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Swisstransplant FAQ

Circulatory death
1.
What is a donor after circulatory death?

A donor after circulatory death (DCD) is a person who has died as a result of cardiac arrest, meaning their heartbeat has stopped and their organs are no longer supplied with blood. This means organs must be removed very quickly, which is why the donation process is different here compared with donors after brain death.

You can find detailed information on DCD here.

Concerning transplantations
1.
Which patients require a transplant?

Patients with a serious organ function impairment, for whom all other medical therapies have been exhausted, are accepted onto the waiting list.

2.
How are organs allocated?

Donor organs are allocated to recipients on the waiting list in accordance with the Transplantation Act and the corresponding ordinances on organ allocation. The primary criteria for allocation are medical urgency, medical benefit and time on the waiting list. In addition, individual criteria apply for each organ.

3.
What is an organ transplantation?

Transplantation is a type of surgery that involves replacing a faulty organ with a healthy one taken from a deceased or living donor. Organ transplants are considered only for patients who have exhausted all other possible medical therapies. The patient receiving the organ is referred to as the “recipient”, the person giving the organ as the “donor”.

4.
How are organs removed?

Organ removal is performed by surgeons in a normal operating theatre, just as in any other standard operation. Removing organs from a deceased person does not alter their appearance – only the surgical incision can be seen. After the organs and/or tissues have been removed, the body is handed over to the family of the deceased.

5.
How much does a transplantation cost?

Heart, lung and small intestine transplantations cost between approximately CHF 150,000 and CHF 250,000; liver transplantations between CHF 110,000 and CHF 180,000; and kidney, pancreas and islets of Langerhans transplantations between CHF 60,000 and CHF 100,000. Services such as rehabilitation, follow-up examinations or medication which are not provided while the patient is in hospital are not included in these costs.

Part of the transplantation costs are reimbursed through the case-based flat rate of Swiss Diagnosis Related Groups, SwissDRG. Payment for any remaining services is governed by a contract between the Schweizerischer Verband für Gemeinschaftsaufgaben der Krankenversicherer (Shared services association of Swiss health insurers – SVK) and the H+ Die Spitäler der Schweiz (Swiss hospitals association).

Costs per transplantation calculated by SwissDRG can vary greatly owing to the complex calculation process, which is based on several factors: a flat rate, which factors in the severity of a case and the circumstances surrounding a transplantation; a basic price (base rate), which varies according to the hospital; and the cost weight, which outlines the average treatment costs for a particular case group.

You can find more information on this topic here (german, french and italian only).

Brain death
1.
What is the difference between a coma and brain death?

A person lying in a coma is still alive and may regain consciousness. When a person is in a coma, their brain is still being supplied with blood. This is not the case with brain death. The brain functions of a brain-dead person have completely and irreversibly ceased. There is no discernible external difference. This is due to the fact that vital bodily functions, such as a heartbeat and breathing, can be prolonged for several hours in brain-dead people by means of artificial respirators and therapeutic medication. Without these intensive care measures, brain death would be immediately followed by respiratory arrest, after which cardiac arrest would set in.

2.
How is brain death determined?

Brain death must be determined by two doctors (the dual-control principle) who work independently of the transplantation team and possess the necessary training and experience in diagnosing brain death. Cessation of all brain functions is verified through neurological testing in compliance with the guidelines of the Swiss Academy of Medical Sciences (SAMS).

You can find detailed information here.

General questions
1.
What are tissue banks?

The purpose of tissue banks is to prepare and store human tissues after removal. Unlike organs, tissues do not have to be transplanted immediately and can undergo sterilization and quarantine procedures during the processing and conservation phases. This largely eliminates the risk of transmission of disease agents.

When tissue banks accept tissues after removal, the tissues undergo a long process governed by the European Commission’s rules and directives. First, the donor’s identity is examined along with all of the relevant data gathered by the coordinators about the donor. Then, the tissue is analyzed, prepared and either placed in cool storage in a conservation solution for immediate transplantation (e.g. corneas) or deep-frozen at temperatures below –80° C (e.g. heart valves). In the case of bones, sterilization techniques are also used or the bone is transformed into bone replacement materials, which must comply with the Therapeutic Products Act  in Switzerland.

Since most tissue banks keep a supply of tissues on hand, hospitals and medical practices can order the tissue directly when they need it. This also means that the necessary tissue types, for example for the transplantation of blood vessels or heart valves, are available when needed for life-saving emergency operations.

2.
Can I donate my body after my death?

It is possible to donate your body to medical science after your death for research use by an anatomical institute. If you select both options (organ and body donation), organ donation will always take higher priority, the reason being that not every deceased person can donate organs. Anatomical institutes do not accept any bodies after an organ donation.

Your local anatomical institute can provide you with further information on this topic.

Bern: +41 (0)31 631 84 33
Zurich: +41 (0)44 635 53 11
Basel: +41 (0)61 267 39 21
Geneva: +41 (0)22 379 52 75
Lausanne: +41 (0)21 692 52 50
Fribourg: +41 (0)26 300 85 40

3.
What is bone marrow donation?

Bone marrow produces blood and can only be taken from living donors. It can also be transferred to somebody who is not a relative. For more information or to receive a brochure, please contact:

Swiss Blood Stem Cells
Laupenstrasse 37
3001 Bern
Tel. +41 (0)31 380 81 51
www.bloodstemcells.ch

4.
What preparatory medical measures are carried out?

In the case of preparatory and organ-preserving medical measures for donors after brain death (DBD), artificial respiration is continued, medication is administered to maintain circulatory function and hormonal balance, and blood samples are taken for laboratory testing. At the same time, the functionality of individual organs is tested, using, for example, ultrasound or radiology procedures. Taking blood samples and running tests with regard to a possible organ donation only begins after brain death has been diagnosed and the consent to organ donation has been given.

5.
Can a person’s next of kin find out who received the organs?

No. In order to protect both the family of the donor and the recipients from additional strain, organ donation is a completely anonymous process. However, recipients may thank a donor’s next of kin in an anonymous letter via Swisstransplant or the transplantation centres, or reveal their story in anonymous form on an online platform (german, french and italian). These anonymous contact options are also made available to the donor’s family.

To: "People affected by organ transplantation".

6.
Which organs are most frequently donated?

The most frequent organs to be donated and transplanted are the kidneys, followed by the liver, lungs, heart, pancreas and the small intestine.

7.
Do the next of kin have time to say goodbye to the deceased?

After the organs have been removed, the next of kin have time to say goodbye to the deceased. Removing organs from a deceased person does not alter their appearance – only the surgical incision can be seen. After the organs and/or tissues have been removed, the body is handed over to the family of the deceased. The body of the deceased can be laid out upon request. The funeral is conducted according to the wishes of the deceased and their next of kin.

8.
Do all donated organs stay in Switzerland?

Swisstransplant works closely with France and the South Alliance for Transplants (SAT). If no suitable organ recipient can be found in Switzerland, the organ is offered to our partner organizations abroad. We also receive offers from abroad.

9.
How long do patients wait for an organ?

Waiting times can vary, depending on the organ required, the urgency for the waiting person and their own state of health. The actual time can be anything from a few days to several years. Since there is a shortage of organs in Switzerland, the law strives to allocate organs available as fairly as possible. You can view the average waiting times in our annual report.

10.
What are the religions’ stances on organ donation?

All of the world’s major religions have spoken out clearly in favour of organ donation, often in the name of altruism and humanity. In particular, Catholicism, Protestantism, Islam, Judaism, the Orthodox Churches, Hinduism and Buddhism all look favourably on organ donation.

You can find a report on the views of the various world religions on organ donation in the March 2014 edition of our swisstransplant news magazine (german and french)

Swisstransplant spoke with Imam Ibram Youssef and Rabbi François Garaï about the stances of the two world religions of Islam and Judaism on organ donation. Watch and listen to impressive and surprising statements.

11.
What are immunosuppressants?

Immunosuppressants are a form of medication which reduces the function of the immune system to help prevent the body rejecting a transplanted organ. Like all medication, immunosuppressants have side effects and risks. They may lead to a weakening of the body’s defences, which can increase the risk of infection. People who have had an organ transplant must take immunosuppressants for the rest of their lives.

12.
Do donor and recipient know each other’s identities?

In Switzerland, the donor and recipients remain anonymous. This is intended to protect both the family of the donor and the recipients from any additional strain. However, recipients may send an anonymous letter of thanks to a donor’s next of kin via Swisstransplant, or reveal their story in anonymous form on an online platform (in german, french, italian). These anonymous contact options are also made available to the donor’s family.

13.
How much does an organ cost?

An organ is a gift from the donor. However, medical professionals carry out work which is reimbursed. For example, they provide care for the donors and their next of kin and manage coordination with the national organ allocation office, Swisstransplant (transport, surgery teams, recipients, etc.). All work on brain-dead patients is covered by the organ recipient’s basic health insurance.

Concerning organ donation
1.
Do you get any money for donating an organ?

No, an organ donation is made without financial gain. Anybody trading in organs is breaking the law and liable to prosecution (Articles 6 and 7 of the Transplantation Act). Burial costs are also not covered. The only exception here is the compensation for any loss of income in the case of a living donor.

2.
How many people can one donor save?

One organ donor can mean up to seven people receiving a transplant. If the lungs and liver are split (divided) for transplantation, as many as nine people can receive organs from a single donor. Often, transplants not only mean someone’s survival, but also massively improve their quality of life.

3.
How long does the whole donation process take?

As a rule, the entire donation process, from the diagnosis of brain death to completion of the organ removal procedure, lasts between 12 and 24 hours.

4.
Wouldn’t doctors rather let a potential organ donor die?

Whether or not a person has decided for or against organ donation makes no difference to the treatment they receive. Saving lives is every doctor’s top priority and obligation according to the Hippocratic oath. Every effort is made to save the patient, even if they could potentially become an organ donor.

Furthermore, the topic of organ donation is only addressed following the diagnosis of brain death. Therefore, doctors may well be unaware whether a person wishes to donate their organs or not prior to this.

For potential donors after circulatory death, the topic of organ donation must be discussed before the point of death. However, this only happens when the prognosis is hopeless (technical term: “infaust”).

5.
What if I change my mind?

You may change your decision regarding organ donation at any time. As there is no donor register, it is sufficient to simply destroy the old donor card and complete a new one, as well as inform your next of kin that your wishes have changed.

6.
Are older versions of the donor card still valid?

Although the old version remains valid, we recommend that people who have previously filled in a donor card replace it with the new donor card.

7.
Can I determine the recipient of my organs?

In principle, organ donation is anonymous. However, you may stipulate that a particular organ be donated to a particular person following your death. No patient group (e.g. sex or age) may be stipulated or excluded, though, pursuant to the Non-discrimination article (Article 17 of the Transplantation Act).

8.
Can somebody who dies at home become an organ donor?

A person who dies at home cannot become an organ donor, since the necessary medical preparations for a donation can only be made in a hospital’s intensive care unit.

9.
Can a child be an organ donor?

Organ donation is also possible in children. Organs from children are primarily allocated to children, too. The only exception is for newborns up to 28 days old; in this case, organ donation will not be considered on ethical and medical grounds.

10.
Who can be considered as a potential donor?

In principle, anybody may donate their organs, unless they are currently suffering from cancer, a prion disease (e.g. Creutzfeldt-Jakob disease) or any untreatable sepsis (bacteria in the blood). Individual organs’ physical condition and ability to function are the deciding factors. There is no upper age limit.

11.
Why do my next of kin have to know my wishes concerning organ donation?

In the event of a person’s death, if there is no donor card available (or it cannot be found), their next of kin must make the decision regarding organ donation on behalf of the deceased. This is why your next of kin need to be made aware of your wishes – you will be making the decision easier for them in a difficult moment.

12.
How do I declare my wish to become an organ donor?

To declare your willingness to become an organ donor, all you need to do is fill in a donor card or activate the digital organ donor card on the Medical ID app. Make sure you always carry it with you. From a legal perspective, the donor card represents a declaration of intent which applies until after your death. We also recommend that you inform your next of kin of your wish to become a donor. If you do not wish to donate certain organs, you can indicate these on your card. There is no donor register in Switzerland.

13.
Which organs and tissues can be donated?

The following organs can be donated: heart, lungs, liver, kidneys, pancreas, pancreatic islets of Langerhans and the small intestine.

The following tissues can be donated: the cornea, ossicles, bones, heart valves, blood vessels, skin, bone marrow and blood.

14.
Who can donate an organ?

Absolute contraindications for organ donation are malignant tumours, prion diseases (Creutzfeldt-Jakob disease), rabies or any untreatable sepsis (bacteria in the blood). In the case of other illnesses, organs are evaluated on an individual basis – it may be the case that only some of the organs can be donated.

People who are HIV-positive or have hepatitis may donate to a recipient who is infected with the same diseases. People who were suffering from cancer but have been successfully treated and have been in remission for at least five years can also be organ donors. 

15.
What about when I go on holiday?

Your donor card is also valid outside Switzerland. If you are not carrying your card, the laws of the relevant country apply. However, depending on the country, your next of kin will also be contacted.

16.
Is there an age limit for organ donors?

There is no upper age limit for organ donors. The health of the donor determines whether organ donation is feasible. Prior to the removal of any organs, a detailed examination is carried out to ensure that organs are functional and suitable for transplantation.

17.
Do you need to have a medical examination if you want to become an organ donor?

No prior medical examination is required to demonstrate your willingness to become an organ donor. You can, if you wish, make note of any specific illnesses on your donor card.

18.
Do all donated organs stay in Switzerland?

Swisstransplant works closely together with various European transplantation organizations which have similar ethical and legal codes. If no suitable organ recipient can be found in Switzerland, the organ is offered to our partner organizations abroad. We also receive offers from abroad. Furthermore, no sales are involved in international exchanges – offers are always for free.

19.
Who must give their consent to organ donation following my death?

Since 1 July 2007, an extended consent solution has been in effect throughout Switzerland. The prerequisite for removing organs is either the presentation of consent from the person making the donation or – if the person did not make any specific requests – from their next of kin.

Information on the consent and opt-out solution can be found here.

20.
Why do I need a donor card?

The donor card can be used to indicate whether organs, tissue or cells may be removed in case of death and if so, which ones. Anyone who is at least 16 years old can make a declaration of this sort. A donor declaration can be rescinded by either modifying or destroying the donor card. In every case, however, the family is informed accordingly. What is important is that potential donors should inform their family members about their desires.

21.
How are organs allocated?

Donor organs are allocated to recipients on the waiting list in accordance with the Transplantation Act and the applicable ordinances on organ allocation. The primary criteria for allocation are medical urgency, medical benefit and time on the waiting list. In addition, individual criteria apply for each organ.

Legal basis
1.
Does the opt-out solution encourage more organ donations?

Whether or not the opt-out solution alone leads to a higher number of donors is debatable. However, it can help to increase the rate of donations along with additional measures, such as targeted education of medical personnel, improved infrastructures and standardized procedures in the organ donation process as well as sufficient personnel resources. The opt-out solution, combined with a centrally controlled register, can make conversations with next of kin easier, since the medical team can be sure of either an explicit “No” or an implicit “Yes” to organ donation.

2.
What are the prerequisites for organ removal?

Organ donation is only possible if the donor’s death has been established beyond any doubt. A person is dead when either brain death (complete and irreversible cessation of brain functions) or irreversible heart failure (donor after circulatory death – DCD) has set in. In addition, consent to organ donation must be provided.

3.
Who must give their consent to organ donation following my death?

Since 1 July 2007, an extended consent solution has been in effect throughout Switzerland. The prerequisite for removing organs is either the presentation of consent from the person making the donation or – if the person did not make any specific requests – their next of kin.

Information on the consent and opt-out solution can be found here.

 

 

4.
Can I register as an organ donor?

No. There is no register for decisions for or against organ donation in Switzerland. In addition to filling in a donor card, a person’s next of kin must also be informed in order for them to be aware of the person’s wishes.

5.
What does the « explicit consent » solution means?

Without documented consent, organ and/or tissue donation is not possible. It's the current system in Switzerland with the extended solution: Consent is given by means of a donor card, through an advance directive, or by the next of kin of the deceased in line with the deceased person’s presumed intentions. This system whereby the next of kin have a right to make decisions regarding organ donation in the absence of a documented decision by the deceased person is known as an extended solution. No register exists at the moment.

6.
What does the « opt-out solution » mean?

If there has been no documented refusal, organ and/or tissue donation is possible. Federal popular initiative with extended solution: Switzerland would need to keep a register of people who have decided against organ donation. Right to decide: The next of kin could prevent organ donation if there is no entry in the register, however, they could not override an existing entry. This means that the deceased person’s decision not to donate any organs would be respected. This system whereby the next of kin have a right to make decisions regarding organ donation is known as an extended solution. It requires a register.