Geven en nemen - dr Erwin JO Kompanje

absent as a result of a terminal circulatory arrest of a duration of more than 10
minutes.
In c1/apter JO the potentialof postmortem argan donars is investigated, and
the causes of clinical brain death assessed. In 85% of the cases the cause was
severe head injury, due to trauma (c. 35%) or a cerebrovascular accident, most
frequentlya subarachnoid hemorrhage (c. 50%). The incidence of clinical brain
death in these hvo groups has decreased because of improved sociodemographic
circumstances and therapentic modalities. In traumatic brain injury clinical brain
death occurs usuaUy within the first 48 hours after trauma. In patients with a
subarachnoid hemorrhage clinical brain death resnlts much later, usually in
the first three weeks after the initial bleed, due to recurrent bleeding or delayed
cerebral ischemia. Each year between 135 and 220 patients younger than 70 years
die within the first h\'o weeks after admission for a subarachnoid hemorrhage.
Approximately 400 patients die each year in the first two days after admission for
traumatic head injury. It has however not been determined how many of these
patients die due to clinical brain death.
Care of patients with severe traumatic head injury or snbarachnoid hemorrhage
should be concentrated in hospitals with neurosurgical facilities. The
potential for non-heart beating kidnel' donors mal' be considerable, although an
accurate estimation is difficult. This type of donation strongly depends on cooperation
of the hospital personnel. lnformation for smaller hospitals concerning
organ donation should focus more on possibilities for non-heart beating kidney
donation.
In c1/apter 11 the soeiaUy relevant aspects of postmortem organ donation are
discussed. The information imparted by the government, concerning the institution
of the central donor registration is criticaIJl' analyzed. It is concluded
that the information provided is insufficient to pennit careful decision making.
The consequences of organ donation for the human body and integrity are
nuther discussed. Exclusion of persons bel on ging to so-called risk groups, snch as
f.L for HIV infection, from organ donation has caused much discussion in 1998.
Exclusion of patients trom such subgroups, as weU as because of other diseases, is
discussed. It is concluded that the risk of stigmatization and discriminatioIl, resulting
from exclusion of snch risk groups, is nearly unavoidable. The moral basis for
postmortem organ donation is analyzed. HumanitarÏan solidarity, in the sense of
willingness to take over part of existantional risk of other human beings, forms
the basis for the moral acceptance of postmortem organ donation. Finally, the
consent for organ donation given by relatives is addressed. The frequently
commended Spanish model is analyzed and found to be moraU)' incorrect on
manyaspects.
414 SUMMARY