Recultivating Intensities

RECULTIVATING INTENSITIES

A Xeno-Organ Breeding Station

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LIST OF CONTENT

INTRODUCTION .......... p. 08

MEDICAL STATUS QUO .......... p. 16 ARCHITECTURAL STATUS QUO .......... p. 32 HOSPITALS IN THE PAST AND THE SHIFT TO MODERN CLINICS .......... p. 44

TRANSPLANTATIONS IN EUROPE .......... p. 50

THE SITE .......... p. 58 PROPOSAL FOR THE BUILDING

.......... p. 70

THE PROJECT .......... p. 90

Physical Modells .......... p. 150 List of refrences .......... p. 158 Register of illustrations .......... p. 160 Acknowledgments .......... p. 161 Appendix “Work in Progress” .......... p. 162

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INTRODUCTION One of the achievements in the evolution of our society is, without doubts, the modern medicine with its highly developed methods of expanding lifetime. During the last centuries, the understanding of the connections between bacteria, viruses and human developed; caused a significant increase in peoples’ lifetime. The invention of the first medical devices, like microscopes made it possible to discover a new microcosmos within our body. Step by step sience started to decode the structure and the internal as well as the external relations of the human body.

But where is this movement coming from? Is it because us humans want to satisfy our inquisitiveness or do we just want to play God? Or is it simply because we can?

Whatever! Through the resources medicine is offering today, we are able to expand our life span significantly compared to former generations. We are able to do some kind of doping with medication which gives us a better quality of life. But whilst doing this, we cannot stop the ageing process of the smallest bits of our human organism - the cells.

As time goes on our body grows older and our cells lose their ability to renew themselves by splitting. This we first recognise in our body‘s decreasing ability to heal small wounds. Later on, our body becomes less powerful and we have to struggle with a couple of

problems - arteries burst, veins constrain and organs fail. Gradually, somehow like a neglected building, parts inside our body start to crack and crumble. These parts, every single one working like a machine fulfilling its task, are all interconnected, working hand in hand, forming together a powerful but fragile system which keeps our organism working.

Due to the fact that humans live longer, our organs more and more tend to fail. At the same time in our lifetime, we are exposed to quite unhealthy circumstances of living. Stress, unhealthy nutrition habits, less exercise and last but not least drugs, which on one hand help but on the other hand cause side effects which harm our organs, are permanent companions in our lives.

This natural failure of organs and homemade methods of weakening our body, also cause organ failures, causing the need of replacements to be able to extend our life span again.

Leaving out of consideration whether we see ourselves in the role of the insane Dr. Frankenstein or in competition with God, in fact we have reached a point, where we are able to intervene in the evolution by manipulation. This progress can lead to something positive as well as to something negative. And also, the positive developments in modern medicine bring along negative side effects. p. 8

We’ve started with the ability to reconstruct the way the human organism works and how the different parts are interlocked and work together. Since then the body became segregated in pieces and units. Methods were developed with the aim to satisfy our needs and desires (see Žižek 2004, p.123).

This development pushed us to the limits of our ethical appreciation, when physicians started to experiment with transplantations of human tissue. Now science is confronting us with facts, which are quaking our ethical foundations again. Whereas in the past the main question was, if it was ethically acceptable to exchange natural human tissue, grown under mystical circumstances which, we couldn‘t yet decode and therefore assumed to be given by God, today our basic understanding of „natural“ and „artificial“ is put to the test.

During the last decades our attitude concerning our body metamorphosed to „one is not being its body one has the body“ (see Žižek 2004, p.121). In the past our understanding was that we only have one body for a lifetime so we have to look after it. This let us act in a way where we take care about the capabilities of our body and its self-recovery. In contrast, modern medicine helps us to dope our body for longer or shorter periods by combating the symptoms instead of giving our body p. 9

the chance to recover. We rather act, as it is typically for our throwaway society, in the very naive way that in the worst case we simply exchange faulty units by functioning ones.

The scientific world is going crazy, magazines publish articles about rats’ hearts or lungs getting transferred from rat „A“ to rat „B“ by replacing the cells from rat „A“ by cells from rat „B“, eluding the risk of that the organ is rejected.

Furthermore, reading scientific articles about being able to extract DNA on the level of a stem cell from a single skin cell and being able to grow any kind of tissue out of it, makes it as comfortable for the future as hearing spooky news from scientist being able to grow miniature brains out of cells which have never been on the level of stem cells. While it is already possible to measure communication activities between brain cells, the only reason why they are not yet intelligent is because they have no input from sensors like our ears or eyes .Scientist say the size of those brains is limited to just five millimetres in diameter. Although those achievements are staggering, the developments, especially those which are still kept secret, have to be considered from a critical point of view as well.

The possibilities of exchanging organs or body parts have already brought and will bring more changes for the common perception of our bodies. New definitions of natural and artificial have to be found as well as all of the stages in between, which could be called „nat-ificial“, „naturally grown“, „naturally“ or „artificially based“, „BIO“,...

Due to those sensitive aspects one question might be arising to our society:

This topic and its possibilities are far too important and valuable to put back into the drawer just because they cause difficulties. Nowadays, our society is confronted with manipulations on a daily life basis and since we know about the scientific modern, we cannot go back to our old ideology, ignoring new possibilities (see Žižek 2004, p.126). The urge for knowledge, as an important human habit, brought us to the point we are at today: This stage of evolution, where we can steer evolutionary processes, might be a revolution.

„Should or shouldn’t we use our knowledge and possibilities to manipulate our bodies in this way?“ I think this question can be answered with another question. If you were suffering from heart failure, dragging around a trolly with a machine keeping your blood moving through your veins, connected to it 24 hours a day, 365 days a year, unable to play soccer with your son or going ice skating with your daughter - wouldn‘t you like to live a normal life again by getting a working heart?

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Fig. 01

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... We inhabit an age of CIRCULATING FLESH. Organs are extracted from one body and are implanted into another body. Limbs that are amputated from a dead body can be reattached and reanimated on a living body. A face from a donor stitched to the skull of the of the recipient becomes a THIRD FACE. A skin cell from an impotent male can be recoded into a sperm cell. More interestingly a skin cell from a female body might be recoded into a sperm cell. HYDRAULIC HEARTS circulate blood without beating. A heart without a heartbeat. A cadaver can be preserved forever through plastination whilst simultaniously a comatose body can be sustained on life-support systems.

The brain-dead have beating hearts. Dead bodies need not to decompose, and near-dead bodies need not die. Death now means to be disconnected from technology. The dead, the near-dead, the not-yet born and the partially living exist simultaneously. And cryogenically preserved bodies await reanimation at some imagined future. We live in an age of the CADAVER. the COMATOSE, the CRYOGENIC and the CHIMERA. Liminal spaces proliferate. Engineering organs through stem-cell growing them or Organ printing them will result in an abundance of organs. An excess of organs. Of organs awaiting bodies.

OF ORGANS WITHOUT BODIES Third Hand / Third Face: Alternative Architectures; Stelarc (Stelarc, http://stelarc.org/_.swf [14.11.2013])

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Stelarc “Natural vs. Virtual” Stelarc, a performing artist, is trying in a rather provocative way to interlock natural and artificial evolutionary processes. He is not only replacing parts of his body but by attaching machines, extensions, artificial organs to himself, he is becoming some kind of cyborg, with new abilities and connexions to the new, interconnected world. By his attitude of „a prosthesis is not seen as a sign of lack but rather as a symptom of excess“. The „Ear On Arm“ project developed in a process of becoming from a simple nonfunctional implant to a functional body part. It is able to record the surrounding sound wherever Stelarc is and transmitting them via internet all over the world. So Stelarc is adding new features to his body which is, as he says, „... biologically not well organised“.

Of course he is pushing the boundaries of understanding our body to the furthest limits but within his work he is describing the total opposite of what Gillez Deleuze & Feilx Guattari describe in „Body without organs“.

The schizophrenia, when the body without organs disconnects itself from all the connexions and dissolves the organism, which is seen as an external hull, wedging the organs in a predefined corset of functions and streams.

Connecting his body to the rest of the world via internet, Stelarc becomes the body with unlimited organs.

Transmitting and receiving information and intensities via a virtual network to and from outsourced organs, revoking the limits of the body and its reach, this can be seen as a final step of interconnection. p. 14

Fig. 02

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Fig. 03

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MEDICAL STATUS QUO

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first successfu California, USA

first suc

Paolo Mac Barcelona

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first skin transplantation between two living persons Jaques Lous Reverdin Switzerland

first skin transplantation from a dead person blood groups discovered

Karl Landsteiner Vienna, Austria

first successful cornea transplantation Eduard Zirm Austria

first kidney transplantation from an animal to a human France

first kidney transplantation between two humans the kidney failed after two days Yu Yu Voronoy Russia

identification of the immunological process of tissue rejection Peter Medawar United Kingdom

first cadaveric kidney transplantation

Boston, USA

first successful pancreas transplant the organ comes from a dead donor first multiple organ donor

Minneapolis, USA

Texas, USA

ul animal-to-human heart transplantation

First artificial heart for long-term use implanted first successful transplantation of a living-donor liver

model Jarvik-7 William DeVries Salt Lake City, USA

first successful kidney transplantation between two identical twins David Hume, Joseph E. Murray Boston, USA

first successful transplantation of a lung James Hardy Jackson, USA

first successful liver transplant first successful human heart transplant Christian Bernard Cape Town, South Africa

Thomas Starzl Aurora, USA

first successful heart-lung transplantation Norman Shumway, Bruce Reitz Palo Alto, USA

first successful bowel transplantation from dead and living donors

first successful transplantation of a hand New Zealand

ccessful transplantation of a tissue engineered windpipe

cchiarini a, Spain

first partial face transplant

France

first production of lab grown brain cells

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J端rgen Knoblich Vienna, Austria

first lab grown organ (human bladder) Anthony Atala North Carolina, USA

first production of Induced Pluripotent Stem cells from human cells Shin'ya Yamanaka Japan

MECHANICAL ASSISTANCE DEVICES Early machines, like the “Iron Lung”, were invented in the 1830’s and reappearing in the 1950’s polio epidemic. The iron lung helped patients with lung failures by applying low and overpressure to the chest and by this keeping their breathing movement.

More modern devices like dialysis machines or pumps, located mainly outside the human body but connected to the organs inside the body, illustrate the medical progress of understanding our body and improving it, when it fails its purpose. A high risk of infections at the threshold of inside and outside the body and the need to be connected to those machines in certain intervals or carrying them along all day long, produses massive restrictions in the patients’ daily life.

The corollary was the development of mechanical implants, which are completely inside the body. This was leading the scientist and engineers into the line of mechanical implants. Simple and well working devices like pace makers are daily practise now, but the will to replace natural organs with little machines turned out to be much more challenging. With a quite high amount of financial resources we were able to develop mechanics with almost the same size as the original natural organs. Nevertheless those are still lacking the body’s unique ability of renewing parts in consequence of attrition.

The newest, medically promising but still very cost intensive devices are a combination of mechanics and natural heart valves out of grown tissue. p. 20

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3D PRINTING Developing mechanical devices, which act in a field ranging from rather rudimentary pumping mechanisms outside the body to highly sophisticated filtering systems inside the body, exposed to be very cost intensive and still are limiting the living quality of the patients.

The best replacement for human organs are obviously human organs, but due to the lack of necessary medical facilities, legal regulations or because of religious discrepancies, a global shortage of human organs is given. While somewhere between political and very questionable capitalistic circumstances the black market takes care of this problem, scientists in the western hemisphere have developed ways of growing cells and human tissue outside the patient‘s body. For this process, some healthy cells of the tissue get removed and placed on a nutrient bed where the cells start to split and grow tissue, which then can be transplanted to the patient. Bio materials, such as polymers, metals or ceramics often get used to bring the cells in a certain shape, for instance for hollow organs or pipes.

One promising way of reproducing human organs is 3D printing. The medium of 3D printing also took over the medical sector with its possibility of industrialising the production of tissue within a very short timeframe.

Instead of normal 3D printer’s plastic, the medical one prints a lotion of human cells mixed with a nutrient gel.

While in theory this seems to be the key, the industry is still struggling with the printing resolution of the devices. The accuracy is not high enough to print the very thin blood vessels within solid organs like kidneys.

So this technology is rather used for printing certain shapes out of bio material to cultivate cells on them.

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ABOUT DNA AND STEM CELLS While it is relatively easy to cultivate a single cell type on a piece of biomaterial, it poses a challenge to grow organs due to their sophisticated combination of different tissues with different behaviors.

Until now scientists, have used a certain celltype which is needed for the wanted tissue, requiring remnants of healthy tissue being left. Otherwise they needed stem cells which caused a couple of ethical and science political discussions and legal limitations for the work with stem cells were released. To be able to grow organs with the best cell material possible the cells have to be as young as possible. This would implicate working with embryonal stem cells which is forbidden for ethical reasons. To understand this, one needs to know that the stem cells which develop during the first four times of splitting are called “omnipotent stem cells”, and contain the whole human genotype.

With these first 16 cells it would be possible to clone an entire human being. From the fifth time of splitting onwards the stem cells, now called “pluripotent stem cells”, are able to differentiate into every type of cell but it don’t contain the human genome and aren’t able to produce a clone.

Due to environmental impact, cells tend to mutate the older they are which is why scientists try to use cells as young as possible and in a very early stage of development. In the past this meant to get embrionic

stem cells of a pluripotent level which wouldn’t be possible without harming the embryo, causing ethical and religious descussions.

In 2007 the Japanese doctor and scientist Shin’ya Yamanaka achieved to reprogramme adult human cells by transdifferentiation, bringing normal cells back to pluripotent level which then allowes to grow any kind of human tissue out of it. For this achievement, the so called “induced pluripotent stem cells” (iPS cells), he and his colleague John Gurdon got awarded with the Nobel Price for Medicine in 2012.

Due to the fact that no ovum is needed and no embryo develops, this field of research developed significantly since 2007.

As an example in may 2013 Jürgen Knoblich, Senior Scientist & Deputy Scientific Director at the Institute for Molecular Biotechnology in Vienna presented miniature brains produced from scratch with iPS cells.

These brains already showed neuronal activities and the cells were communicating with each other. The only reason they were not acting in a “intelligent” way was because they got no input as our brain gets from our senses.

The next step scientists are currently working on is to achieve a direct conversion from skin cells to neuronal cells without going back to the pluripotent level of the cells, which already worked in early experiments. p. 24

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RECELLULARIZATION Due to the fact that we don’t have the machines and the abilities to build a whole organ with sophisticated structure and layering of different cell types, the most promising way to counteract the shortage of organs is recellularization. The core of this method is, to take a human or an animal organ and exchange the donor’s cells with the recipient’s own cells. By doing this one eludes the immune response of the recipients body against the new organ. Furthermore, since it is the recipients own tissue that’s transplanted, the recipient will never have to take immunosuppressiva which increases the life expectancy after a transplantation.

Nowadays immunological tests have to be done previous to the donation in order to figure out if there is a recipient with only a small immunological difference so that the body, in combination with immunosuppression, won’t reject the organ. If the risk is too high and there is no matching recipient, the organ cannot be transplanted and decays.

With recellularization every organ can be used. The realm of available organs also is extended to nonhuman organs as a basis for new ones.

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One of the key processes of recellularization is sodium dodecyl sulfate, which gets pumped through the vascular system of the donated organ. It acts as a detergent and separates the cells of the donor from the scaffold, which is made out of proteins and collagen giving the organ its shape. Within a few hours, one can see that the organ becomes white and after few days all cells are washed out. Due to this, the whole vascular structure with all its filigrane branchings remains and becomes the supportive structure for new cells. Since the proteins themselfes behave like a biomaterial and don’t evoke immunological refusal this whitish translucent scaffold is the ideal base to cultivate new cells on.

When all cells are removed, one starts to inject cells which are already cultivated out of iPS cells and partly defined. For instance muscle cells, of the recipient.

Because it’s not possible to put every single species of cells into the correct place, a solution of precursor cells and nutrients is pumped through the vascular system.

Those cells of an early level of development can become any kind of tissue and through the shape of the scaffold the cells automatically place themselfes at the right spot and develop into the desired cell type.

After bringing the cells onto the scaffold the entire organ gets positioned in a hermetically sealed bioreactor, which is completely disconnected from the environment to ensure a sterile environment inside.

The organ floats in a nutrient liquid, a nutrient gets pumped through the organ and the muscle tissue is electrically stimulated to “teach” the cells how to act.

After a timeframe of a couple of days up to a few weeks the organ is ready to be transplanted.

STEP 1 Perfusing with detergent to wash out the donor’s cells until a proteine scaffold is left.

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STEP 2

STEP 3

The recipients precursor cells are pumped through the proteine tissue and muscle cells are injected.

Electrical stimulation helps the heart muscles to contract and a pulsing flow of nutrients forces the heart to beat.

HOUR 0

HOUR 8

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Even if this whole process seems like some kind of science fiction, in today’s medical routine experiments, on rats worked promisingly and transplanted hearts, lungs and kidneys did their job at least for a couple of hours or with reduced power.

As it seems today, the next step in this developement will be using machines which are able to print this proteine scaffold as a copy of the original one, based on a CT scan. As usual all this technology which could be able to fulfil this task already exists in other scientific fields but transforming it into medical use still presents a huge challenge.

If this works, it is possible to produce organs on an industrial scale which gives us the chance to bring the world wide shortage of organs to an end.

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ARCHITECTURAL STATUS QUO Technical infrastructure became more and more present in almost every part of our built environment Whereas in the historic landscape of our built environment the infrastructure was heavily visible due to the enormous spacious requirements until the modern times when our environment became cleaned with the help of modern technology - and so did the architecture during modernism.

True to the motto „Less is more“, architecture was reduced to an arrangement and stringing together of simple rectangular shaped spaces with certain qualities.

As few elements as possible should distract from the architecture’s cleanness and the needed infrastructure was hidden.

An attitude which is, probably found in the clients’ requirements, still rooted in to todays building culture. p. 33

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During the 1970’s and the 1980’s some projects were realized which are describing a paradigm shift in the handling of infrastructure as an architectural element.

Reversing the classical approach and turning the technical and infrastructural spine of a building inside out made the Centre Pompidou, finished 1977 by Renzo Piano and Richard Rogers. The best known example of revealing the infrastructure on the facade.

The infrastructure became a concise part of the building’s appearance and an architectural element.

It is an honest architecture, where the technological effort for the space’s function and the space are visually linked.

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The Lloyds Building in London, build by Richard Rogers in 1986, is following the endeavour for an open floor plan in an office building. The whole infrastructure including staircases and elevators in a clean and robust metal cladding are symbolizing the high tech ambitions of architecture at this times.

The inversion of the conventional way designing architecture shows components of the building which are normally hidden. Through rational and functional arrangement of pipes, access system and statical elements outside the building, all these systems become architectural elements pushing back classical design elements. The facade as the weatherproof surface and spatial boundary is acting in the background - the aesthetics of the building is made of clearly aligned hierarchical systems which give the appearance of a naturally grown conclusive organism. p. 36

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Günther Domenig’s Zentralsparkasse in Vienna (completed 1979) demonstrated a less technological but rather artistical approach. Compared to the buildings surrounding it clearly distinguishes itself with its dynamic facade made of metal panels.

„Die sowohl Aussen als auch Innen konsequent ablesbar belassene Technologie des Bauwerkes ist künstlerisch zur biomorph-gleichnishaften Erscheinung von Knochen, Sehnen, Häuten, Schuppen, Röhren und Adern transformiert. Auf diese Weise bildet das Bankgebäude einen organhaften Körper mit eigener ästhetischer Dichte und Geschlossenheit, der als Symbol lebenszugewandter Aktivität die Menschen anspricht und in seine dynamischen Raumkonzeptionen einlädt.“ – Univ. Doz. Hofrat Dr. Werner Kitlitschka (http://venyoo.de/veranstaltungsort/74723/galerie-im-domenig-haus-wien, [14.09.2014])

Like in conventional buildings, the infrastructure is installed inside the building but installed visible in a more dynamic and less organized appearance. p. 38

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Tom Wiscombe is working on implementing emergent systems into architecture using digital design tools. By integrating natural logics, his designs are freed from a rectangular grid and the systems become more optimized in terms of structural behavior instead of a simple way constructing it.

The surface articulation, the relation between interior and the architecture as a set of interactive whole objects are key elements of his architecture.

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„… Like tattoos on the body, figuration on building skins can simultaneously interact with underlying form, but also deviate from it, creating unexpected scale effects and links between architectural objects.“ - Tom Wiscombe (http://www.tomwiscombe.com/about.html [21.09.2014])

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A different articulation of a possible connection between functions or parts of a building and the design of the facade is visible at Nakagin Capsule Tower, built by Kisho Kurokawa in 1972 in Tokyo. It shows a repetition of a single type of capsule which is connected to an infrastructural core comparable to a plug in system.

This capsules are the physical border between inside and outside and predefine the visual appearance of the building.

Frano Gotovac, a Croatian architect based in Split was commissioned in the 1970’s to develop a housing project in Split 3, at this time a new development for the city’s extension. Within the boundaries of the city’s regulations he designed a building - the so-called „Cruiser“ - with cantilevering parts and parts stepping back from the facade. The flats are organized as a mix of 5 different units, which are arranged alternately causing a dynamic facade due to the different types of flats becoming visible on the outside. The building as a whole with it’s sculptural design and the facade has a very Tetris-like and naturally grown appearance.

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HOSPITALS IN THE PAST AND THE SHIFT TO MODERN MEDICAL CLINICS The beginnings of medical care go back as far as the first human civilizations. In Europe the shift to a system like the one we are familiar with today started by the end of the 17th century. During medieval times, hospitals rather were a hostel for diseased pilgrims or people at the edge of the society, which were treated according to the christian love. Religious orders with their monasterial facilities ensured some kind of network of sanatoriums and the orders’ monks and nuns treated the patients mainly with natural medicine from their herb gardens, and prayers.

The spaces for the patients were huge poorly ventilated halls, where up to 60 people were sharing beds. This supported the transfer of diseases and slowed down the process of recovery.

The old „Allgemeine Krankenhaus“ in Vienna is an example of the shift from an almshouse to a modern hospital. In 1784 emperor Joseph II reopened the facility as a hospital, which should only be used for the recovery of diseased people. The design included smaller rooms for the patients. Every patient had his own bed and the facility had big open spaces for fresh air.

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Another example of the new way of health care is the St. Jacob hospital in Leipzig, which was newly built at the beginning of the 19th century. Through the new way of making diagnoses, it was possible to arrange separated areas for different groups of diseases, making it possible to prevent an uncontrolled sprawl of diseases all over the hospital. Therefore the St. Jacob hospital was organized in different buildings for different clusters of symptoms, which established some kind of specialization and hindered the sprawl of different diseases over the hospital. The single buildings themselves were connected to each other with a network of hallways.

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OLD MONASTERIAL PART OF THE HOPSITAL

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In the past, the Ospedale Civile SS. Giovanni e Paolo di Venezia in Venice was a monasterial congregation until it was terminated in 1808 by Napolen. After serving some years as an Austrian military hospital, it became a public hospital in 1819.

Today there are still parts of the hospital which are housed in the old monasterial building which offers, due to the arcades with patios and enormous ceiling heights with vaults, a completely different experience of spatial qualities in a hospital than we are used to today.

Disconnected from the occurrences outside, the patios with the gardens create some kind of calm green island between the hospitals activities and a rather dense city.

Alvar Aalto’s Paimio Sanatorium in Finland, which was built due to the increasing number of tuberculosis patients, was completed in 1932 and salready hows a new style of hospital architecture. Inspired by modernistic architecture, it has features like roof terraces and ribbon windows, which offered a high amount of natural light inside the patient rooms and open spaces. Due to the long stay in this sanatorium - sometimes expanding up to several years - Aalto tried to give every patient’s space a personal and unique quality. This started with having rooms with only two beds, where every patient had his own sink and an individually designed bedside table.

He also offered terraces and balconies for the fitter patients as well as paths through the forest surrounding the facility, to include the factor of moving through nature into the healing process.

The complex itself, with its buildings parts sprawling into the landscape, was already a step in the direction of stacking floors with similar functions as it is common today. High thin parts, oriented to the south, house the patients’ rooms and the sun balconies whereas the infrastructural and medical spaces are situated in the lower wings in the north.

When the number of patients decreased after the disease was virtually eliminated due to the treatment with antibiotics, the sanatorium was converted into a general hospital.

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TRANSPLANTATIONS IN EUROPE

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Today there is a worldwide shortage of organs for necessary transplantations, although it is a much more discussed topic in developed countries. One needs to know that in the industrialized countries, we have a well organized donation and transplantation system compared to third world countries, which don’t have such a well developed medical care system.

Another reason for not performing transplantations are religious discrepancies between the medical knowledge and the particular confessions. Compared to the Christianity and Islam, where a donation is seen as an act of benevolence, the buddhist process of dying is seen as a path, which shouldn’t be interfered with any human being, since they have no clear religious statement as to when the soul of a human gets separated from its material body.

For instance in countries like Austria or Spain, which have a relatively high amount of transplanted organs, every person is inherently a potential organ donor if he or she dies in an accident. If someone doesn’t want to have his or her organs harvested after death, this person needs to state this will during their lifetime. This dissent regulation of course leads to a much higher amount of potential donations than the consent regulation, which is for instance used in Germany, where everybody who wants to donate his/her organs after death, needs an organ donor card, which indicates the person as a potential donor to the doctors.

But also within the European Union there are big differences, which are caused on one hand by the different legal regulations for harvesting organs and on the other by medical and infrastructural backlogs. p. 52

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The medical indications of the donor and the recipient must be as equal as possible. When the risk of the medical procedure and a probable rejection of the organ is too high, not every donated organ can be transplanted.

Therefore, the merge of multiple countries’ organ databases increases the number of listed recipients, the probability to find the right recipient for an organ and allows for a more efficient use of the organs.

But there are still areas in Europe where the statistics show an almost unnoticeable amount of transplantations. In the countries of former Jugoslavia, which are mainly still recovering from the wars in the 1990’s, the organ donation system lacks in a couple of necessary areas. First of all, the medical system and the accessibility to medical treatment is behind the european average. There are also no legal regulations, for legal aspects of a donation system. Furthermore the possibility of donating organs is not well established in people’s minds - especially in rural areas, which are still economically struggling.

Croatia has, due to its geographical situation, a certain and important role within the balkan countries. As the southernmost country of the Eurotransplant incorporation, it has access to a broad variety of organs and with its long coast, reaching far into the south, it is able to offer the possibility of taking care of the under developed countries further in the inlands of the balkan area. Already today, Croatia is acting in this way and therefore has one of the highest numbers in the european organ transplantation statistics.

At the moment organ transplantations are performed in the capital Zagreb, Osijek and Rijeka which means that recipients from countries like Bosnia or Serbia still need to take a long travel. Distances can be a reason for getting a new organ or not, since organs can only be preserved for a couple of hours and the recipients need to find their way to the hospitals in a determined, short period of time. Therefore the project is situated further in the south, to be able to provide medical treatment to a broader set of people. p. 56

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THE SITE Due to the fact that the only three cities where transplantations are performed are situated in the north of Croatia, the choice for another possible clinic fell onto a city further in the south. Split, the capital of Dalmatia, with its metropolitan area, is the second biggest city in Croatia and and southern center of university and medical knowledge.

Down in the south, where Croatia becomes narrower and the borders to Bosnia and Montenegro get close to the mediterranean sea, Split is due to its well developed network of transportation the logical choice for a transplantation clinic. The highway leading further to the south is passing by the city in a 12 kilometer distance. As a former industrial city, Split is the southern most city in Croatia which is connected to the railway network. 15 kilometers to the east of Split, close to Trogir, Split International Airport, the biggest Croatian airport in terms of passenger numbers, is situated. As a port city, it has (beside the industrial ports) a harbor for the ferries heading to the islands off the coast and to Italy.

In the case of this transplantation clinic where the organs are, due to the preceding process of washing out the cells and recellularization, not transplanted in such a hurry, the connection to a well developed network of transportation possibilities might not seem to a be too influental parameter. Nevertheless, a good connection is necessary to ensure patients are able to reach this institution. p. 58

HUNGARY

AUSTRIA

Varazdin

ljana/ to Ljub ste Trie

to Ljub

ljana

Bjelovar Ivanic Grad Velinka Gonca Sisak

KARLKOVAC

Kutina

Crikvenica

OSIJEK

Nasice

Vukovar

Pakrac

Novska

Glina

Bell Manastir

Donjl Miholjac

Podravska Slatina Daruvar

Vinkovci

Pozega

Slavonski Brod

Nova Gradiska

Ogulin

Zupanja

Backa Palanka

to Belg

rade

to Saraje

Bosanski Novi

Labin Pula

Virovitica

ZAGREB

Samobor

RIJEKA

Rovinj

Cakovec Koprivnica

Ljubljana

Opatlja

B

to

to Budapest

to Graz

SLOVENIA

st

pe

a ud

Senj Otocac

vo

Gospic

BOSNIA AND HERZEGOVINA

Gracac ZADAR

Knin

Sarajevo Sinj

o

SPLIT

to

Makarska

Sa raj ev

SIBENIK

Ploce

MONTENEGRO DUBROVNIK

Highway Railway p. 59

Pogorica

SPLIT AIRPORT

TROGIR

p. 60

SPLIT 43°30’N 16°26’E CITY POPULATION: ~180.000 METRO POPULATION: ~350.000 AREA: 79,38km2

p. 61

MAIN ROADS SHIPPING ROUTES RAILWAY

RECREATION & LEISURE INDUSTRIAL HISTORICAL CITY CENTER HEALTH CARE

The city of Split is situated on a peninsula with the industrial harbor in the northern bay. Further to the north the 1300 meters high „Mosor” mountain chain separates the coastal area from the hinterlands. The harbor with its wharfs is, beside the tourism, one of the most important economical motors for the region.

A relict from the turbulent history of changes of different national belongings is the historical city center with the Roman Diocletian’s Palace from the fourth century AD. This tourist attraction, which is stated as UNESCO World Heritage, in combination with the historical town around it and the waterfront, is the main reason for tourists to visit Split during summer time.

For the local population a small hill called „Marjan“ acts as a nearby recreational space. The nearly 180 meters elevation encompasses a protected park with around 400 protected plants and provides a view over the city and how it is situated in the landscape. Beside Marjan the entire littoral in the south with its esplanade and the beaches is a popular destination for the people on weekends or in the evenings.

GSEducationalVersion

p. 62

p. 63

0

125

250

500

1000m

N

JANUARY DECEMBER

30

FEBRUARY

25

20

Investigations and research in environmental aspects of the recovery process of humans have shown that not only green as a color helps to create a soothing atmosphere but also green vegetation has a positive influence on the speed of the healing process. Although the mountains out of karstic limestone around Split are barely vegetated, due to its location relatively far in the south, Split has a mediterranean climate with moderate winters and also, during wintertime, there is green vegetation in the coastal areas.

The site for the clinic itself is situated to the south east of the city’s center, where, with the university hospital and the general hospital, todays quarter for healthcare is located. Surrounded by concrete residential towers, which were constructed during the 1970’s, this area has a noticeably different, chaotic layout of spatial planning. Wedged in between a compartmentalized small scale development in the west, orthogonal big scale concrete towers in the north and some kind of neglected structural steppe in the east, this quarter has not yet found its identity.

Close to the sea but still separated by a 30 meters high embankment, the actual site is situated on top of a small elevation in this area, which is used as the helicopter landing zone for the hospitals. Hidden by the dense vegetation, the site is barely visible from the beach down in the bay. The lifted position offers a quiet, protected space with a great view into the landscape and the islands in the distance.

NOVEMBER

MARCH

15

10

5

W

APRIL

OCTOBER

SEPTEMBER

E

MAY

AUGUST

JUNE JULY

S

WEATHER IN SPLIT AVERAGE HOURS OF SUN [h] AVERAGE MINIMUM TEMPERATURE [°C] AVERAGE MAXIMUM TEMPERATURE [°C] AVERAGE PRECIPITATION [1/4 mm] AVERAGE WIND DIRECTION [%]

p. 64

HOSPITALS MIXED USE SITE 0 10 25

p. 65

50

100

200m

p. 66

p. 67

p. 68

p. 69

p. 70

PROPOSAL

p. 71

DESIGN CONCEPT The proposal for a design strategy is a system, which is addressed to the infrastructural aspects of the body and a hospital. The architecture of a hospital and the human body share a lot of similarities in terms of their topological structure, of their units and functional spheres. But still a human body, with all its requirements and capabilities, would look different, if it was planned by mankind from scratch because our human, rather rational, logically structured understanding of our environment distinguishes essentially from how evolution has evolved. Nowadays we have reached a level of understanding, where we are able to observe the smallest parts within our body, cultivating them and reproducing body parts in a semi-artificial way.

Contrary to this development our way of constructing, organizing and in the end building hospitals made an evolution from an open and spacious agglomeration of buildings to a compressed, spatially structure out of boxes, perfectly nested into each other. Of course there

are reasons for optimizing travel distances or reducing the footprint within an urban environment but by doing this, mostly the building itself lost architectural qualities.

Historical hospitals were a cluster of buildings with open spaces in between to offer enough fresh air and to prevent an outbreak of epidemics within the hospital. This allowed visual relationships, allowing to experience the architecture also from the outside of the building, created more open or rather closed spaces and made it easier to orientate in the set of buildings.

This set of buildings were in some kind an array of organs, connected by a vascular system of paths. Every organ fulfilling a certain task is connected in a rather linear order to its predecessor and its successor.

It is not about propagating a strictly linear way of organization, but modern hospitals with their requirement of multi use of spaces, even though they are path wise almost perfectly planned, produce a lot of p. 72

back and forth as well as cross traffic. Compared to our body, the only thing which enters and exits our body through the same way is the air. All other substances we bring into our body get modified, used, filtered and discharged in a linear way.

The backside of the medal of this multi use architecture, which implies somehow a repetitive box type of planning, is a bad architectural articulation in terms of identity whereas in the human body there is nothing like a repetition. But through mutation and modification of cells, an adaptation to different functions and demands is possible.

Another point of critique of modern clinics is that they work with one of the most efficient, complex, adaptable and at the same time delicate and vulnerable organism we know and not even consider to somehow showing how they work or how the building works.

The proposal for an architectural articulation of a clinic for organ transplantation tries to liberate the built thing p. 73

from its corset of strictly functional, organizationally requirements. Similar to the human body, it should act and be stimulated by intensities, flows and movements.

Creating a circulation system of supply, use, filtration and removal which still allows an interlocked acting between the functional units, the protagonists, the organs. Freed from an architectural modularity, open spaces in between provide visual connections, easy orientation and let one experience the architecture.

Different densities of intensities, different speeds and separation of flows will be articulated. Not only circulation paths but also everted infrastructure will make it possible to distinguish certain parts by transferring the development of understanding our body into an understanding of architecture. Like under an electron scan microscope the delicate architecture should be perceived with all its layers and its complexity in a high resolution, in High Definition.

INTERNAL PROCESSES After the second world war, due to the possibilities of new technologies and antibiotics against bacteria, hospitals started to become more compact and compressed buildings. In those new types of hospitals the thresholds, which were handled by distance in the past, came closer together and new sterile ventilation systems, locks and new ways of treatment ensured a high-quality medical care within an optimized, compressed environment.

But there are not only thresholds in terms of sterility of the patients areas, operating rooms and a possible spread of diseases. In hospitals there is an enormous effort in the background of the medical care. There are thresholds between the different people within a hospital such as medical staff, the secondary staff working in the background, the patients and visitors

which all have different spatial requirements. A need for a designed separation of those user groups but still being able to offer an exchange and collaboration is also aksed for. Some groups need to work together, meet each other or are simply using the same facilities, resulting in overlapping spacial arrangements. Others have separated areas in terms of a functional or medical and sterile isolation. There is also a strict separation between the supply of medical equipment, supply of food and other consumer goods and the disposal of those goods, especially the medical equipment and contaminated materials.

Similar to a body’s tectonic, there is a very important network of paths and connections icomprised in this system of functional parts. p. 74

p. 75

PATIENTS The patient as the main person in this health facility with quite long duration of stay only enters a rather small part of the whole structure. Although the patient is using every area of the clinic, beginning at the operation rooms and ending in the normal care station as the last station, the diagram shows, that he is spending time only in a very certain and limited area, whereas a big part of the facility is only for the support of the main function of the area. p. 76

STAFF As the driving impulse of the clinic, of course the staff members such as doctors and nurses use the spaces of the facility in their entirety. Their reach of action is partly in spaces which are designed for the staff only but also overlays with the patients’ spaces.

p. 77

GOODS/ MATERIALS The materials and goods in a hospital are mainly stored in one central storage area, which acts as a supply for the smaller storages in the hospital stations. So the materials which get delivered are first stored in this main storage before they find their way to the place where they are needed. A key element in modern hospitals is to outsource as much storage as possible and to work with just-in-time delivering in order to reduce the required space.

This doesn’t only work for textile fabrics and articles for daily use but also for the sterile goods and surgical instruments, which get disinfected in an external sterilisation company instead of having this job done within the clinic.

Also the products for the hospital kitchen get delivered just in time, requiring a minimum of storage areas.

p. 78

VISITORS The visitors are the people spending the least time in the hospital and also seeing the least of the spaces and all the effort behind a clinic. The visitors’ paths are ways with a quite stringent and linear articulation without almost any cross-links.

p. 79

SPATIAL PROGRAMME Another aspect which needs to be considered is the duration of an average stay inside such an organ transplantation facility. This type of surgery usually, of course depending on the transplanted organ, demands a long time for recovery. After the surgery itself, one is under medical observation for a couple of days, in order to figure out if the transplantation was successful and the organ isn’t rejected. After the positive diagnoses one gets to do rehabilitation as fast as possible to make the new organ working in its regular way. This means that depending on the transplanted organ, a stay can take up to 6 weeks before the patient can do his rehabilitation outside the hospital and only ambulant follow-up checks are necessary. Because of this, the environment for the patients in areas where the medical requirements allow it ,need to have a rather hotel-like design, giving the patient a feeling of self confidence, strength and not being a person in need. p. 80

6h

2h

4h

AMOUNT

OF NEEDED

BEDS

LEVEL OF STERILITY

8h

S)

EEK

AY (W

F ST

O TION

A

DUR

ORGAN BREEDING (average time of breeding)

Kidney: ~16 days Liver: ~16 days Lung: ~19 days Heart: ~21 days

INTENSIVE CARE

(amount beds / average time of stay)

Kidney: 0 beds / 0 days Liver: 4 beds / 2 days Lung: 5 beds / 5 days Heart: 4 beds / 4 days

13 beds in total

NORMAL CARE INTERMEDIATE CARE

(amount beds / average time of stay)

Kidney: 12 beds / 2 days Liver: 4 beds / 2 days Lung: 4 beds / 4 days Heart: 4 beds / 4 days

24 beds in total

p. 81

(amount beds / average time of stay)

Kidney: 20 beds / 5 days Liver: 10 beds / 8 days Lung: 14 beds / 12 days Heart: 20 beds / 16 days

64 beds in total

SPAC E CHR S IN ONO LIGIC A

L SEQ

UEN

CE

DESIGN EXPERIMENTS Beside analytical research for fulfilling the requirements for a functioning hospital and a gen-lab, a second field research for the aesthetically formulation of the proposal was done.

Using the paths of flows, which could be seen as design informing intensities different ways generating fibrous arrangements were tested. Within those inspiring shapes to distinguish between two different types. One being rather compact shapes which are intertwined within a very limited compressed space and the other examples showing cross links of intertwined bundles forming knots when they are meeting each other.

p. 82

p. 83

DNA EXTRACTION

ORGAN BREEDING

100 sqm

300 sqm

DIAGNOSTIC WING 500 sqm

OPERATING ROOMS 1x60 sqm I 1x50 sqm 1x40 sqm side rooms 300sqm

INTENSIVE CARE

INTER-MEDIATE CARE

NORMAL CARE

REHAB

13 beds ≈ 7x 40sqm side rooms 280 sqm

24 beds ≈ 12x 36sqm side rooms 70sqm

64 beds ≈ 32x 28sqm side rooms 100sqm

400 sqm

FLATS /

KITCHEN/ STORAGE

600 sqm

600 sqm

ADMINISTRATION

STERILE STORAGE / STORAGE 600 sqm

CAR PARK 1000 sqm

p. 84

Difficulties in steering those processes of generating this kind of forms made it necessary to find new ways of actively bundling fibrous elements. Along controlled paths of movement, which were manually designed according to the spatial program, a network of fibers was generated.

Starting to interpret those diagrams with parts being more dense and showing some kind of noise and action, and other parts having a reduced amount of fibers with less action. Defining those different qualities made it possible to address certain functions into certain parts of the diagram.

p. 85

By implementing volumes in those three dimensional digital diagrams, a process of evolving from a diagram to a more controlled and precise 3D model took place. This digital model which corresponds more to our today’s understanding of an architectural model allowed to implement volumes describing the buildings functions.

The fibrous bundles got transformed into a system of paths nestling up and around the volumes, creating a possible system of connecting the different volumes and parts of the complex.

By numerous steps of iterations the volumes became more precise in their size and correlations to each other.

A rough shape of the building with its different areas and parts developed in combination with a fibrous network of paths connecting them. By separating the fibers in bundles according to the particular user of the building a system was found which was clearly visible supplying the building with intensities.

Those could be simply the hospital staff or materials, but could also be seen an infrastructural system. Sitting outside the building like an exoskeleton it can transport electricity, fluids and gases, which ensure the working capability of the different organs.

p. 86

PATIENTS

STAFF

GOODS/ MATERIALS

p. 87

N NW

NE

E

W

SE

SW Another parameter arranging the spatial program was the local situation. The site being situated on the border between the busy and highly frequented hospital quarter in the north and the calm bay acting as a recreational space in the southeast made it clear to arrange the more busy parts of the clinic facing the street in the northwest.

S

ACOUSTICAL NOISE EMITTER INSIGHTS VIEW p. 88

N NW

NE

E

W

SE

SW Since the buildings southeast of the site are following the terrain down to the bay they don’t restrict the view.

To prevent the big clerical facility northeast having too much insight into the courtyard of the clinic, the patients’ rooms are situated at the northern border of the site. p. 89

S

ACOUSTICAL NOISE EMITTER INSIGHTS VIEW

p. 90

THE PROJECT

p. 91

p. 92

43°30’10.48’’ N 16°27’46.83’’ E

SITEPLAN 0 10 25

p. 93

50

100

N 200

EXPLOSION DRAWING CLINIC

p. 94

HELIPAD

STATICAL STRUCTURE

BUILDING’S FIRST SKIN INFRASTRUCTURE SEMINAR SPACE SURGERY ROOMS

STERILE SECOND SKIN INTENSIVE CARE DIAGNOSTIC WING RESIDENCE CLINIC ADMINISTRATION INTERMEDIATE & NORMAL CARE KITCHEN & STORAGE STERILE CORRIDOR

CIRCULATION PATHS DNA EXTRACTION ORGAN BREEDING REHAB STORAGE & STERILE STORAGE

UNDERGROUND CAR PARK SITE

p. 95

GREEN FACADE The new built architecture in an existing environment - especially with an extraordinary appearance - can be described as an alien element. Similar to a 3D-printed medical implant which gets planted into a human body, the architecture becomes used by the existing vegetation as growth support. The natural environment takes over the implanted structure and adopts it into its system. By growing together the alien becomes a part of the existing system enhancing qualities already being there bringing in new possibilities.

This hybrid facade describes a symbiosis between the building and the surrounding nature. Besides concealing the buildings mass volume, allowing the greenery to expand onto the buildings structure brings some further benefits to building as the plants are acting as shading elements and greenery supports the patients’ healing process.

p. 96

p. 97

p. 98

p. 99

p. 100

p. 101

p. 102

p. 103

p. 104

p. 105

p. 106

p. 107

+3

Infusionsst채nder

+2

+1

0

-1

-2

-3

p. 108

DNA EXTRACTION

ORGAN BREEDING

100 sqm

300 sqm

DIAGNOSTIC WING 500 sqm

p. 109

OPERATING ROOMS 1x60 sqm I 1x50 sqm 1x40 sqm side rooms 300sqm

INTENSIVE CARE

INTER-MEDIATE CARE

NORMAL CARE

REHAB

13 beds ≈ 7x 40sqm side rooms 280 sqm

24 beds ≈ 12x 36sqm side rooms 70sqm

64 beds ≈ 32x 28sqm side rooms 100sqm

400 sqm

FLATS /

KITCHEN/ STORAGE

600 sqm

600 sqm

ADMINISTRATION

SEMINAR

STERILE STORAGE / STORAGE 600 sqm

CAR PARK 1000 sqm

N

FLOORPLAN TOP VIEW 1_500 p. 110

p. 111

N

FLOORPLAN LEVEL+3 1_500 p. 112

p. 113

N

FLOORPLAN LEVEL+2 1_500 p. 114

p. 115

N

FLOORPLAN LEVEL+1 1_500 p. 116

p. 117

N

FLOORPLAN GROUND FLOOR 1_500 p. 118

p. 119

N

FLOORPLAN LEVEL-1 1_500 p. 120

p. 121

N

FLOORPLAN LEVEL-2 1_500 p. 122

p. 123

N

FLOORPLAN LEVEL-3 1_500 p. 124

p. 125

SEC

N TIO

2

p. 126 SECT ION 1

SECTION 1 1_500 p. 127

SECTION 2 1_500 p. 128

p. 129

ELEVATION SOUTH 1_500 p. 130

p. 131

p. 132

ELEVATION NORTH 1_500 p. 133

ELEVATION EAST 1_500 p. 134

ELEVATION WEST 1_500 p. 135

p. 136

FLOW OF DIFFERENT USERS MOVEMENT ... STAFF ... PATIENTS ... MATERIALS/ GOODS

p. 137

p. 138

p. 139

p. 140

p. 141

PATIENTS’ ROOMS The further one moves to the eastern end of the building, a change of its embracing structure is visible.

The infrastructural pipes are branching out to supply the patients’ rooms with all necessities and so does the statical system.

The rooms themselves are organized in modules - one module houses two rooms. The rooms are arranged around central roofed yards being connected to the rest of the building via a plug-in gate.

Every single module has its own statical structure which carries the load of it. The infrastructure is extended from the buildings skin onto the modules where it intrudes into the shell through defined ports. So the entire section of the building for the patients consists out of cells being placed within a scaffold of statical and infrastructural elements.

Just by the formation of elements one can read the rough shape of the building and is able to assume which cell could fit into the scaffold. p. 142

The interior is designed in a rather clean and reduced manor in order to create a calm atmosphere. Through the combination of slik and shiny materials, the room provides both, a cozy ambience as well as the feeling of being in an secure, neat place.

p. 143

HEATING/ COOLING HEATING/ COOLING BACK FLOW ELECTRICITY

OUTER SHELL PATIENT’S ROOM

INNER SHELL PATIENT’S ROOM

VENTILATION INERT GASES SEWAGE SUN SHADING PANELS

STATICAL STRUCTURE

p. 144

MODULES PATIENTS’ ROOMS

p. 145

p. 146

p. 147

p. 148

p. 149

p. 150

PHYSICAL MODELS

p. 151

p. 152

p. 153

p. 154

p. 155

p. 156

p. 157

LIST OF REFRENCES INTERVIEW

Interview with Georg Vogel, MD - Division for Histology and Embryology and visit of a cell research facility at the Center of Chemistry & Biomedicine in Innsbruck [5.12.2013]

LITERATURE

Žižek, Slavoj (2004). Bodies without Organs: Deleuze and consequences. 1st Edition, New York, NY: Routledge Deleuze, Gilles & Guattari Felix (1977). Anti-Ödipus: Kapitalismus und Schizophrenie I. Erste Auflage, Frankfurt am Main: Suhrkamp Taschenbuch Verlag Kelly, Kevin (1995). Out of C ontrol: the New Biology of Machines, Social Systems, & the Economic World. Reprint Edition, New York, NY: Basic Books Irmtraut Sahmland (2005). Geschichte der Medizin: Beginn landesherrlicher Fürsorge. In: Deutsches Ärzteblatt, Jg. 102, Heft 14, A960-A965 Debatin, Jörg F. (2010). … und fertig ist das Klinikum: jetzt 12 Monate am Netz; vom Konzept bis zur Inbetriebnahme. 2. Auflage, Stuttgart: Themie

ARTICLES

Shen, Helen (2013). Stem cells mimic human brain [online]. Available: http://www.nature.com/news/stem-cells-mimic-human-brain-1.13617 [21.09.2014] science.orf.at (2013). Künstliche Minihirne, made in Vienna [online]. Available: http://science.orf.at/stories/1723885/ [21.09.2014] Fountain, Henry (2012). A First: Organs Taylor-Made With Body’s Own Cells [online]. Available: http://www.nytimes.com/2012/09/16/health/research/ scientists-make-progress-in-tailor-made-organs.html?pagewanted=all&_r=1& [21.09.2014] TED Quote by Anthony Atala (2012). Printing a human kidney [online]. Available: http://www.bbc.com/future/story/20120621-printing-a-humankidney [21.09.2014] Hsu, Jeremy (2013). 3D printing aims to deliver organs on demand [online]. Available:http://www.foxnews.com/health/2013/09/24/3d-printing-aimsto-deliver-organs-on-demand/ [21.09.2014] Choi, Charles Q. (2010). Breakthrough: Lab Lungs Live and Breathe [online]. Available: http://www.livescience.com/8359-breakthrough-lab-lungs-livebreathe.html [21.09.2014] Rettner, Rachael (2013). Lab-Engineered Kidney Works in Animals [online]. Available: http://www.livescience.com/28709-bioengineered-kidney-worksin-rats.html [21.09.2014] Müller-Jung, Joachim (2013). Das Leben ist eine Scheibe [online]. Available: http://www.faz.net/aktuell/wissen/medizin/zellersatz-ohne-stammzelleoder-embryo-das-leben-ist-eine-scheibe-12197412.html [21.09.2014] BMJ (2013). Aser Garcia Rada: Exporting the Spanish and Eropean organ donation system [online]. Available: http://blogs.bmj.com/bmj/2013/07/25/ aser-garcia-rada-exporting-the-spanish-and-european-organ-donation-system/ [21.09.2014] Çagla Pınar Tunçel (2011). Turkey needs more organ donations, officials say [online]. Available: http://www.hurriyetdailynews.com/turkey-needs-moreorgan-donations-officials-say.aspx?pageID=438&n=turkey-needs-more-organ-donations-officials-say-2011-11-03 [14.10.2013] New Europe Online (2011). Ukraine: European capital for illegal organ transplants [online]. Available: http://www.neurope.eu/article/ukraine-europeancapital-illegal-organ-transplants [14.10.2013] derStandard.at (2010). Forschern gelingt Konstruktion von künstlicher, implantierbarer Niere [online]. Available: http://derstandard.at/1282979164469/ Nie-wieder-Dialyse-Forschern-gelingt-Konstruktion-von-kuenstlicher-implantierbarer-Niere [21.09.2014] Maher, Brendan (2013). Tissue engineering: How to build a heart [online]. Available: http://www.nature.com/news/tissue-engineering-how-to-builda-heart-1.13327 [21.09.2014] Ärzteblatt.de (2013). Niere aus dem Bioreaktor: Erste Transplantation an Ratten [online]. Available: http://www.aerzteblatt.de/nachrichten/54045/ Niere-aus-dem-Bioreaktor-Erste-Transplantation-an-Ratten [21.09.2014] CBSNews.com (2013). Scientists growing livers, kidneys, ears in labs amidst organ shortage [online]. Available: http://www.cbsnews.com/news/ scientists-growing-livers-kidneys-ears-in-labs-amidst-organ-shortage/ [21.09.2014] p. 158

rt.com (2013). World’s 1st self-regulating artificial heart transplanted in France [online]. Available: http://rt.com/news/france-artificial-heart-transplant-662/ [21.09.2014] Taschwer, Klaus (2014). Revolution in der Stammzellforschung [online]. Available: http://derstandard.at/1389858672643/Revolution-in-derStammzellforschung [21.09.2014] http://medtravelbelarus.com/heart-transplantation.html [14.10.2013] ekathimerini.com (2013). Greek clerics oppose law that eases restrictions on organ donations [online]. Available: http://www.ekathimerini. com/4dcgi/_w_articles_wsite1_1_28/04/2013_496354 [14.10.2013]

STATISTICS/ DATA

http://www.indexmundi.com/map/?t=0&v=2227&r=eu&l=en [21.09.2014] http://www.indexmundi.com/map/?t=0&v=2226&r=eu&l=en [21.09.2014] http://www.who.int/gho/map_gallery/en/ [21.09.2014] http://www.transplant-observatory.org/Pages/Facts.aspx [21.09.2014] http://www.sciencedirect.com/science/article/pii/S0041134512004010# [21.09.2014] http://optn.transplant.hrsa.gov/latestData/step2.asp? [21.09.2014]

OTHER

http://www.pflegewiki.de/wiki/Krankenhaus [21.09.2014] Walsh, James J. (1920) Medieval Medicine: Part 3 [online]. Available: http://bookdome.com/history/Medieval-Medicine/Medieval-Hospitals-Part-3. html#.VB7BsUsgGuo [21.09.2014] http://de.wikipedia.org/wiki/Allgemeines_Krankenhaus_der_Stadt_Wien [21.09.2014] http://de.wikipedia.org/wiki/Jacobshospital_(Leipzig) [21.09.2014] http://de.wikipedia.org/wiki/Scuola_Grande_di_San_Marco [21.09.2014] http://www.archiprix.org/2015/index.php?project=2544 [21.09.2014] http://www.alvaraalto.fi/net/paimio/paimio.html [21.09.2014] http://www.krass-mag.net/glossar/body-without-organs/ [21.09.2014] http://stelarc.org/?catID=20242 [21.09.2014] http://en.wikipedia.org/wiki/Centre_Georges_Pompidou [21.09.2014] http://en.wikipedia.org/wiki/Lloyd%27s_building [21.09.2014] http://en.wikipedia.org/wiki/Nakagin_Capsule_Tower [21.09.2014]

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REGISTER OF ILLUSTRATIONS Fig. 01: http://cubeme.com/blog/wp-content/uploads/2012/11/Heart_of_Glass_Sculptures_Gary_Farlow_CubeMe1.jpg [28.11.2013 - 16:50] Fig. 02: http://www.fact.co.uk/media/6173514/EarScaffold-FACT.jpg [25.11.2013 - 10:38] Fig. 03: http://digitaljournal.com/img/8/7/8/i/5/7/9/o/stelarc.jpg [25.11.2013 - 10:39] Fig. 04: http://ottlab.mgh.harvard.edu [10.11.2013 - 20:34] Fig. 05: http://www.pressemeldungen.at/wp-content/uploads/2009/11/herzschrittmacher.jpg [28.11.2013 - 16:28] Fig. 06: http://www.arztzeit.at/wp-content/uploads/2012/08/excor_ped_torso1.jpg [28.11.2013 - 16:30] Fig. 07: http://upload.wikimedia.org/wikipedia/ru/6/6b/Abiocor-hand.jpg[28.11.2013 - 16:30] Fig. 08: http://www.dailyherald.com/storyimage/DA/20130624/ENTLIFE/706249972/EP/1/8/EP-706249972.jpg&maxw=3649&maxh=2737&Q=70 &&updated= [01.12.2013 - 18:20] Fig. 09: http://ottlab.mgh.harvard.edu [10.11.2013 - 20:33] Fig. 10: http://ottlab.mgh.harvard.edu [10.11.2013 - 20:33] Fig. 11: http://miromatrix.com/wp-content/uploads/2012/01/ability-slide-e1329252013737.png [04.10.2013 - 07:46] Fig. 12: Illustration based on http://www.nature.com/polopoly_fs/7.11287.1372788792!/image/build-a-heart-graphic.jpg_gen/derivatives/lightbox/ build-a-heart-graphic.jpg [04.10.2013 - 07:50] Fig. 13: http://graphics8.nytimes.com/images/2012/09/16/health/research/body/body-superJumbo.jpg [04.10.2013 - 11:58] Fig. 14: http://www.retronaut.com/wp-content/uploads/2013/09/Telephone-Tower-Stockholm-1.jpg [13.09.2014 - 13:23] Fig. 15: http://members.xoom.virgilio.it/cateraddi/RENZO%20PIANO.gif [13.09.2014 - 17:54] Fig. 16: http://www.parisreise.at/images/centrepompidou/869883_54096489.jpg [13.09.2014 - 17:52] Fig. 17: http://www.lloyds.com/~/media/Images/Lloyds/About%20Lloyds/Lloyds%20Building/Exterior/Lloyds%20building%20exterior%20 HiRes/20111108Exterior1.jpg [13.09.2014 - 16:00] Fig. 18: http://www.domusweb.it/content/dam/domusweb/en/from-the-archive/2012/06/23/remembering-g-nther-domenig/ big_387147_8066_1a4.jpg [13.03.2014 - 15:58] Fig. 19: http://24.media.tumblr.com/tumblr_mbnf95swcp1qzqju7o1_500.jpg [13.03.2014 - 15:58] Fig. 20: http://www.formakers.eu/media/89.234.1331625246.deep7.jpg [13.09.2014 - 18:50] Fig. 21: http://www.modemachine.com/_IMAGES/ARCH_ENVIRONMENT/EMERGENT/0011_TAIPEI/tai_10.jpg [13.09.2014 - 18:48] Fig. 22: http://www.tomwiscombe.com/gallery/project_05/Large2.jpg [30.04.2014 - 16:03] Fig. 23: http://bouncingideas.files.wordpress.com/2012/04/tom-wiscombe-fish-market.png?w=590&h=386 [30.04.2014 - 16:03] Fig. 24: http://static3.evermotion.org/files/EVRprfolio/33ad5191d622b3fd896afee4cb9973f11be3b4b8.jpg [14.09.2014 - 00:23] Fig. 25: http://upload.wikimedia.org/wikipedia/commons/e/e7/AAKH-1784.jpg [12.01.2014 - 13:49] Fig. 26: http://upload.wikimedia.org/wikipedia/commons/0/0d/Die_Gartenlaube_%281871%29_b_345.jpg [12.01.2014 - 13:58] Fig. 27: http://visualizingvenice.org/wp-content/uploads/2012/10/Render-1940-A-e1355055689251.jpg [07.12.2013 - 15:08] Fig. 28:http://visualizingvenice.org/wp-content/uploads/2012/10/Render-1931-A-pianta.jpg [12.01.2014 - 13:43] Fig. 29 & Fig. 30: http://www.archiprix.org/projects/2009/P09-1882/P09-1882_6775_blowup.jpg [27.02.2014 - 15:08] Fig. 31: http://image.architonic.com/imgTre/01_11/Paimio1-bearbeitet.jpg [27.02.2014 - 15:07] ALL OTHER ILLUSTRATIONS WERE PRODUCES OR PHOTOGRAPHED BY MYSELF. p. 160

DANKSAGUNG / ACKNOWLEDGMENT

Danke an Marjan Colletti für die Diskussionen und die Betreuung der Masterarbeit.

Danke an meine Eltern die mir den bisherigen Weg ermöglicht haben.

Vielen Dank an folgende Personen, die mir mit ihrem fundierten Wissen zur Verfügung gestanden sind: Ass.-Prof. Arch. DI Erich Gutmorgeth Georg Vogel, MD Sektion Histologie und Embrylogie, Med-Uni Innsbruck

Martina Baucic MSc GIS, BSC Geodesy GIS Division Manager, GEOdata d.o.o. engineering firm

Ganz vielen Dank an meine Freunde und Mag. Carmen Rella, die mir im Vergangenen Jahr immer beigestanden sind.

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