only way to justify a duty of solidarity towards sick people whose lives are at stake. Because medically, of course, the cause of the illness and, in the event of the patient's death, the cause of their death is organ failure and not a lack of organs. This deficiency only prevents rescue. It must therefore be demonstrated why this solidarity with these people in the emergency situation of the specific illness, which is linked to human dignity, exists. Is it therefore permissible to restrict one's right to self-determination to such an extent that an organ declaration could be obligatory after death? Or does the body have a "sacrality" beyond death (Joas) or require piety (Preuß ), so that organ removal always requires consent in the broader sense.
In a second step, the applicant will therefore address the debate surrounding the criteria for death. Whole-brain death as the death of a human being as a result of irreversible cardiovascular failure combined with rigor mortis, already described by Xavier Bichat (1771-1802), is not controversial. In contrast, the debate has become very complex with regard to death criteria that are important for organ transplantation, such as dissociated whole-brain death, but also cardiac death criteria. In dissociated whole-brain death, the brain dies, but the heart continues to beat thanks to intensive medical measures. There is a fierce debate about this, which has already been discussed by the renowned philosopher Hans Jonas. He left the Harvard ad hoc committee that established whole-brain death as the death of a human being in 1968, after Barnard's heart transplant in 1967 made the cardiac death criterion obsolete. Jonas (could not imagine that a warm, apparently breathing body could already be dead. In this debate, the neurologist Shewmon in particular disputed that whole-brain death should be understood as human death. The debate continues to this day, even though most medical associations recognize whole-brain death as human death.
In addition, the question of the time of death is to be linked to the current international debate as to whether cardiac death, as Switzerland and the Netherlands for example, can also be understood as human death if the person concerned or, in the case of children, the responsible legal guardians have issued a "do-not-resuscitate-order" (order not to carry out resuscitation measures).
In a third step, alternatives to organ procurement such as living donation and the development of new alternatives, for example with the help of adult stem cell research for the regeneration of heart tissue, should be addressed. If there were reliable alternatives, this would also be of great relevance to the question of the obligation to donate organs in the event of whole-brain death.