Demand for healthy organs outpaces supply

Last year 62 people died in Switzerland while waiting for transplants Keystone

Donated organs like kidneys, hearts and lungs are in short supply in Switzerland, where demand for transplants has increased notably in the past year.

Representatives of Swisstransplant, a foundation that promotes organ donations and transplants, said on Wednesday that the key to resolving the shortfall was simple: find more people willing to give up their organs upon their deaths.

Trix Heberlein, president of the foundation, told swissinfo that Switzerland’s number of registered organ donors was currently ranked near the bottom compared with European Union countries.

“That’s hard to accept,” she said. “How many unfortunate fates rest behind these numbers?”

In an effort to combat the problem, Swisstransplant has proposed several measures to help bring more healthy organs into hospitals. For one, Switzerland needs a programme to allow organs to be harvested from brain-dead patients.

Others propose an online database to help match hearts with children needing transplants from all over Europe. Swisstransplant also hopes to forge closer cooperation between organ donor programmes and intensive medicine groups.

Waiting for help

Despite the dearth of available organs, the number of Swiss donors in 2008 actually increased – up 11.1 per cent – over the previous year. In all there were 90 people who died in 2008, leaving their organs for donation. In 2007, there were 81 so-called cadaver donors.

During the past decade the annual number of available cadaver donors has been on a downward slide. In 1999 there were 101 donors, a high point. Just 75 cadavers could be harvested for organs in 2002.

Meanwhile the number of people waiting for an organ transplant has been on a steady increase and leapt 19 per cent to 942 people in 2008. That is up from 630 people in 2004.

Franz Immer, director of Swisstransplant, said the figures for the first months of 2009 showed more than 1,000 people were now waiting, most of them for healthy kidneys. The typical waiting time for a healthy organ is two to three years and during that time many may never get one.

Last year 62 people died in Switzerland while waiting for transplants. That’s up from 43 people in 2004.

The figures for available cadaver donors appear to be direr when compared on a per capita basis with other EU nations. In 2008 there were just 11.8 Swiss donors per million people. By comparison Austria had 20.3 donors per million, France had 25.1 per million and Spain had more than 30.

“Without foreign donors we would have far fewer organs,” Heberlein said, adding that doctors last year completed 19 transplants on Swiss patients using organs from other countries.

“The Swiss are very open to transplants and organ donation. The problem is that they don’t take care of the steps they need to take to become a donor.”

Avoiding a difficult situation

Swisstransplant has begun working with doctors, hospitals and pharmacies to help inform people of what they need to do be sure their organs do not go to waste upon their death.

Potential donors should register with Swisstransplant and fill out a donor card specifying which organs doctors can harvest. Most importantly, people need to tell their loved ones how they feel about donating their organs before it’s too late.

“It’s incredibly hard for relatives not to know what their deceased loved ones would have wanted done with their organs,” said Stephan Marsch, a representative of the Swiss Society of Intensive Care Medicine.

“As you can imagine it puts them in a very difficult situation.”

That lack of communication may contribute to Switzerland’s relatively high refusal rate by surviving family members to agree to donate a loved one’s organs.

The rate is higher than 60 per cent here, figures show, compared with an average of 40 per cent for Europe in general.

The group is also working to identify potential donors to inform them about the process and how they can help. Members are working to train workers in intensive care units on how to talk about the subject.

Other measures include working to harvest organs from the “warm dead”, people with brain damage so severe they will never recover.

Still, some people simply do not want to have their organs donated when they die.

“Some say their heart is the centre of their being and they don’t want that to be taken away,” Immer said.

“But you can give a gift so that someone else may live. Many people are cremated after they die, so why not help improve the quality of life for someone still alive?”

swissinfo, Tim Neville

Key facts

62 people died in 2008 while waiting for an organ transplant.
19 organs were imported from other countries.
942 people were waiting for organs in 2008, up 19% on 2007.
128 people, up 14%, received organs from live donors in 2008.
90 cadavers, up 11.1%, provided organs in 2008.

Transplant operations

By far the most common organ transplants in Switzerland are for kidneys, accounting for nearly two out of every three transplants. That is followed by operations for livers, hearts and lungs.

Operations are carried out at hospitals in Basel, Bern, Geneva, Lausanne, St Gallen and Zurich.

In 2008 the University Hospital Zurich carried out the most transplants with 136 operations, 54 of which were for kidneys. Hospitals in Bern and St Gallen were the only two to harvest more organs than the number of transplants doctors at those hospitals performed.

New rules for donations

Switzerland has followed a new framework for regulating transplants since July 1, 2007. Under the regulations a person’s organs can be harvested after death only if consent is given beforehand. The will of the dead person overrides the wishes of surviving relatives.

But if people do not make their intentions clear before dying, the next of kin can decide. If no relatives exist, the organs can’t be taken. Last year less than 10% of the organs harvested from cadavers came from people who had filled out a donor registration card.

There is no age limit on who can be a donor. Last year an 85-year-old’s organs were used. Children are not frequently donors but last year a one-year-old child received a transplant.