Health and prevention

Organ donation – could the opt-out system soon apply in Switzerland?

STUDY
|
Organ donation – yes or no? You decide what happens to your organs after you die. Source: iStock.com / DieterMeyrl

In Switzerland, around 100 people die each year because of a lack of organ donors. It doesn’t have to be this way. comparis.ch shares some key insights on the topic.  

There are currently around 1,400 people in Switzerland waiting for a new organ. But too few organ donors means that some 100 people die each year in this country. It doesn’t have to be this way. A representative survey conducted by Market Agent on behalf of comparis.ch shows that in principle, Swiss people are open to the idea of organ donation. 60 per cent of those surveyed felt that even those without a donor card should be considered for organ donation.

63 per cent of respondents in the German-speaking and French-speaking parts of Switzerland would even be in favour of a constitutional amendment that would require people to explicitly opt out of organ donation. Doctors could then routinely remove organs from deceased persons without having to make further enquiries.

Opt-out system in place in various European countries

The Junior Chamber International (JCI) launched the federal popular initiative “Promote organ donation – save lives” to achieve precisely that. A collection of signatures is currently under way. The aim of the initiative is to change the Swiss Federal Constitution. Under the so-called “opt-out system”, every adult would become a potential donor in the event of their death, unless they have expressly opted out while still alive by having their names entered in an official register. Based on “presumed consent”, this system is already in place in various European countries, such as Austria, France, Italy, Spain, Portugal and Belgium.

Relatives do not consent in 60 per cent of cases

Currently, potential organ donors in Switzerland must have a donor card, or they must have expressed their consent to organ removal in the event of death to their relatives while still alive. You can order a donor card from Swisstransplant – the Swiss National Foundation for Organ Donation and Transplantation. You can receive it by post or download it via app to your smartphone.

According to our survey, only 30 per cent of respondents have a donor card. This means that for the remaining 70 per cent, relatives must make a decision on organ removal. Although 75 per cent of respondents think this approach is a good one, this principle has proved disadvantageous in practice. According to Swisstransplant, relatives do not consent to organ removal in over 60 per cent of cases. The reason for this is that they do not know the wishes of the deceased and are afraid to go against them by consenting.

State of health key to organ donation

Anyone of any age can be considered for organ donation – as long as the person is in a good state of health and the relevant organs are functioning well. Children can also be organ donors. Their organs are usually donated to other children. Newborns up to the age of 28 days are not eligible for organ donation for ethical and medical reasons.

A donor must also have been free of tumours for five years – anyone with current active cancer may not become an organ donor. People with a prion disease (e.g. Creutzfeld-Jakob disease) or untreatable sepsis are not eligible either. Organs from HIV-positive donors may only be transplanted in HIV-positive recipients.

Type of organ donation determines what is transplanted

In Switzerland, a distinction is made between three types of organ donation:  

  • Donation following circulatory death
  • Donation following brain death
  • Living donation

In Switzerland, brain death is a condition for a donation after death. Brain death is considered the unequivocal end of life – the brain is completely and irreversibly damaged. Circulatory death is when a person cannot be resuscitated after a cardiac arrest despite several attempts. Circulatory death inevitably leads to brain death. After a circulatory death, all organs can be removed from the donor, apart from the heart. Living donors can donate their kidneys, a part of the liver and blood stem cells. This type of donation usually occurs within a family.

What can be donated

Swisstransplant has compiled a list of organs, tissue and cells that can be donated. They include:

  • Amniotic membrane
  • Cornea
  • Pancreas
  • Blood vessels
  • Small intestine
  • Skin
  • Heart
  • Heart valves
  • Bones and cartilage
  • Liver
  • Lung
  • Kidneys

Swisstransplant also coordinates the allocation of organs for the whole of Switzerland and maintains a central waiting list. Organs are allocated based on urgency and medical benefits as well as position on the waiting list.

“Opt-out system an incentive to reflect”

“The opt-out system provides an incentive for all of us to reflect on the subject of organ donation, and to make a decision for or against,” says Comparis health expert Felix Schneuwly. “Anyone who misinterprets it as a breach of personal autonomy or even forced organ donation should refrain from accepting a donated organ in order to save their own life.” 

Update from October 2018: new online register created by the Swisstransplant foundation

On 1 October 2018, Swisstransplant published the National Organ Donor Register – a digital replacement for the donor card. Are you a resident of Switzerland or Liechtenstein and over 16 years of age? If so, you can register online. There, you can state whether or not you would like to donate organs, and whether they can be used for research. You can also delegate the decision to a trusted person. The following also applies to the online register:

  • Your entry can be changed at any time.
  • Medical staff at the hospital can only access your data when further treatment is considered futile and any current treatment is to be stopped.
  • Until this point, the Swisstransplant foundation will keep your data safely under lock and key.

Organ donation – yes or no?

This is a question that should be given due consideration. There are good reasons for discussing the issue with your family or close friends:

  • For your sake:

    You decide what happens to your body.

  • For the sake of your family:

    Share your thoughts and decisions with your nearest and dearest. They should be informed of your wishes so that they can act in your interests if and when the need arises.

  • For the sake of life:

    Many people in Switzerland are awaiting an organ transplant. Becoming a donor can save someone's life.

To find out more about organ donation, visit the Swisstransplant website or Leben-ist-Teilen (pdf available in English), where you will find more in-depth information about donating, donor cards and so on.