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Psychosomatische Aspekte der Leberlebendspende

Psychosomatic aspects of living donor liver transplantation

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Zusammenfassung

Die Methode der Leberlebendspende bietet die Möglichkeit, der Organknappheit und der damit verbundenen Wartelistenmortalität entgegen zu wirken. Das zentrale ethische Problem der Leberlebendspende liegt in der Gefährdung eines gesunden Spenders mit dem Ziel der Verbesserung der Lebensqualität des Empfängers. Um die psychische Gesundheit des Spenders nicht zu gefährden, sollte eine psychosomatische Evaluation der Spender stattfinden, die neben der Bewältigungsfähigkeiten und der Stabilität des Spenders auch dessen Freiwilligkeit feststellt. Hierfür ist eine ausführliche Aufklärung des Spenders über das Verfahren notwendig. Realistische Erwartungen an die Leberlebendspende, familiäre Beziehungen, die nicht extreme Konflikte beinhalten, eine ausreichende Autonomie in der Spender-Empfänger-Beziehung sowie eine soziale und familiäre Unterstützung werden als Prädiktoren für ein günstiges psychosoziales Outcome für den Spender angesehen. Die Lebensqualität vor und nach der Spende ist ähnlich oder besser als die der Allgemeinbevölkerung; bei einer Gruppe von etwa 13% der Spender können psychische Komplikationen auftreten. Weibliche Spender, Spender mit eigenen chirurgischen Komplikationen oder unrealistischen Ergebniserwartungen sollten unbedingt eine psychotherapeutische Unterstützung erhalten, bevor diese zur Spende zugelassen werden. Die dringliche Spendeindikation beim akuten Leberversagen und die Spende der erwachsenen Kinder für ihre Eltern stellen besondere Belastungsfaktoren dar. Diese Konstellationen sollten, wenn möglich, zum Schutz des potenziellen Spenders vermieden werden.

Abstract

Living donor liver transplantation (LDLT) offers the option to reduce organ scarcity and thereby waiting list mortality. The crucial ethical problem of LDLT is the fact that the well being of a donor is being jeopardized for the improvement of quality of life of the recipient. To preserve mental health of the donors, psychosomatic evaluation should be conducted including examination of the coping capacity, the mental stability of the donor and the voluntary nature of the donation. Thus a comprehensive disclosure of information to donors is necessary. Realistic outcome expectations, family relationships without extreme conflicts, sufficient autonomy of the donor-recipient relationship and social and familiar support are predictors facilitating a favorable psychosocial outcome for the donor. Before and after LDLT the health-related quality of life of the donors is similar or increased in comparison to the general population. Psychiatric complications following LDLT can occur in 13% of the donors. Female donors, donors who have surgical complications themselves and donors with unrealistic outcome expectations should be given psychotherapeutic support before they are admitted to living liver donation. Urgent indications in the case of acute liver failure and the donation by adult children for their parents are particular stress factors. For the safety of the donor, these combinations should be avoided whenever possible.

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Authors and Affiliations

  1. Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Essen, Virchowstraße 174, 45147, Essen, Deutschland

    Y. Erim, M. Beckmann & W. Senf

  2. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland

    G. Gerken & S. Beckebaum

  3. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland

    A. Paul & S. Beckebaum

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  1. Y. Erim
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  2. M. Beckmann
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  3. G. Gerken
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  4. A. Paul
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  5. W. Senf
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  6. S. Beckebaum
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Correspondence to Y. Erim.

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Erim, Y., Beckmann, M., Gerken, G. et al. Psychosomatische Aspekte der Leberlebendspende. Chirurg 81, 820–825 (2010). https://doi.org/10.1007/s00104-009-1876-8

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  • DOI: https://doi.org/10.1007/s00104-009-1876-8

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