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Dona­ting Organs Means Saving Lives

Last year, the Swisstransplant Foundation set a new record for organ donations and transplants. But there’s still a long waiting list. The new ‘opt-out’ system is intended to remedy this situation.

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.’ 

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