Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges.

Various actions have been taken during the last decade to increase the number of organs from deceased donors available for transplantation in Switzerland. This study provides an overview on key figures of the Swiss deceased organ donation and transplant activity between 2008 and 2017. In addition, it puts the evolution of the Swiss donation program's efficiency in relation to the situation in the neighboring countries. This study is an analysis of prospective registry data, covering the period from 1 January 2008 to 31 December 2017. It includes all actual deceased organ donors (ADD) in Switzerland. Donor data were extracted from the Swiss Organ Allocation System. The "donor conversion index" (DCI) methodology and data was used for the comparison of donation program efficiency in Switzerland, Germany, Austria, Italy and France. During the study period there were 1116 ADD in Switzerland. The number of ADD per year increased from 91 in 2008 to 145 in 2017 (+ 59%). The reintroduction of the donation after cardiocirculatory death (DCD) program in 2011 resulted in the growth of annual percentages of DCD donors, reaching a maximum of 27% in 2017. The total number of organs transplanted from ADD was 3763 (3.4 ± 1.5 transplants per donor on average). Of these, 48% were kidneys (n = 1814), 24% livers (n = 903), 12% lungs (n = 445), 9% hearts (n = 352) and 7% pancreata or pancreatic islets (n = 249). The donation program efficiency assessment showed an increase of the Swiss DCI from 1.6% in 2008 to 2.7% in 2017 (+ 69%). The most prominent efficiency growth was observed between 2012 and 2017. Even though Swiss donation efficiency increased during the study period, it remained below the DCI of the French and Austrian donation programs. Swiss donation activity and efficiency grew during the last decade. The increased donation efficiency suggests that measures implemented so far were effective. The lower efficiency of the Swiss donation program, compared to the French and Austrian programs, may likely be explained by the lower consent rate in Switzerland. This issue should be addressed in order to achieve the goal of more organs available for transplantation

In the eye of the hurricane: the Swiss COVID-19 pandemic stepwise shutdown approach in organ donation and transplantation.

The Swiss stepwise shutdown approach in organ donation and transplantation helped to maintain a limited national organ procurement and vital organ transplant activity, avoiding a complete nationwide shutdown of organ donation and transplant activity.&nbsp

Organ donation in the ICU - a survey on next of kin response in two Swiss academic centres.

AIM OF THE STUDY In the Swiss population, attitudes to organ donation are mostly positive. However, a high refusal rate by the next of kin may be observed. We aimed to investigate potential underlying reasons. METHODS In two independent Swiss tertiary care academic centres 167 next of kin were confronted with potential organ donation, over a period of 18 to 24 months. Of these, 147 could be contacted and were asked ≥6 months later to participate in a post-hoc survey (72-item questionnaire). Aspects related to conversations, time and care in the intensive care unit (ICU), underlying concepts for organ donation, impact on mourning, and other potential influencing factors were addressed. RESULTS The overall return rate was 66%. Seventy four of 77 (96%) next of kin stated that the request for organ donation was appropriate and they agreed to address the issue. Personal attitudes of next of kin regarding organ donation correlated with the decision for or against organ donation (p <0.0001). Thirteen percent (8/62) reported that conversations with ICU physicians changed their decision. In 56% (18/32) of reports when organ donation was refused, the next of kin stated that presence of a documented will might have changed their decisions. Mourning was reported to be impaired by the request for organ donation in 8% (6/71), facilitated in 14% (10/71) and not affected in 77% (55/71) of cases. Twenty-seven percent (16/59) indicated that an opt-out policy for organ donation would subjectively have facilitated their decision and 81% (34/42) of consenting next of kin stated that an objection law should be put into place (p <0.0001). CONCLUSIONS In this observational study, the majority of the next of kin stated that addressing organ donation did not affect mourning. Presence of a presumed will could likely facilitate grief and provide comfort for affected families. (Trial registration: ClinicalTrials.gov. Identifier: NCT03612024. Date of registration: 24 July 2018.)

In the eye of the hurricane: the Swiss COVID-19 pandemic stepwise shutdown approach in organ donation and transplantation

AIMS OF THE STUDY Coronavirus disease 2019 (COVID-19) pandemic has an ongoing severe impact on health care, but there is a lack of information on COVID-19 and its effect on organ donation and solid organ transplantation. Early in the pandemic, Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, set up a national stepwise shutdown approach to avoid a collapse of transplant activities during phases of the pandemic with sufficient available healthcare capacities. The approach allowed regional adaptation of transplant-associated activities depending on available healthcare capacities, instead of implementing a rigid centralistic system. The aim of this study was to describe the stepwise shutdown approach and to determine whether this flexible approach would be helpful for avoiding complete cessation of transplant activities during a pandemic. METHODS A retrospective nationwide study was conducted to evaluate donor procurement and solid organ transplantation activity in Switzerland during the COVID-19 pandemic (1 January to 31 May 2020). To assess the impact of the flexible stepwise shutdown plan on overall transplantation activity in Switzerland, we compared total and individual numbers of transplanted organs during the first wave of the pandemic with the transplant activity immediately before the pandemic. RESULTS The pandemic evolved heterogeneously across Swiss cantons, severely affecting western cantons and the Ticino. Overall, there was a reduction in deceased donor transplants in Switzerland of 16.7% in March and April 2020 (during the pandemic) compared with January and February 2020 (prior to the pandemic), the decline mostly driven by kidney transplants (−27.6%) and to a lesser extent by transplants of vital organs (heart, lungs, liver) (−5.9%). In May 2020, solid organ transplantation activity in Switzerland again exceeded the average of pre-pandemic months (January and February), with 35 transplanted organs, but the increase from April to May 2020 was exclusively driven by liver and kidney transplants. CONCLUSION The Swiss stepwise shutdown approach in organ donation and transplantation helped to maintain a limited national organ procurement and vital organ transplant activity, avoiding a complete nationwide shutdown of organ donation and transplant activity. We therefore propose a flexible shutdown approach that regulates transplant activities dependent on regional healthcare resources rather than uniform centralistic regulations. This approach proved to be especially useful during a regional heterogeneously evolving pandemic