Swisstransplant
| Swisstransplant | |
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| Purpose: | National Foundation for Organ Donation and Transplantation |
| Chair: | Pierre-Yves Maillard (President) |
| Managing directors: | Franz Always |
| Consist: | 1985 |
| Number of employees: | 40 |
| Seat: | Effingerstrasse 1, 3011 Bern |
| Website: | www.swisstransplant.org |
Swisstransplant is the Swiss National Foundation for Organ Donation and Transplantation . The aim of the foundation is the nationwide promotion, development and coordination of the transplantation of organs, tissues and cells as well as informing the public about organ donation and organ transplantation. On behalf of the federal government, the foundation is responsible for the legally compliant allocation of organs to the appropriate recipients and also maintains the national waiting list. The foundation, headquartered in Bern, has around 40 employees.
history
In 1963, the first kidney transplant in Switzerland from a deceased donor was carried out at Inselspital Bern . Organ transplants followed at the Basel Cantonal Hospital (1968), the St. Gallen Cantonal Hospital (1969) and the University Hospitals of Geneva (1970) and Lausanne (1971). The Swedish cardiac surgeon Åke Senning also carried out the first heart transplant in Switzerland in 1969 at the Clinic for Cardiovascular Surgery at the Zurich Cantonal Hospital . Due to the steadily increasing transplant rate and the rapidly advancing developments in the field of transplant medicine, the first conferences were convened in Bern at the beginning of the 1980s under the chairmanship of Felix Largiadèr, which led to the establishment of the Swisstransplant Foundation at Geneva University Hospital ( Hôpitaux Universitaires de Genève ).
Jakob Schöneberger's six-year presidency from 1985 to 1991 was followed by a phase of foundation expansion: Under President Guy O. Segond, the allocation of organs was coordinated nationally for the first time. Felix Largiadèr held the presidency from 1998 to 1999 , before Trix Heberlein took over the chairmanship of the foundation at the beginning of the new millennium and headed Swisstransplant until 2013, paying special attention to government tasks. On January 1, 2007, the national transplant law came into force, the implementation of which has been coordinated since the beginning of 2009 by the National Committee for Organ Donation CNDO (Comité National du Don d'Organes). In 2004, under the leadership of Heberlein, Conrad E. Müller was appointed the first managing director of the Swisstransplant Foundation. In May 2008, Müller left his position to Franz Immer , then a specialist in cardiac surgery FMH at the Clinic for Cardiovascular Surgery at Inselspital Bern. In 2014 Trix Heberlein also stepped down from the foundation management and handed over the presidency to her successor Pierre-Yves Maillard, under whose leadership the Swisstransplant Foundation is largely responsible for the implementation of the Federal Office of Public Health's (FOPH) action plan “More organs for transplants”.
Foundation structure (organization)
The supreme body of Swisstransplant is the Board of Trustees, which includes around twenty members from various fields such as transplant and intensive care medicine, medical societies, health insurers and specialists in the fields of law and politics. The Board of Trustees has been chaired by Pierre-Yves Maillard since 2014, with Christoph Haberthür, Head of Anesthesiology at the Hirslanden Clinic in Zurich, and Daniel Candinas, Director and Head of Visceral Surgery and Medicine at Inselspital Bern, chairing the Board of Trustees .
Bern office
The office of the Swisstransplant Foundation is under the direction of Franz Immer and is based in Bern. It employs around 40 people. The management of the foundation is flanked by two committees, the Comité Médical (CM) and the Comité du Don d'Organes (CNDO).
Comité Médical
The Comité Médical designates the medical committee of the Swiss Foundation for Organ Donation and Transplantation. The medical committee CM deals with issues relating to transplant medicine and is made up of the presidents of the Swisstransplant working groups and representatives of the transplant centers. In collaboration with the working groups, the medical committee is significantly involved in the development and optimization of the rules for allocating organs to potential recipients and ensures ideal connections to national and international transplant centers .
Comité National du Don d'Organes
In contrast to the Comité Medical, the Comité National du Don d'Organes (CNDO) consists of representatives of the six donor networks, the local organ donation coordination and representatives of the medical societies and thus designates the national committee for organ donation of the Swisstransplant Foundation. The CNDO, which emerged at the beginning of 2009 from the integration of the Swiss Foundation for Organ Donation FSOD, is dedicated to promoting organ and tissue donation throughout Switzerland and ensures the exchange of information and coordination between donor networks and the National Foundation for Organ Donation Swisstransplant.
Activity and goals
The main objective of the foundation is the nationwide promotion, development and coordination of the transplantation of organs, tissues and cells. As a national allocation agency, Swisstransplant is also responsible on behalf of the federal government for the legally compliant allocation of donor organs to appropriate recipients and organizes and coordinates all activities associated with organ allocation at national level and, if necessary, in cooperation with foreign allocation organizations.
Furthermore, according to the foundation's statutes, providing information to the public on the subject of organ donation and transplantation is one of the elementary tasks of Swisstransplant. In addition, the foundation maintains the national waiting list for organ recipients and regularly compiles and publishes statistics on the population's willingness to donate to transplants and current organ-specific waiting times.
Transplant coordination
In addition to the information and awareness-raising tasks listed above, national transplant coordination is also one of the main areas of activity of the Swisstransplant Foundation. In accordance with Art. 19 of the Swiss Transplantation Act , Swisstransplant, as the responsible allocation agency, keeps the list of all registered persons waiting for a transplant and allocates the available organs to the appropriate recipients after consulting the transplant centers. The specially responsible 10-person coordination team can be reached around the clock, organizes and coordinates all activities related to a transplant and is in constant contact with foreign allocation organizations and the transplant coordination of the six domestic transplant centers .
Campaigns
Swisstransplant has launched several target group-oriented campaigns over the past few years to raise public awareness of the issue of organ donation and transplantation.
Hospital campaign "Decide - Talk - Relieve"
Based on the results of a representative population survey, which revealed a generally high level of social acceptance of organ donation and transplants, but also established that the willingness to donate rarely leads to a clear expression of will, Swisstransplant carried out a nationwide campaign in mid-September 2015 to raise awareness and Information from specialists and the population in and around Swiss hospitals. The core message of the hospital campaign Decide, Talk, Relieve was aimed at deciding and talking about organ donation in order to relieve both relatives and hospital staff considerably. As part of this awareness-raising campaign, a total of eight different portraits of transplant recipients were published with the sentence “I've been dead”, the year of the transplantation of the protagonists affected and the words “... actually. But there was someone who donated his heart to me “are titled.
Youth campaign "We decide"
At the suggestion of a high school graduate student at Willisau high school, Swisstransplant launched the “We decide” campaign in 2013. The aim of this project, originally conceived by Giuliana Affentranger as part of a high school diploma thesis, is to inform young people from the age of 16 about the possibility of organ donation by means of a brochure specially tailored to this target group and, if possible, to encourage young adults to make their own, reflective decision on organ donation . The “We decide” campaign is therefore primarily aimed at young people as well as schools and teachers at the relevant levels. In the meantime, Swisstransplant is in contact with over 180 school buildings across the country and, due to the great demand from the institutions, has developed learning sets in cooperation with teachers from a wide variety of disciplines, which comprehensively illuminate the topic of organ donation and transplantation, taking into account subject-specific aspects.
Medical ID app
With the help of the Medical ID application, donation cards can be filled out in digital form on the smartphone. When entering one of around 40 emergency wards equipped with EID technology across Switzerland, the organ donation card is displayed on the smartphone's lock screen and can be accessed by medical staff via Bluetooth without an unlock code.
"Talk about organ donation"
In September 2016, Swisstransplant and the Federal Office of Public Health (FOPH) launched the “Speech about organ donation” campaign. The campaign aims to encourage people to consider organ donation by April 2020 and to inform relatives of the decision for or against organ donation. The campaign is part of the “More organs for transplants” action plan, which was launched in March 2013 by the Federal Council.
FOPH action plan "More organs for transplants"
The demand for transplantable organs is currently greater than the existing supply. In 2013, Switzerland had a donation rate of 13 donors per million inhabitants. This puts it in the bottom third of a European comparison. With the action plan “More organs for transplants” initiated on March 8, 2013, the Federal Council, in cooperation with actors such as Swisstransplant, is pursuing the goal of using the existing potential of organ donors more effectively and reducing the donation rate of deceased by around 60% - from 13 to 20 donors per million inhabitants - to increase. The implementation of the action plan launched by the FOPH should essentially take place in two stages: In a first phase, until the end of 2013, the necessary priorities were defined, which should be implemented in sub-projects in a second period from 2014–2017. In order to create the appropriate legal basis for individual measures, a revision of the Transplantation Act was sought in the second implementation phase. Although the measures introduced showed positive effects, the goal of 20 donors per million inhabitants with 18.6 pmp was not quite achieved. The new action plan “More organs for transplants” 2019–2021 is intended to further increase the number of organ donations with updated and adapted measures and to achieve the goal of 22 donors pmp. As an organization represented on both the steering and the monitoring committee, the Swisstransplant Foundation is heavily involved in the development and implementation of this action plan drawn up by the BAG.
Waiting list and donor numbers
In order to document the progress of the implementation of the FOPH's action plan until 2017, the Swisstransplant Foundation collects and publishes figures on transplanted donor organs and on the current recipient waiting list maintained by the Foundation four times a year. The latter covers patients with severely impaired organ function, for whom all alternative therapy options have been exhausted. The waiting time of those listed for a transplant can take a few days to several years, depending on the organ required and the state of health of the recipient and the medical urgency of the procedure.
As the figures collected by Swisstransplant show, a total of 40 hearts , 32 lungs , 143 livers and 19 pancreas were transplanted in the six recognized Swiss transplant centers in 2017 . The largest number of transplanted organs was recorded with 360 kidney transplant operations . In 2018, Switzerland recorded a peak in donations with 158 deceased donors. A total of 50 hearts, 42 lungs, 156 livers, 17 pancreas and 352 kidneys were transplanted.
Donation networks and transplant centers
Organ transplantation takes place in six different transplant centers across the country. These include the university hospitals of Geneva , Lausanne , Bern , Basel and Zurich as well as the St. Gallen Cantonal Hospital . Each of the centers specializes in the transplantation of certain organs. While heart, liver and kidney transplants are carried out at the University Hospital in Bern, the University Hospital in Basel and the Cantonal Hospital in St. Gallen concentrate on kidney transplants. Heart, liver and kidney transplants are also possible in Geneva, where livers, pancreata and islets of Langerhans as well as small intestines are ex- and implanted. However, the largest transplant center in Switzerland is located at the University Hospital Zurich. In addition to heart, liver, small intestine and pancreatic transplants, surgical teams also perform islets of Langerhans at the center, which opened in 2007.
While transplant operations in younger children at the centers in Bern and Lausanne are limited to the heart and kidneys, close cooperation between the Zurich Transplant Center and the neighboring children's hospital enables the Zurich Transplant Center not only for adults but also for children with heart, lung and heart disease Carry out kidney transplants. In addition to transplanting organs, the transplant centers are also responsible for listing organ recipients on the national waiting list. The centers decide which patients need a transplant and must be placed on the waiting list for organ transplants.
Organ donation cards
Public relations work with regard to organ donation and transplantation is one of the core tasks of the Swisstransplant Foundation. However, the goal of raising public awareness is not just to acquire donors. Rather, the focus of the foundation's endeavors is to encourage individuals to make a personal decision for or against donating their own organs. According to the National Foundation for Organ Donation, documenting one's own will with an organ donation card is an effective means of relieving relatives and hospital employees in the event of a decision. If, on the other hand, there is no will to remove organs, tissues and cells for the purpose of transplantation, the next of kin decide whether the deceased person's organs are donated or not - a decision that represents a great burden for both the bereaved and the hospital staff can.
National Organ Donation Register
On October 1, 2018, Swisstransplant launched the national organ donation register. In the online register, people aged 16 and over living in Switzerland or Liechtenstein can document whether and, if so, which organs and tissues may be removed in the event of death. It can also be used to determine whether organs and tissues that cannot be transplanted can continue to be used for research purposes. The voluntary register entry, which can be modified at any time, is made via a user account with a personal login. If the question of organ and tissue donation arises after a death in the hospital, the responsible doctors can consult the register entry via the national coordination of Swisstransplant after a decision has been made to discontinue therapy. In contrast to the still valid organ donation card, which can often not be found at the crucial moment, the decision documented in the register is made safely accessible in an emergency. With the clearly defined decision, the treating physicians as well as their relatives have the certainty that they are acting in the interests of the deceased.
International cooperation
Swisstransplant works closely with various foreign transplant organizations - in particular with the French Agence de la biomédicine (ABM), the south-western European South Alliance for Transplants (SAT), the Scandinavian Scandiatransplant and the British organization NHS Blood and Transplant "NHSBT". If no suitable recipient can be found for an organ within Swiss national borders, it will be given to foreign partner organizations for transplantation purposes. In 2018, a total of 16 transplantable organs were sent abroad from Switzerland and exported. Conversely, a total of 43 organs from other countries were imported into Switzerland and implanted at local centers.
successes
The foundation promoted open discourse on organ donation and transplantation by means of increased publicity and hospital campaigns.
Swisstransplant has also achieved success with the action plan launched by the federal government and the cantons, the aim of which was to increase the rate of post-mortem donors throughout Switzerland to 20 donors per million inhabitants by 2018. During the 2015 calendar year, a total of 471 organs from 143 donations were successfully transferred to convention recipients, which corresponded to the highest level of donations at the time and an increase in allocation of almost 17% compared to 2014. From the point of view of the foundation, a positive development was also recorded in connection with the organ waiting list in 2015. After the national waiting list had grown steadily in previous years, the increase in the number of listed patients was noticeably curbed in 2015. While 1,370 people were hoping for a life-saving organ at the end of 2014, the number increased only slightly in the following year and, on December 31, 2015, recorded a total of 1,384 listed patients. Against the background of the action plan pursued by the Confederation and the cantons, however, the aim of the foundation is to continue increasing the number of national donors. With a total of 111 donors in 2016, Swisstransplant was unable to match the success of the previous year, but recorded a peak in 2018 with 158 donors. As part of the 2019–2021 action plan, processes are to be standardized, the training of medical staff to be deepened and structures in hospitals to be further improved. The aim is to increase the donation rate in Switzerland to 22 donors per million inhabitants by 2021.
criticism
As a Swiss foundation for organ donation and transplantation, Swisstransplant is faced with a large number of critical objections. The criticism is directed against the structure and work of the foundation on the one hand, and against the actual area of activity of Swisstransplants, against organ donation and transplantation on the other.
Criticism of the foundation's structure and track record
Increasing the donation rate is one of the main goals of the Foundation for Organ Donation and Transplantation. While there were 96 post-mortem organ donors in 2012, the number increased to 110 in 2013, to 117 in the following year and to a record number of 143 donors in 2015. Nevertheless, the foundation received public criticism regarding the number of donors it had reached. Despite a massive increase in staff and the expansion of the available funds, the foundation is unable to increase the consistently low donation rate of the Swiss population in an analogous manner, criticizes the renowned cardiac surgeon and director of the Clinic for Cardiovascular Surgery at the Inselspital in Bern, Thierry Carrel, the record number of donations in 2015 to the Swiss radio and television station SRF.
Criticism of the Foundation's sphere of activity
The national organ donation foundation Swisstransplant is exposed to criticism of its structure and work as well as general objections to the organ donation practice and transplantation. As a target for statements critical of donations, the foundation is particularly responsible for objections to the validity of the criterion of brain death. The complete and irreversible failure of all brain functions ( brain death ), which is required of organ removal , does not, according to the argumentation of the transplant opponents, include a holistic, closed process of dying and is therefore not to be equated with the actual death of a person. For this reason, the removal of organs from brain-dead patients is tantamount to killing human life and is drastically contrary to moral and ethical values as well as medical principles.
In the science magazine Schweizerische Ärztezeitung from September 2013, Franz Immer, Director of the Swisstransplant Foundation, took up the skepticism about organ donation caused by the criterion of brain death and took a stand against critics of transplant medicine. Always told the Ärztezeitung that the cardiovascular system of a brain-dead person can only be maintained thanks to intensive care equipment : "A brain- dead person is effectively and irretrievably dead, his organs can only be kept alive artificially. [...] If you would Switching off artificial ventilation would also bring the heart and circulation to a standstill. ”Furthermore, Immer argues that brain death must be diagnosed by two doctors independently of one another and on the basis of seven explicitly defined clinical features and must therefore be medically unequivocally established before organ removal.
Web links
Individual evidence
- ↑ Bylaws, Swisstransplant, Swiss Foundation for Organ Donation and Transplantation, Art 2.
- ^ First transplants in Switzerland. Retrieved March 20, 2017 .
- ^ Federal Office of Public Health FOPH: Action plan "More organs for transplants". Accessed January 31, 2020 .
- ↑ Swisstransplant: portrait. Retrieved March 20, 2017 .
- ↑ Swisstransplant - Comité Médical. Accessed January 31, 2020 .
- ↑ Swisstransplant - CNDO. Accessed January 31, 2020 .
- ↑ Bylaws, Swisstransplant, Swiss Foundation for Organ Donation and Transplantation, Art 2.
- ↑ Not, Isabelle: We introduce ourselves - the national coordination at Swisstransplant - a new team with a lot of commitment . In: magazine . No. 28 . Bern September 2015.
- ↑ Swisstransplant: Magazine No. 28, p. 12/13 .
- ↑ Swisstransplant: Youth campaign: "We decide". Accessed January 31, 2020 .
- ↑ Talk about organ donation. Federal Office of Public Health, accessed on March 20, 2017 .
- ↑ More organs for transplants. Federal Office of Public Health (FOPH), accessed on January 20, 2020 .
- ↑ Swisstransplant: Annual report 2014 .
- ↑ Swisstransplant: quarterly figures. Swisstransplant, accessed on March 20, 2017 .
- ↑ Swisstransplant (Ed.): Annual report . Bern 2018.
- ↑ Transplant Center Zurich: About the Center. Retrieved March 28, 2017 .
- ↑ Swisstransplant: Transplant Centers. Swisstransplant, accessed on March 20, 2017 .
- ↑ BAG: Three good reasons to talk about organ donation. Retrieved March 28, 2017 .
- ↑ Swisstransplant: National Organ Donation Register. Retrieved April 18, 2019 .
- ↑ Swisstransplant: Years. Swisstransplant, accessed on March 20, 2017 .
- ↑ Swisstransplant: Media release "2015: Best year for organ donation". Swisstransplant, January 19, 2016, accessed on March 20, 2017 .
- ↑ Swisstransplant: Annual report 2014 .
- ↑ SRF: criticism of Swisstransplant despite record numbers. SRF, January 5, 2017, accessed March 20, 2017 .
- ↑ Always, Franz: It is up to you to improve the situation . In: Swiss Medical Journal . No. 38 , 2013, p. 1429-1431 .