The year 2023 was record-breaking for Swisstransplant: 200 people donated their organs after death. This is 20 per cent more than in the previous year and more than ever before. The number of organ recipients also reached a new high of 675. So, a good year for the foundation responsible for allocating donor organs in Switzerland?
Not exactly, says Franz Immer, long-standing Managing Director of Swisstransplant. At the end of 2023, 1,391 people were still waiting for at least one donor organ, and 92 people on the waiting list died last year – more than ever before. Kidneys are by far the most sought-after organ in Switzerland: two thirds of patients on the Swisstransplant waiting list are in need of a donor kidney.
However, the organ that is most urgently needed is the liver: after all, a patient with a kidney disorder can survive with regular dialysis. Someone with a non-functioning liver, however, will die. Last year, 48 of the people on the waiting list for a liver transplant passed away. In contrast, three quarters of liver and heart recipients are still alive ten years after their transplant, while a transplanted kidney can function for almost 20 years on average.
Specialists in intensive care units
The number of organ donors will probably fall somewhere between 180 and 220 over the next two years, according to Franz Immer. The Managing Director of Swisstransplant attributes last year’s increase partly to the fact that more and more hospitals are donating organs not only after brain death, but also after death from cardiac arrest: ‘This now accounts for almost half of our donors.’ Another reason for the increase in donations is that the foundation now has access to 160 specialists in intensive care units in Switzerland, who help Swisstransplant to identify and report potential organ donors, while also providing support and information to relatives.
According to Swisstransplant, around 80 per cent of the Swiss population are in favour of organ donation in principle. However, the actual refusal rate is still 58 per cent. This means that in 100 conversations about a potential organ donation, the option will be refused in 58 cases. By way of comparison, the refusal rate in Spain, which is considered the world leader in organ donation, is 15 per cent. One reason for the high level of scepticism in Switzerland is that – unlike in most European countries – the ‘opt-in’ system still applies: if potential donors or their relatives do not expressly consent to organ donation, their organs may not be removed in the event of their death. In the majority of cases, if the wishes of the deceased person are not known, their relatives decide against organ donation. ‘Many people do not express their views on organ donation during their lifetime,’ says Immer. ‘If someone dies in the intensive care unit, their relatives have to decide on their behalf. People are often overwhelmed by having to make this decision in such a stressful situation, which usually results in refusal.’ It is also often the case that people decide not to register as organ donors as a result of misinformation: for example, many people do not know that it is still possible to donate organs in older age. People who decide during their lifetime to donate their organs after their death usually do so for one of two reasons, says Immer: ‘Some donate their organs out of solidarity, to help other people. Others want to take care of the matter so that their relatives don’t have to.’ Interestingly, there are different trends in different parts of the country: while the idea of solidarity prevails in French-speaking Switzerland, the people of German-speaking Switzerland prefer to establish clarity by means of an organ donor card.
Increased organ donation thanks to ‘opt-out’ system
In May 2022, the Swiss electorate voted by a large majority in favour of switching to the extended opt-out system. This law, which will enter into force in 2026 at the earliest, stipulates that, in future, everyone will be considered a donor, unless they have expressly objected to organ donation during their lifetime. Franz Immer assumes that, after switching to the extended ‘opt-out’ system, the refusal rate in Switzerland will stabilise at around 30 to 35 per cent, meaning that the number of organ donors will practically double. However, there will always be people who are fundamentally opposed to organ donation, explains Immer: ‘It’s often about the question of when someone is really dead. The desire for bodily integrity also plays a role.’ In some cases, people also cite religious reasons, though there are very few world religions that oppose organ donation. ‘On the contrary, in Catholicism and Judaism, organ donation is considered an act of charity.’
