Variation in Organ Donation Rates in Switzerland: Prospective Cohort Study of Potential Donors (SwissPOD) STUDY REPORT
Mar 14, 2016
Variation in Organ Donation Rates in Switzerland:
Prospective Cohort Study of Potential Donors (SwissPOD)
STUDY REPORT
SwissPOD Study Report
Contents
1. Editorial Committee and Authors ............................................................................ 1
1.1. Mandate .................................................................................................................... 1
1.2. Principal Investigator ................................................................................................. 1
1.3. SwissPOD Steering Committee ................................................................................. 1
1.4. Members of the Comité National du Don d’Organes (CNDO) .................................... 1
1.5. Authors ...................................................................................................................... 2
1.6. Executive Summary ................................................................................................... 3
2. Introduction .......................................................................................................... 5
3. Patients and Methods ............................................................................................ 6
3.1. Study Design ............................................................................................................. 6
3.2. Study Period .............................................................................................................. 6
3.3. Participating Hospitals ............................................................................................... 6
3.4. Eligibility Criteria ....................................................................................................... 6
3.5. Exclusion Criteria ....................................................................................................... 6
3.6. Number of Patients ................................................................................................... 6
3.7. Ethical and Regulatory Aspects ................................................................................. 6
3.8. Study Methodology Assessments and Procedures .................................................... 6
3.8.1. The Critical Donation Pathway for Donation after Brain Death (DBD) ............. 7
3.8.2. Data Base ........................................................................................................ 8
3.8.3. Data collection ................................................................................................. 8
3.8.4. Data Analysis ................................................................................................... 8
4. Results .................................................................................................................. 9
4.1. Hospital and Admission Modalities ............................................................................ 9
4.2. Aggregated Data, Donation Outcomes ................................................................... 10
4.3. Possible Donor ......................................................................................................... 11
4.4. Potential Donor ....................................................................................................... 16
4.5. Eligible Donor .......................................................................................................... 16
4.6. Seeking Permission for Donation ............................................................................. 17
4.7. Outcomes for Donation after Circulatory Death (DCD) ............................................ 20
4.8. Comparison of Networks (adult ICU) ....................................................................... 21
4.8.1. Possible Donor ............................................................................................... 22
4.8.2. Outcomes ...................................................................................................... 27
4.8.3. Donation Efficiency........................................................................................ 28
4.8.4. Conversion Rates ........................................................................................... 29
4.8.5. Reasons for Non-Donation ............................................................................ 31
4.8.6. Consent Rate ................................................................................................. 33
4.9. Comparison of University Hospitals / Transplant Centres (adult ICU) ....................... 37
4.9.1. Possible Donor ............................................................................................... 37
4.9.2. Outcomes ...................................................................................................... 41
4.9.3. Donation Efficiency........................................................................................ 42
4.9.4. Conversion Rates ........................................................................................... 43
4.9.5. Reasons for Non-Donation ............................................................................ 44
4.9.6. Consent Rate ................................................................................................. 45
5. Discussion ........................................................................................................... 49
6. References .......................................................................................................... 56
7. Annex ................................................................................................................. 58
7.1. Hospital Characteristics by Network ........................................................................ 58
7.2. Participating hospitals ............................................................................................. 59
7.3. SwissPOD Study Approval ....................................................................................... 60
EDITORIAL COMMITTEE AND AUTHORS
SwissPOD Study Report 1
1. Editorial Committee and Authors
1.1. Mandate
The study “Variation in Organ Donation Rates in Switzerland: Prospective Cohort Study of
Potential Donors (SwissPOD)” was mandated by the G15 to
PD Dr. Franz F. Immer and Comité National du Don d’Organes (CNDO)
Swisstransplant
Laupenstrasse 37
3008 Bern
1.2. Principal Investigator
Comité National du Don d’Organes (CNDO)
Swisstransplant
Laupenstrasse 37
3008 Bern
1.3. SwissPOD Steering Committee
PD Dr. Markus Béchir, Leitender Arzt, Intensivstation Viszeral-, Thorax- und Transplantations-
chirurgie, Universitätsspital Zürich
Prof. Dr. Léo Buhler, Médecin adjoint, Service de chirurgie viscérale et de transplantation,
Hôpitaux Universitaires de Genève
Dr. Christian Garzoni, Leitender Arzt Innere Medizin und Infektiologie, Clinica Luganese
PD Dr. Lukas Hunziker, Leitender Oberarzt Medizinische Intensivstation, Universitätsspital Basel
Dr. Roger Lussmann, Leitender Arzt Chirurgische Intensivstation, Kantonsspital St. Gallen
Dr. Bruno Regli, Stv. Chefarzt Universitätsklinik für Intensivmedizin, Inselspital Bern
PD Dr. Jean-Pierre Revelly, Médecin adjoint soin intensifs, Centre Hospitalier Universitaire
Vaudois Lausanne
Karin Wäfler, Projektleiterin Bevölkerungsinformation, Sektion Transplantation und Fortpflan-
zungsmedizin, Bundesamt für Gesundheit, Bern
1.4. Members of the Comité National du Don d’Organes (CNDO)
PD Dr. Markus Béchir, Leitender Arzt, Intensivstation Viszeral-,Thorax- und Transplantations-
chirurgie, Universitätsspital Zürich
Petra Bischoff, Head of Transplant Coordination, Inselspital Bern
Corinne Delalay, Dipl. Pflegefachfrau mit Fachausweis Intensivmedizin, Hôpital de Sion
Dr. Philippe Eckert, Head of ICU, Clinique la Source, Lausanne
PD Dr. Yvan Gasche, Médecin adjoint soin intensifs, Hôpitaux Universitaires de Genève
Eva Ghanfili, Vertretung Intensivpflegepersonal, Ospedale Regionale di Lugano-Civico
Prof. Dr. Christoph Haberthür, Präsident CNDO, Leiter Chirurgische Intensivstation, Kantons-
spital Luzern
PD Dr. Lukas Hunziker, Leitender Oberarzt Medizinische Intensivstation, Universitätsspital Basel
PD Dr. Franz Immer, Direktor Swisstransplant, Bern
Dr. Roger Lussmann, Leitender Arzt Chirurgische Intensivstation, Kantonsspital St. Gallen
Dr. Sven Mädler, Leitender Arzt Anästhesie und Intensivmedizin, Kantonsspital Nidwalden
EDITORIAL COMMITTEE AND AUTHORS
SwissPOD Study Report 2
Dr. Luca Martinolli, caposervizio pronto soccorso / medicina d'urgenza, Ospedale Regionale di
Lugano-Civico
Diane Moretti, coordinatrice générale, Programme Latin de Don d’Organes (PLDO), Hôpitaux
Universitaires de Genève
Stefan Regenscheit, Netzwerkkoordinator ZH, Universitätsspital Zürich
Dr. Thomas Riedel, Oberarzt Intensivbehandlung Pädiatrie, Inselspital Bern
Caroline Spaight, data manager, Swisstransplant, Bern
Prof. Dr. Reto Stocker, Institutsleiter Institut für Anästhesiologie und Intensivmedizin, Klinik
Hirslanden, Zürich
Dr. Jan Wiegand, Oberarzt Universitätsklinik für Intensivmedizin, Inselspital Bern
1.5. Authors
Caroline Spaight, Julius Weiss, Isabelle Keel, PD Dr. Franz F. Immer
EXECUTIVE SUMMARY
SwissPOD Study Report 3
1.6. Executive Summary
SwissPOD, the Swiss Monitoring of Potential Donors, is the first comprehensive, nationwide
study to identify the number of patients dying in an intensive care unit (ICU) or accident and
emergency department (A&E) who are potential organ donors.
Seventy six (100%) of Swiss hospitals with an intensive care unit recognised by the Swiss Society
of Intensive Care Medicine (SSICM) participated to the SwissPOD audit. Data was collected in 139
units; 87 (62.6%) from intensive care units (ICU) and 52 (37.4%) from accident and emergency
departments (A&E). Data was collected for all deaths in ICU or A&E, resulting in 4524 audited
deaths; 3664 from an adult ICU, 62 from paediatric ICU, and 798 from A&E.
This audit has enabled a general overview of the potential for donation in Switzerland as well as a
comparison of the performances in the six donation networks1, and the six university hospitals /
transplant centres2.
Main findings
The estimated maximum capacity in Switzerland for organ donation after brain death from ICU
and A&E deaths is 290 donors per year, equalling 36.5 per million of population (pmp). It is
noteworthy that this capacity does not include patients who died on general hospital wards,
intermediate care units and out-of-hospital. There may be an unquantifiable additional potential
of donors out of this patient group.
The study shows four major findings:
(1) An overall objection rate to organ donation of 52.6%.
(2) An overall conversion rate of 45.4%.
(3) Structural differences on an organisational level among the networks, resulting in a
variation in donation rates.
(4) Varying degrees of awareness for the detection and referral of a possible donor, mainly in
smaller hospitals.
(1) Objection to donation
Of the 350 patients considered for donation during the study period, permission was sought in
268 (76.6%) cases. This resulted in 127 consents (47.4%) and 141 objections (52.6%) to organ
donation. Objection rates by networks varied between 39.4% and 68.4%. This objection rate is
higher than the average European refusal rate of 30% and an increase, compared to a previous
Swiss audit which showed a refusal rate of 42% in 2008.
Aggregated study data show that objection to donation was observed during all phases of the
donation process, demonstrating that approach to the next of kin in view of seeking consent for
donation is occurring at different time points. There was a direct correlation between an early
approach for requesting organ donation and the number of objections. Out of 91 approaches at
the possible donor level, 71 (78.0%) objected to donation. These early approaches were more
frequently documented in the networks of the German-speaking area compared to the
Programme Latin de Don d’Organes (PLDO) including the French- and Italian-speaking cantons.
1 The six donation networks and their affiliated cantons are Basel (BS, BL, AG), Bern (BE, SO), Luzern (LU,
OW, NW, UR), Programme Latin de Don d’Organes PLDO (GE, VD, VS, NE, FR, JU, TI), St. Gallen (SG, AR,
AI) and Zürich (ZH, SH, TG, ZG, SZ, GL, GR).
2 There are six transplant centres in Switzerland; the university hospitals Basel, Bern, Genève, Lausanne,
Zürich, and St. Gallen cantonal hospital.
EXECUTIVE SUMMARY
SwissPOD Study Report 4
(2) Conversion rate
Our Swiss study data showed an overall conversion rate of 45.4%, (calculated as the percentage
of potential donors who become an organ donor), which is comparable with UK and US data. Our
data shows that Swiss ICUs are generally doing an excellent job in considering the option of
donation at end of life care. 350 patients out of the 4524 audited deaths (7.7%), representing
44.0 pmp were considered for organ donation. However, the conversion of these patients to
organ donors show variations by networks and by hospital with losses in all steps of the donation
process.
(3) Structural differences
This study, in addition to patient information, collected information on hospital infrastructure,
hospital policies as well as directives and guidelines for caring for a potential donor. Data
revealed that there are considerable variations by network. In some of the networks, there are
hospitals without guidelines or institutional directives on brain death. There is also a difference
between the networks concerning the number of hospitals that procure organs for
transplantation and the availability of an on-site transplant coordinator. Additionally, the PLDO
network finances local donor coordinators in each hospital with an ICU. To our knowledge, no
canton within a network from the German-speaking area is supporting the local donor
coordinators financially. However, article 56(2) of the Transplantation Law (SR 810.21) states that
the cantons are in charge of implementing the measures required in the context of organ
donation and transplantation. Among others, these include the appointment and training of staff
responsible for detecting and referring potential organ donors.
(4) Varying degrees of awareness for the detection and referral of a possible donor
Audited data shows that patients diagnosed brain dead came from three categories of
diagnoses: cerebrovascular accident, head trauma and anoxia. All of the 76 hospitals had patients
who died from these death selected causes. However, there was a large variation between
hospitals and networks for patients dying on an ICU with one of these pathologies and the
transfer of these patients from non transplant centres. The study demonstrates that a number of
patients with these death selected causes are never admitted to an ICU from A&E or that they
were admitted to an ICU but transferred to general ward for end of life care. It would be incorrect
to presume that all of these patients could have been brain death diagnosed. However, one can
consider that a small proportion of these patients are probably non identified donors due to lack
of awareness for organ donation, and therefore the option for donation was not considered.
Conclusion
All 6 networks showed that they were well performing in at least one step of the donation
process, such as donor identification, referral, seeking permission for donation, donor
management and organ donation. However, all networks equally show that there is room for
improvement in one or more steps.
The interpretation of the data is partial, due to a number of small networks and hospitals with
limited data samples over the one year period. This has to be considered, to avoid
misinterpretation in the understanding of the results.
The high refusal rate in Switzerland is multifactorial and requires detailed further analysis.
However, this problem should be addressed both within the hospitals and the public.
The issues concerning the structural differences as well as the varying degrees of awareness in
the identification and referral of a possible donor may be overcome by implementing best
practices, offering educational programmes for physicians and nurses, and the financing of local
donor coordinators in ICUs.
INTRODUCTION
SwissPOD Study Report 5
2. Introduction
On the 1st of July 2007, the national Transplantation Law (SR 810.21) was implemented in
Switzerland. Alongside the change from centre-oriented organ allocation to patient-oriented
national allocation of organs came two new major elements with the aim to increase the Swiss
organ donation rate: First, the obligation to detect and refer donors to Swisstransplant (the
national organisation for organ donation and transplantation), intended as a quality assurance
tool. Secondly, the introduction of “local donor coordinators” in intensive care units of each
hospital and financed by the responsible canton.
However, the number of donors in Switzerland has remained stable over the last five years,
ranging from 81 deceased donors in 2007 (10.7 per million of population [pmp]) to a maximum
number of 103 donors in 2009 (13.2 pmp). The covered study period from 1 September 2011 to 31
August 2012, shows a total of 98 donations after brain death (DBD), representing 2.2% of all
audited deaths, and 6 donations after circulatory death (DCD). This equals an actual donation
rate of 12.3 pmp (13.1 pmp with DCD included). Despite the actions that have been taken, the
donation rate – which is one of the lowest in Europe – has remained static. Yet, considerable
variations of the donation rates amid the Swiss regions historically existed and continue to
persist.
The Programme Latin de Don d’Organes (PLDO), being one of Switzerland's six “donation
networks”, was at the forefront regarding the implementation of the new legal requirements and
apposite structures for the purpose of improving the donation process within the hospitals of the
PLDO cantons (GE, VD, VS, NE, FR, JU and TI). Pre-eminently, this incorporated enhancements
in donor detection within the hospitals, which resulted in improvements in the donation process.
In the PLDO network, unlike in the other donation networks, organs are procured not only in the
university hospitals (transplant centres) but also in several regional hospitals. In the networks of
the German-speaking area of Switzerland, Basel and St. Gallen networks were also able to
improve the structures in the donation process, mainly owed to the commitment of their teams.
However, the general picture for the German-speaking area shows stable or even slightly
decreasing donation rates, resulting in an overall longer waiting list in Switzerland (although this
is due also partly to technical reasons), which tends to lead to a higher mortality.
In order to investigate the reasons for the regional differences in organ donation rates, the G15∗
mandated the Swiss Monitoring of Potential Donors (SwissPOD) study to the Comité National du
Don d’Organes (CNDO). SwissPOD is the first comprehensive, nationwide study to try to identify
the number of patients dying in a ICU or A&E who could donate their organs after brain death or
circulatory death for transplantation. The results presented in this report were obtained by
recording detailed information for all deaths from every patient who died in an adult and
paediatric ICU, or A&E department. It is important to note that there was a 100% participation
rate to the study that included all of the 76 hospitals with an ICU recognised by the Swiss Society
of Intensive Care Medicine (SSICM). This audit has enabled a comparison of performance of ICUs
between donation networks, university and transplant hospitals as well as hospitals with
neurosurgical facilities and those who have no neurosurgical facilities. We have been able to
accurately determine the potential donor pool and give reasons why potential donors after brain
death did not donate organs for transplantation. However, the data from accident and
emergency departments, due to small data samples and a variety of hospital policies, will need
further in depth analysis before giving any conclusions.
∗ The G15 (Group of 15) consists of the heads of the university hospitals (Basel, Bern, Genève, Lausanne
and Zürich), including the hospital directors, medical directors and the deans of the faculties, as well as
the hospital director of St. Gallen cantonal hospital.
PATIENTS AND METHODS
SwissPOD Study Report 6
3. Patients and Methods
3.1. Study Design
Prospective cohort study of all deaths in Swiss intensive care units (ICU) and accident and
emergency departments (A&E).
3.2. Study Period
1 September 2011 – 31 August 2012
3.3. Participating Hospitals
All 76 hospitals with an ICU recognised by the Swiss Society of Intensive Care Medicine (SSICM)
and their associated A&E.
3.4. Eligibility Criteria
All patients who died in a ICU or A&E
3.5. Exclusion Criteria
• All deaths under the age of 44 weeks gestation.
• All patients, who in life refused to participate to a clinical study.
3.6. Number of Patients
The total number of patients included in this study is 4524.
• 3664 ICU adult deaths
• 62 ICU paediatric deaths
• 798 A&E deaths
3.7. Ethical and Regulatory Aspects
This study was conducted in accordance with ICH-GCP guidelines and Swiss national legislation
and regulations as listed below:
• Eidgenössische Expertenkommission für das Berufsgeheimnis in der medizinischen
Forschung, 17. 8. 2011, 035.0001-59 [copy included in the Annex]
• Approval by all Cantonal Ethics Committees, 2011–2012
• ICH Topic E6 Guideline for Good Clinical Practice, step 5, consolidated Guideline, 1 May
1996
• Verordnung vom 17.10.2001 über klinische Versuche mit Heilmitteln (VKlin; SR 812.214.2)
• Bundesgesetz vom 15. Dezember 2000 über Arzneimittel und Medizinprodukte
(Heilmittelgesetz; SR 812.21)
3.8. Study Methodology Assessments and Procedures
This cohort study is designed in two parts. One by collecting patient data from medical records
for deaths in ICUs and A&E departments, and secondly by collecting information on hospitals and
ICUs concerning their structures and policies regarding organ donation.
The collection of patient data was designed on a hierarchical basis with a series of forms using
the Critical Donation Pathway for donation after brain death (DBD) as defined by the European
Donation Commission in 2010 [1]. The process describes the different steps; possible donor,
potential donor, eligible donor, actual donor and utilised donors and the losses at each step of
the process with the reasons and causes for possible organ and tissue donors (see next page for
details).
PATIENTS AND METHODS
SwissPOD Study Report 7
The forms include basic demographic information (non patient identifiable). Date, time and
cause of admission to hospital and whether the patient was transferred from a regional hospital
to a reference centre as well as date, time and cause of death. This is followed by questions on
documented signs of brain damage in the absence of an iatrogenic explanation, transient or
permanent and whether these signs were observed with the patient under sedation. Detailed
information on the causes of brain injury, medical suitability and whether the patient was
considered at some point as a possible organ donor are obtained as independent variables. Next,
there are questions on brain death with brain death testing and formal diagnosis and if not why.
A lot of emphasis is requested on the timing and the process in which the next of kin were
approached, the decision of the next of kin and the reasons evoked for their decision. Finally,
information on whether organs were retrieved and transplanted. If organs were transplanted,
detailed information is asked on the infectious status of the donor. Information on whether
organs are offered for transplantation, and if not why, were extracted from the Swiss Organ
Allocation System (SOAS).
Hospital and ICU information were collected separately and include selected information from
the minimal dataset (MDSi) of the Swiss Society of Intensive Care Medicine (SSICM). Hospital
information includes: number of hospital beds, type of hospital, hospital facilities and specialities,
hospital catchment area and population, hospital infrastructure enabling to care for a potential
donor, hospital policies for the transfer of a potential donor to a reference centre, hospital
guidelines and institutional directives on the donation process.
ICU information principally involved: type of ICU, number of beds, total number of admissions by
year, total number of deaths by year, mean length of stay, mean occupancy of beds, number of
fulltime working physicians and nurses working with and without FMH and ICU speciality.
3.8.1. The Critical Donation Pathway for Donation after Brain Death (DBD)
Organ donation after death is a rare and an infrequent event. It is only authorized in limited
circumstances when death occurs in a ICU or A&E after all life saving measures have been taken
but have failed and explicit consent for donation has been obtained (signed donor card or
consent from the next of kin or person of trust).
Donation after brain death (DBD) is possible when cerebral functions are totally and irreversibly
abolished due to a lesion affecting the brain. Death diagnosis in view of organ donation is strictly
regulated by the Swiss Academy of Medical Sciences (SAMS) and is governed by the Swiss
Transplantation Law.
The dead donor rule applies which is to say that patients may only become donors after death,
and the recovery of organs must not cause a donor’s death.
Possible DBD Donor
A person mechanically ventilated, with a devastating brain injury or lesion
Potential DBD Donor
A person mechanically ventilated and whose medical condition is suspected to fulfil brain death criteria1.
1 Brain death criteria as defined by the Swiss Academy of Medical Sciences SAMS must demonstrate that a patient fulfils seven cumulative clinical
signs. The coma must be due to a known origin and the seven clinical signs must be present in the absence of an iatrogenic explanation. The seven
clinical signs are:
1) Coma
2) Bilateral fixed mydriasis (absence of pupillary light reaction)
3) Absence of oculocephalic and oculvestibular reflexes
4) Absence of corneal reflex
5) Absence of cerebral reactions to painful stimuli
6) Absence of cough & swallowing reflexes
7) Absence of spontaneous respiration (apnea test)
PATIENTS AND METHODS
SwissPOD Study Report 8
Eligible DBD Donor
A medically suitable2 person who has been declared dead based on neurologic criteria (brain death) as defined by
the Swiss Academy of Medical Sciences (SAMS)
2 Medically suitable for donation is defined as patients who have no absolute contra-indications for organ donation. Absolute contra-indications
include:
� coma of an unknown origin
� unresolved systemic infection or infections from an unknown origin
� suspicion or risk of prion disease
� suspicion of rabies
� degenerative diseases of the nervous system from an unknown origin
� malignancy or <5 year history of treated malignancy, with the exception of:
– carcinoma in situ
– primary central nervous system tumours that rarely metastasise outside the nervous system
– low-grade skin tumours with little metastatic capacity such as basocellular carcinoma
Actual DBD Donor
A consented eligible donor:
(A) in whom an operative incision was made with the intent of organ recovery for the purpose of transplantation
or
(B) from whom at least one organ was recovered for the purpose of transplantation
Utilised DBD Donor
An actual donor from whom at least one organ was transplanted.
3.8.2. Data Base
The SwissPOD database was programmed and is operated by EPYX, Lausanne (formerly CAI SA,
Lonay).
3.8.3. Data collection
Data are collected and entered to the web-based system database by the local donor coordinator
in each hospital (physician or nurse). Each auditor is trained by one of the two data monitors. The
system database and documentation are available in the three national languages. Data
monitors at Swisstransplant validate and archive each form with any queries being resolved
directly with the person who completed the form. Treating clinicians are interviewed if the
information in the medical record is not clear. As there is a 100% participation rate, a great effort
was made monthly to ensure that the actual number of deaths correspond to the amount of
forms entered. There is no missing data from the intensive care units and 9 missing cases were
reported for A&E.
3.8.4. Data Analysis
SwissPOD was designed to monitor the potential for organ and tissue donation in a hospital.
Limited hospital resources only enabled us to collect data for deaths in ICU and A&E. This report
is focused on donation after brain death (DBD) in adult ICUs, and the comparison of performance
of these ICUs between donation networks and university hospitals / transplant centres
exclusively.
We have chosen not to show detailed data for potential donation after circulatory death and no
data for tissue donation as presently only a couple of university hospitals have these policies.
Likewise, data from paediatric ICUs and A&E also due to small data samples and a variety of
hospital policies, will require further in-depth analysis and will be given posteriorly.
RESULTS Aggregated Study Data
SwissPOD Study Report 9
4. Results
4.1. Hospital and Admission Modalities
76 (100%) of Swiss hospitals with an intensive care unit recognised by the Swiss Society of
Intensive Care Medicine (SSICM) participated to the Swiss Monitoring of Potential Donors
(SwissPOD) audit. Data was collected in 139 units; 87 (62.6%) from intensive care units (ICU) and
52 (37.4%) from accident and emergency departments (A&E). Of the 4524 audited deaths, 3726
(82.4%) came from ICU and 798 (17.6%) came from A&E (Table 1).3
Table 1: Participating hospitals and units
01.09.2011 – 31.08.2012 Number Per million population
Hospitals 76 (100%)
Units
- ICU
- A&E
139
87 (62.6%)
52 (37.4%)
Unit deaths
- ICU
- A&E
4524
3726 (82.4%)
798 (17.6%)
Brain death diagnosed 142 (3.1%) 17.9
Organ donors 98 (2.2%) 12.3
Table 2: Unit on admission to hospital and unit at death
Unit on admission n % Age (mean) ±1SD
A&E 2808 62.1% 69.0 16.8
of which died on A&E 795 17.6% 70.4 18.9
of which died on ICU 2013 44.5% 68.5 15.9
General ward 979 21.6% 71.0 13.9
of which died on A&E 3 0.1% 62.7 9.5
of which died on ICU 976 21.6% 71.0 13.9
ICU 684 15.1% 65.9 19.4
of which died on ICU 684 15.1% 65.9 19.4
Intermediate care unit 53 1.2% 67.5 17.5
of which died on ICU 53 1.2% 67.5 17.5
All deaths 4524 100.0% 69.0 16.7
Table 2 shows that 62.1% of all audited deaths were admitted to the hospital via the A&E
department. 82.4% of these patients died on an ICU and 17.6% in the A&E department. The
mean age of all deaths is 69.0 ±16.7 years.
3 Due to rounding, the sum of percentages in the following may not always equal 100 percent.
RESULTS Aggregated Study Data
SwissPOD Study Report 10
4.2. Aggregated Data, Donation Outcomes
Figure 1: Aggregated study data: Summary of the DBD donation process
RESULTS Aggregated Study Data
SwissPOD Study Report 11
Figure 1 shows a schematic breakdown of the 4524 audited deaths. In summary, 1834 patients
(40.5%) had signs of severe brain damage of which 1413 (77.0%) were mechanically ventilated at
some point during their stay in ICU or in A&E. (This category of patients is referred to as Possible
Donor). 350 (24.8%) of these patients were considered as organ donors. 216 (15.3%) of the
patients mechanically ventilated with signs of severe brain damage were suspected to fulfil brain
death criteria on clinical grounds (Potential Donors). All 216 cases were documented with clinical
signs of brain damage as well as the absence of spontaneous respiration. Of the 216 patients,
formal brain death testing was performed in 160 cases (74.1%) which resulted in 142 (88.8%) of
these patients being brain death diagnosed (Eligible Donors). 98 patients (69.0%) of those brain
death diagnosed actually became organ donors (Utilised Donors) which represents 2.2% of all ICU
and A&E deaths.
Table 3: Patient characteristics (gender, age)
Gender n % Age (years [mean]) ±1SD
Female 1783 39.4% 70.3 17.1
Male 2741 60.6% 68.1 16.5
Total 4524 100.0% 69.0 16.7
The patient characteristics of all audited deaths show that 60.6% of deaths were male and 39.4%
female. The mean age of the female deaths is 70.3 ±17.1 years compared to 68.1 ±16.5 years for
their male counterparts (see Table 3).
4.3. Possible Donor
The identification of a possible donor is the starting point in the donation process. The detection
process starts with a patient who has clinical evidence of brain injury. The definition of a possible
donor is a person mechanically ventilated, with a devastating brain injury or lesion.
Table 4 (see next page) shows the causes of brain injury for the 1953 patients with a neurological
pathology (43.2%) of all 4524 deaths. The 142 patients diagnosed brain dead came principally
from three categories of diagnoses (subsequently referred to as “death selected causes”):
(1) Cerebrovascular accident (CVA) all types, intracranial haemorrhage and intracranial
ischemia
(2) Head trauma, including open and closed traumatic brain injury
(3) Anoxia, all types, including anoxia secondary to cardiac arrest following prolonged
reanimation, asphyxia etc.
RESULTS Aggregated Study Data
SwissPOD Study Report 12
Table 4: Causes of brain injury
All patients
(n=4524)
Possible donor1
(n=1413)
Potential donor2
(n=216)
Eligible donor3
(n=142)
Total number of patients with a neurological
pathology
1953 (43.17%) 1251 (88.54%) 214 (99.07%) 142 (100.00%)
Patients ventilated with a neurological
pathology
1676 (37.05%)
Patients never ventilated with a neurological
pathology
277 (6.12%)
Cause of brain injury
intracranial haemorrhage 386 (8.53%) 332 (23.50%) 105 (48.61%) 75 (52.82%)
intracranial ischemia 156 (3.45%) 101 (7.15%) 10 (4.63%) 9 (6.34%)
open traumatic brain injury 27 (0.60%) 26 (1.84%) 9 (4.17%) 6 (4.23%)
closed traumatic brain injury 134 (2.96%) 118 (8.35%) 32 (14.81%) 23 (16.20%)
anoxia/hypoxia (all causes), cardiac arrest 1218 (26.92%) 654 (46.28%) 56 (25.93%) 28 (19.72%)
primary brain cancer 3 (0.07%) 0 (0.00%) 0 (0.00%) 0 (0.00%)
meningitis/encephalitis 15 (0.33%) 13 (0.92%) 3 (1.39%) 1 (0.70%)
intoxication 14 (0.31%) 8 (0.57%) 0 (0.00%) 0 (0.00%)
other diagnoses from non primary cerebral
causes
2571 (56.83%) 161 (11.39%) 1 (0.46%) 0 (0.00%)
1A person mechanically ventilated, with a devastating brain injury or lesion. (Patients who have a cardiac arrest with a failed resuscitation are excluded as
possible DBD donors but included as a possible DCD donor.)
2A person whose medical condition is suspected to fulfil brain death criteria.
3A medically suitable person who has been declared dead based on neurologic criteria as defined by the Swiss Academy of Medical Sciences (SAMS).
Of the 142 patients who were eligible donors (brain death diagnosed) 141 came from a death
selected cause of CVA, head trauma or anoxia, data was analysed to assess the conversion of this
patient population to brain death diagnosis.
Figure 2a: Admission diagnosis of patients
who died on a ICU or A&E (n=4524)
Figure 2b: Brain death diagnosis by
death selected cause (n=141)
RESULTS Aggregated Study Data
SwissPOD Study Report 13
Figure 2a shows that 1921 (42.5%) of all ICU and A&E deaths came from a death selected cause;
CVA 542 (12.0%), head trauma 161 (3. 6%), or anoxia 1218 (26.9%).
Figure 2b shows that of the 542 patients who died from a CVA, 84 were diagnosed brain dead,
which represents 59.6% of the total number of patients diagnosed brain dead. Of the 1218
patients who died from anoxia, 28 were diagnosed brain dead, corresponding to 19.9% of brain
deaths, and of the 161 patients who died following traumatic brain injury, 29 were brain death
diagnosed, representing 20.6% of brain deaths.
Table 5: Distribution of ICU and A&E deaths by death selected cause
Unit Deaths by selected cause Total number of deaths Mean age [years] ±1SD
ICU* 1378* (71.7%) 3726 (82.4%) 68.7 ±16.2
A&E 543 (28.3%) 798 (17.6%) 70.4 ±18.9
Total 1921 (100.0%) 4524 (100.0%) 69.0 ±16.7
*ICU deaths include adult and paediatric deaths. Of the 1378 patients with a death selected cause, 1339 came from adult ICU from a total of 3664 deaths
and 39 out of a total 62 came from a paediatric ICU.
Table 5 shows that out of all 4524 deaths, 1921 (42.5%) died of a death selected cause (CVA, head
trauma or anoxia). Out of these deaths, 1378 died on ICU (37.0% of all ICU deaths) and 543 on
A&E (68.0% of all A&E deaths).
Table 6: Ventilation
All patients Pat. with signs of brain damage
n % Age (mean) ±1SD n % Age (mean) ±1SD
All deaths 4524 100.0% 69.0 16.7 1834 100.0% 64.9 18.8
Ventilated 2879 63.6% 66.3 17.1 1379 75.2% 62.9 18.8
Ventilation withheld/withdrawn 440 9.7% 69.5 17.4 235 12.8% 68.3 17.7
Never ventilated 1205 26.6% 75.1 13.7 220 12.0% 73.2 16.8
Table 6 displays the distribution of the patients who were mechanically ventilated or never
ventilated with clinical signs of brain damage. In summary, 3319 (73.3%) of all deaths were
mechanically ventilated at some point during hospital stay. This rises to 88.0% (n=1614) for
patients who had a devastating brain injury with clinical signs of brain damage.
As an analysis of the 220 patients with signs of brain damage and who were never ventilated
showed, 124 (56.4%) patients died on A&E and 96 (43.6%) died on an ICU (data not shown in
table). Of the 124 patients who died on A&E, 34 (27.4%) patients were aged less than 70 years
and 90 (72.6%) patients were aged over 70. Of the 90 patients older than 70, 35 patients were
aged 70–80 years (28.2%) and 55 patients were older than 80 years (44.4%). Of the 96 patients
who died on ICU, 66 (68.8%) were over 70 years old. 31 were aged 70–80 years and 35 were over
80 years old. In general, patients dying on A&E are older (in the order of 80 years) than patients
dying on ICU.
RESULTS Aggregated Study Data
SwissPOD Study Report 14
Table 7 shows the distribution of patients with documented clinical signs of brain damage for the
steps in the donation process.
Table 7: Signs of brain damage
All patients
(n=4524)
Possible donor1
(n=1413)
Potential donor2
(n=216)
Eligible donor3
(n=142)
Total number of patients with clinical
signs of brain damage (SBD)
1834 (40.54%) 1413 (100.00%) 216 (100.00%) 142 (100.00%)
Patients with SBD and ventilated 1379 (30.48%) 1192 (84.36%)
Patients with SBD and ventilation
withdrawn or withheld
235 (5.19%) 221 (15.64%)
Patients with SBD never ventilated 220 (4.86%)
Clinical signs of brain damage
Total number of patients who showed
signs of brain damage who were under
sedation
327 (7.23%) 304 (21.51%) 6 (2.78%)
Glasgow Coma Scale GCS <8 1810 (40.01%) 1394 (98.66%) 216 (100.00%) 142 (100.00%)
bilateral fixed mydriasis (absence of
pupillary light reaction)
850 (18.79%) 650 (46.00%) 212 (98.15%) 142 (100.00%)
absence of occulocephalic reflex 296 (6.54%) 275 (19.46%) 188 (87.04%) 142 (100.00%)
absence of occulovestibular reflex 269 (5.95%) 251 (17.76%) 181 (83.80%) 142 (100.00%)
absence of corneal reflex 393 (8.69%) 362 (25.62%) 196 (90.74%) 142 (100.00%)
absence of cerebral reactions to painful
stimuli
368 (8.13%) 330 (23.35%) 189 (87.50%) 142 (100.00%)
absence of cough reflex 344 (7.60%) 310 (21.94%) 199 (92.13%) 142 (100.00%)
absence of swallowing reflex 317 (7.01%) 286 (20.24%) 194 (89.81%) 142 (100.00%)
absence of spontaneous respiration 237 (5.24%) 231 (16.35%) 216 (100.00%) 142 (100.00%)
1A person mechanically ventilated, with a devastating brain injury or lesion. (Patients who have a cardiac arrest with a failed resuscitation are excluded
as possible DBD donors but included as a possible DCD donor.)
2A person whose medical condition is suspected to fulfil brain death criteria.
3A medically suitable person who has been declared dead based on neurologic criteria as defined by the Swiss Academy of Medical Sciences (SAMS).
Clinical signs are the triggers that show the different degrees of brain damage following a
devastating brain lesion and which may lead to a diagnosis of brain death. There are 7 brainstem
reflexes that need to be tested as part of brain death determination; all reflexes must be absent
in the absence of an iatrogenic explanation.
The seven clinical signs for brain death diagnosis are:
(1) Coma
(2) Bilateral fixed mydriasis (absence of pupillary light reaction)
(3) Absence of oculocephalic and oculvestibular reflexes
(4) Absence of corneal reflex
(5) Absence of cerebral reactions to painful stimuli
(6) Absence of cough & swallowing reflexes
(7) Absence of spontaneous respiration (apnea test)
Note: the table shows only the signs which were documented in medical notes, possibly not all
absent reflexes were documented. A patient who has an absence of spontaneous respiration in
the absence of sedation or relaxants can be suspected to fulfill brain death criteria.
RESULTS Aggregated Study Data
SwissPOD Study Report 15
Table 8 shows the summary of the reasons why the 1271 patients who were possible organ
donors were not brain death diagnosed. With 142 patients diagnosed brain dead from 1413
possible donors, this represents a loss of 90.0% of the possible donor pool.
Table 8: Reasons why a patient was eliminated from the potential donor pool
number % of deaths
Total number of patients with clinical signs of brain damage 1834 100%
Patients with clinical signs of brain damage never ventilated 220 12.0%
Total number of possible and potential DBD donors who were not brain
death diagnosed
1271 100%
Medical contra-indication to donation 298 23.4%
Not expected to fulfil brain death criteria / did not fulfil brain death
criteria
587 46.2%
Objection to donation (patient / next of kin) 105 8.3%
No next of kin/no donor card 12 0.9%
Coroner objection 3 0.2%
Cardiac arrest with failed resuscitation 174 13.7%
End stage therapeutic treatment 58 4.6%
Multi-organ failure 16 1.3%
Considered as an organ donor after circulatory death 18 1.4%
Results show that there are a number of losses in every step of the donation process. From the
1413 possible donors, 1271 (90.0%) patients did not become an eligible donor. Of the 1271 lost
cases, 1197 (94.2%) were possible donors who did not become potential donors and 74 (5.8%)
were potential donors who did not become an eligible donor.
The principal reasons for not diagnosing brain death were: 587 (46.2%) were not expected to
meet brain death criteria, 298 (23.4%) had an absolute or relative contra-indication to donation
and 105 (8.3%) objected to donation. 18 (1.4%) patients were considered for donation after
circulatory death, Maastricht classification type III. This resulted in 6 patients donating organs
after circulatory death.
It is not known and would be incorrect to say that the 587 (46.2%) patients who were not
expected to meet brain death criteria were missed donors. However, a proportion of these
patients could possibly have become a potential donor after brain death and a number of
hospitals did document that a patient was probably a missed donor due to documented imaging
findings consistent with brain death. Furthermore some of these patients may have been suitable
for donation after circulatory death.
RESULTS Aggregated Study Data
SwissPOD Study Report 16
4.4. Potential Donor
The definition of a potential donor is a person who is mechanically ventilated and who is
suspected to fulfil brain death criteria.
Table 9: Brain death diagnosis
All patients Patients medically suitable
n
% of
all deaths n
% of
medically suitable
All deaths 4524 100.0% 3131 100.0%
Signs of brain damage 1834 40.5% 1475 47.1%
Possible donor1 1413 31.2% 1136 36.3%
Suspected to meet brain death criteria2 216 4.8% 204 6.5%
Brain death tests performed 160 3.5% 160 5.1%
Brain death diagnosed 142 3.1% 142 4.5%
1A person mechanically ventilated, with a devastating brain injury or lesion. (Patients who have a cardiac arrest with a failed resuscitation are
excluded as possible DBD donors but included as a possible DCD donor.)
2A person whose medical condition is suspected to fulfil brain death criteria.
Table 9 shows that out of the 4524 audited deaths, 1393 (30.8%) had an absolute contra-
indication to organ donation. Of the 1475 medically suitable patients who were documented to
have clinical signs of brain damage, 1136 (77.0%) were mechanically ventilated and could be
considered as possible organ donors. 204 (18.0%) of these possible donors were suspected to
meet brain death criteria of which 160 (78.4%) underwent formal brain death testing. 142 (69.6%)
patients who were suspected to meet brain death criteria were formally brain death diagnosed,
representing 3.1% of all audited deaths.
4.5. Eligible Donor
The definition of an eligible donor is a medically suitable person who has been declared dead
based on neurologic criteria (brain death) as defined by the Swiss Academy of Medical Sciences
(SAMS).
In summary, the study revealed that Switzerland has 142 patients (17.9 per million of population
[pmp]) who were brain death diagnosed and who had no contra-indication to donation,
representing 3.1% of all ICU and A&E deaths. The percentage of organ donors after brain death
from all ICU and A&E deaths is 2.2% (12.3 pmp).
Table 10 shows that 44 (31.0%) of the 142 patients brain death diagnosed did not donate organs.
The principal reason why an eligible donor did not become a utilised donor was objection, 75.0%
(n=33).
Table 10: Reasons why an eligible donor did not donate organs
number % of deaths
Total number of patients brain death diagnosed who did not become an organ donor 44 100%
Objection to donation 33 75.0%
Consent obtained; no procurement for medical reasons 9 20.5%
Cardiac arrest with failed resuscitation 2 4.5%
RESULTS Aggregated Study Data
SwissPOD Study Report 17
4.6. Seeking Permission for Donation
Out of all deaths 350 patients (7.7%) were considered for organ donation. This represents 44.0
pmp. A patient considered for donation is where hospital staffs have brought up the option of
donation at end stage therapeutic treatment. This does not necessarily mean that a patient was
suspected to fulfil brain death criteria or that the next of kin were approached in view of seeking
permission for donation.
16 (4.6%) patients of those considered for donation had no next of kin or the next of kin was not
attainable and the patient was not known to have a donor card. The option for donation was
abandoned for these cases as the Transplantation Law requires an explicit consent for donation.
Table 11 shows detailed information on patients considered for organ donation and seeking
permission.
Table 11: Seeking permission for donation
Considered as a DBD or
DBD/DCD donor1 (n=350)
Potential donor2
(n=216)
Eligible donor3
(n=142)
Seeking Permission for donation
next of kin approached in view of seeking
permission for organ donation
247 (70.57%) 183 (84.72%) 141 (99.30%)
no next of kin/next of kin not
available/patient was not known to have a
donor card
16 (4.57%) 6 (2.78%) 0 (0.00%)
no approach the next of kin spontaneously
object to donation before formal request
10 (2.86%) 2 (0.93%) 1 (0.70%)
no approach: medical reasons 41 (11.71%) 4 (1.85%) 0 (0.00%)
no approach: coroner objection 2 (0.57%) 2 (0.93%) 0 (0.00%)
no approach: absolute contra indication to
organ donation
23 (6.57%) 12 (5.56%) 0 (0.00%)
no approach: patient objected to organ
donation (donor card)
8 (2.29%) 2 (0.93%) 0 (0.00%)
no approach: patient not considered for
organ donation
0 (0.00%) 5 (2.31%) 0 (0.00%)
considered as a DBD organ donor, but next
of kin only approached for tissue donation
3 (0.86%) 0 (0.00%) 0 (0.00%)
1All patients who at any time were considered or discussed on ICU or A&E, or with any local, regional or national authority as a possible DBD or
DBD/DCD organ donor.
2A person whose medical condition is suspected to fulfil brain death criteria.
3A medically suitable person who has been declared dead based on neurologic criteria as defined by the Swiss Academy of Medical Sciences (SAMS).
RESULTS Aggregated Study Data
SwissPOD Study Report 18
Table 12 shows that permission for donation was sought for 268 patients. This includes either
patient (donor card) or the next of kin who was approached for organ donation and who
consented or objected. The next of kin who spontaneously brought up the subject of donation
and objected to organ donation as well as coroner objections were included as seeking
permission. Cases where the next of kin were approached but who did not take a decision were
counted as a refusal.
Of the 268 cases where permission for organ donation was sought, 127 (47.4%) consented to
organ donation and 141 (52.6%) objected.
Table 12: Seeking permission for donation, consents vs. objections
Seeking permission
(n=268)
Potential donor2 where
permission was sought
(n=190)
Eligible donor3
(n=142)
TOTAL CONSENTS to organ donation* 127 (47.39%) 120 (63.16%) 109 (76.76%)
Consent Summary
next of kin consented to any donation
following approach
112 (41.79%) 106 (55.79%) 96 (67.61%)
next of kin consented to organ donation
only following approach
15 (5.60%) 14 (7.37%) 13 (9.15%)
patient consented to any donation (donor
card)
17 (6.34%) 14 (7.37%) 13 (9.15%)
patient consented to organ donation only
(donor card)
4 (1.49%) 3 (1.58%) 2 (1.41%)
TOTAL OBJECTIONS to donation 141 (52.61%) 70 (36.84%) 33 (23.24%)
Objection Summary
next of kin spontaneously objected to
donation before formal request
10 (3.73%) 2 (1.05%) 1 (0.70%)
next of kin objected to any donation
following approach
116 (43.28%) 62 (32.63%) 32 (22.54%)
next of kin objected to organ donation
only following approach
1 (0.37%) 0 (0.00%) 0 (0.00%)
next of kin did not take a decision
following approach
3 (1.12%) 1 (0.53%) 0 (0.00%)
coroner objection 3 (1.12%) 3 (1.58%) 0 (0.00%)
patient objected to any donation (donor
card)
8 (2.99%) 2 (1.05%) 0 (0.00%)
1All patients who at any time were considered or discussed on ICU or A&E, or with any local, regional or national authority as a possible DBD or
DBD/DCD organ donor and where consent was sought in view of donation.
2A person whose medical condition is suspected to fulfil brain death criteria.
3A medically suitable person who has been declared dead based on neurologic criteria as defined by the Swiss Academy of Medical Sciences (SAMS).
*Total consents to organ donation correspond to a consent by patient. The sub types of consent show absolute numbers for a specified type of
consent. The sub types added together can be superior to the sum of total consents (for example a patient can have a donor card with consent for
donation and the next of kin can be approached for organ donation and consent. This will be counted as one consent in the total consent field).
RESULTS Aggregated Study Data
SwissPOD Study Report 19
Objection to donation is documented in all steps of the donation process. Of the 141 objections
to donation, 71 objections (50.4%) were documented at the possible donor level (patients
mechanically ventilated with clinical signs of brain damage). 37 objections (26.2%) were recorded
at the potential donor level (patients who were suspected to fulfil brain death criteria) and 33
objections (23.4%) occurred at the eligible donor level (after brain death had been formally
diagnosed). Of the total 141 objections to donation, 108 (76.6%) were documented as occurring
before brain death diagnosis.
Figure 3 shows the percentage of objections vs. consents at each level of the donation process.
Out of 91 approaches at the possible donor level, 71 (78.0%) objected to donation. There were
118 approaches at the potential donor level, resulting in 37 (31.4%) objections. Out of 59
approaches at the eligible donor level, 33 (55.9%) objected to donation.
Figure 3: Objection vs. consent during the donation process
Table 13: Donor card
Considered as a DBD or
DBD/DCD donor1 (n=350)
Potential donor2
(n=216)
Eligible donor3
(n=142)
Donor card not known to exist 294 (84.00%) 173 (80.09%) 106 (74.65%)
Patient had a donor card 56 (16.00%) 43 (19.91%) 36 (25.35%)
consent for any donation 17 (4.86%) 14 (6.48%) 13 (9.15%)
consent for organ donation only 4 (1.14%) 3 (1.39%) 2 (1.41%)
consent for tissue donation only 0 (0.00%) 0 (0.00%) 0 (0.00%)
decision taken by person of trust 27 (7.71%) 24 (11.11%) 21 (14.79%)
objection to any donation 8 (2.29%) 2 (0.93%) 0 (0.00%)
1All patients who at any time were considered or discussed on ICU or A&E, or with any local, regional or national authority as a possible DBD or
DBD/DCD organ donor.
2A person whose medical condition is suspected to fulfil brain death criteria.
3A medically suitable person who has been declared dead based on neurologic criteria as defined by the Swiss Academy of Medical Sciences
(SAMS).
Table 13 shows that 56 patients (16.0%) who were considered for donation carried a donor card.
This is not representative of all deaths as hospital staff would have no reason to look for the
presence of a donor card if the patient was not considered for donation. From the 56 patients
who had a donor card, 27 (48.2%), chose to leave the decision on organ donation to a person of
trust. This resulted in 22 (81.5%) of the next of kin (person of trust) consenting to organ donation.
RESULTS Aggregated Study Data
SwissPOD Study Report 20
4.7. Outcomes for Donation after Circulatory Death (DCD)
Donation after circulatory death (DCD) is authorized following death diagnosis of a permanent
cardio-circulatory arrest in medical establishment as defined by the SAMS and is governed by the
Swiss Transplantation Law.
Figure 4: Aggregated study data, summary of the DCD donation process for
university hospitals / transplant centres
Donation after circulatory death is limited to university hospitals / transplant centers. Figure 4
shows that from the 1813 ICU and A&E deaths from these hospitals, 86 (4.7%) patients were
roughly estimated as a possible/potential donor pool for DCD donation. These were split into two
categories; Maastricht category type III, for which we selected patients who had at least 5 of the 7
clinical signs of brain death, who did not die from polytrauma and who were aged between 16 to
65 years old which resulted in 67 patients (3.7%) if death was to occur in a time frame that would
enable organ donation. The second group was evaluated for Maastricht category type II, for
patients who died following a cardiac arrest with failed resuscitation, excluding polytrauma
patients and who were aged between 16 and 55 years old, resulting in 19 patients (1.0%).
From these 1813 patients, 35 (1.9%) were considered for DCD donation. 18 (51.4%) patients for
DCD Maastricht Category type III and 17 (48.6%) for Maastricht Category type II.
During the study period, only Zürich university hospital had a DCD policy for Maastricht category
type III on ICU, and Genève university hospital with a DCD Maastricht Category type II in A&E
which started in January 2012. St. Gallen cantonal hospital wishes to start with a DCD Maastricht
Category type III policy and did consider a couple of patients for DCD donation, although no
procedure was started for medical reasons and age.
The main reasons why 27 procedures were not started were age, objection to donation and
absence of the next of kin. 13 patients (48.1%) were over age limits, 5 (18.5%) objected to
donation and of 4 patients (14.8%) the next of kin were not available.
From the 8 procedures that were started, 6 (75.0%) were completed and resulted in organs being
donated for transplantation. All these patients came from Zürich university hospital.
RESULTS Comparison of Networks
SwissPOD Study Report 21
4.8. Comparison of Networks (adult ICU)
There are six donation networks in Switzerland: Basel, Bern, Luzern, PLDO, St. Gallen and
Zürich. Figure 5 shows the cantons which are affiliated to these networks and their population.
Results should be interpreted with caution due to the fact that two of the networks, Luzern and
St. Gallen have small data samples.
Results for the comparison of networks are shown exclusively for ICU adult deaths (n=3664).
Paediatric (n=62) and A&E (n=798) deaths have been excluded due to small data samples and a
variety of hospital procedures.
Figure 5: Overview of the donation networks
Network Affiliated cantons Number of
procurement centres*
Population
[2]
Percentage
Basel BS, BL, AG (Aarau and Baden cantonal hospitals) 2 1'079'913 13.6%
Bern BE, SO 1 1'242'036 15.6%
Luzern LU, OW, NW, UR 1 494'544 6.2%
PLDO GE, VD, VS, NE, FR, JU, TI 7 2'368'836 29.8%
St. Gallen SG, AR, AI 1 552'212 6.9%
Zürich ZH, SH, TG, ZG, SZ, GL, GR, AG (Hirslanden Klinik Aarau; the
population of AG is counted in Basel network only)
2 2'217'121 27.9%
*A procurement centre is a hospital that has the authorisation from the FOPH and necessary infrastructure for the retrieval of organs for
transplantation.
A table showing the hospital characteristics by network can be found in the annex.
RESULTS Comparison of Networks
SwissPOD Study Report 22
4.8.1. Possible Donor
Data shows that the patients diagnosed brain dead came from three categories of diagnoses:
cerebrovascular accident (CVA), head trauma (HT) and anoxia (ANOX). These death selected
causes are examined individually by network and show the percentage of these deaths that were
brain death diagnosed.
Figure 6: Death selected causes as percentage of total ICU deaths
Figure 6 shows that of the 3664 ICU adult deaths, 1339 died from a death selected cause. There
are important variations by network.
The Swiss average of all ICU deaths with these neurological pathologies was 36.5%. Basel, Luzern
and Zürich networks had fewer deaths on their ICUs from these death selected causes than Bern,
the PLDO and St. Gallen who were above the national average.
With the exception of 1 patient, all patients diagnosed brain dead came from a death selected
cause of CVA, head trauma or anoxia, data was analysed to assess the conversion of this patient
population to brain death diagnosis by network.
RESULTS Comparison of Networks
SwissPOD Study Report 23
Figures 7a/b to 12a/b show (a) the percentage of death selected causes out of ICU adult deaths,
(b) the percentage of patients brain death diagnosed by death selected cause.
Figure 7a: Basel network
Admission diagnosis of patients who died
on an adult ICU
Figure 7b: Basel network
Brain death diagnosis by death selected
cause
Figure 7a shows that 152 (30.4%) of the 500 audited ICU deaths, came from a death selected
cause; CVA 62 (12.4%), head trauma 12 (2.4%) or anoxia 78 (15.6%.
Figure 7b shows that the 20 patients who were diagnosed brain dead all came from one of these
death selected causes. 14 (70.0%) of brain deaths came from the CVA group, 4 (20.0%) from head
trauma, and 2 (10.0%) from anoxia.
Figure 8a: Bern network
Admission diagnosis of patients who died
on an adult ICU
Figure 8b: Bern network
Brain death diagnosis by death selected
cause
Figure 8a shows that 241 (41.2%) of the 585 audited ICU deaths came from a death selected
cause; CVA 96 (16.4%), head trauma 30 (5.1%) or anoxia 115 (19.7%). from
Figure 8b shows that the 31 patients who were diagnosed brain dead all came from one of these
death selected causes. 20 (64.5%) of brain deaths came from the CVA group, 7 (22.6%) from
head trauma, and 4 (12.9%) from anoxia.
RESULTS Comparison of Networks
SwissPOD Study Report 24
Figure 9a: Luzern network
Admission diagnosis of patients who died
on an adult ICU
Figure 9b: Luzern network
Brain death diagnosis by death selected
cause
Figure 9a shows that 71 (32.4%) of the 219 audited ICU deaths came from a death selected cause;
CVA 24 (10.9%), head trauma 7 (3.2%) or anoxia 40 (18.3%).
Figure 9b shows that the 6 patients who were diagnosed brain dead all came from one of these
death selected causes. 3 (50.0%) of brain deaths came from the CVA group, 2 (33.3%) from head
trauma, and 1 (16.7%) from anoxia.
Figure 10a: PLDO Network
Admission diagnosis of patients who died
on an adult ICU
Figure 10b: PLDO Network
Brain death diagnosis by death selected
cause
Figure 10a shows that 456 (42.5%) of the 1072 audited ICU deaths came from a death selected
cause; CVA 139 (12.9%), head trauma 29 (2.7%) or anoxia 288 (26.9%).
Figure 10b shows that the 55 patients who were diagnosed brain dead came from one of these
death selected causes (the total of brain death diagnosed patients is 56, but 1 patient who died of
meningitis is excluded). 32 (58.2%) of brain deaths came from the CVA group, 8 (14.5%) from
head trauma, and 15 (27.3%) from anoxia.
RESULTS Comparison of Networks
SwissPOD Study Report 25
Figure 11a: St. Gallen Network
Admission diagnosis of patients who died
on an adult ICU
Figure 11b: St. Gallen Network
Brain death diagnosis by death selected
cause
Figure 11a shows that 73 (38.6%) of the 189 audited ICU deaths came from a death selected
cause; CVA 34 (18.0%), head trauma 5 (2.6%) or anoxia 34 (18.0%).
Figure 11b shows that the 12 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 10 (83.3%) of brain deaths came from the CVA group, none from head
trauma, and 2 (16.7%) from anoxia.
Figure 12a: Zürich Network
Admission diagnosis of patients who died
on an adult ICU
Figure 12b: Zürich Network
Brain death diagnosis by death selected
cause
Figure 12a shows that 346 (31.5%) of the 1099 audited ICU deaths came from a death selected
cause; CVA 110 (10.0%), head trauma 35 (3.2%) or anoxia 201 (18.3%)..
Figure 12b shows that the 8 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 3 (37.5%) of brain deaths came from the CVA group, 4 (50.0%) from head
trauma, and 1 (12.5%) from anoxia
RESULTS Comparison of Networks
SwissPOD Study Report 26
In summary, total CVA deaths on ICUs by network varied between 10.0% for Zürich network and
18.0% for St. Gallen with Luzern 10.9%, Basel 12.4%, the PLDO 12.9% and Bern 16.4% in-
between. Resulting that 37.5% of these patients in Zürich network were brain death diagnosed,
50.0% for Luzern network, 58.2% for the PLDO network, 64.5% for Bern network, 70.0% for
Basel network and 83.3% for St. Gallen network.
Head trauma deaths varied between 2.4% for Basel and 5.1% in Bern networks, with St. Gallen
2.6%, the PLDO 2.7%, Zürich and Luzern both with 3.2%, in-between. Resulting that 0% of these
patients were diagnosed brain dead for St. Gallen network, 14.5% for the PLDO network, 20.0%
for Basel network, 22.6% for Bern network, 33.3% for Luzern, and 50.0% for Zürich.
Anoxia deaths varied between 15.6% for Basel network and 26.9% for the PLDO, with St. Gallen
18.0%, Luzern and Zürich both with 18.3% and Bern 19.7% in-between. Resulting that 10.0% of
these patients were diagnosed brain dead for Basel network, 12.5% for Zürich network, 12.9% for
Bern network, 16.7% for Luzern network, 16.7% for St. Gallen network and 27.3% for the PLDO
network.
Note: The percentages need to be taken with caution and should not lead to misinterpretation
due to the small data samples in all networks (see Discussion section).
RESULTS Comparison of Networks
SwissPOD Study Report 27
4.8.2. Outcomes
Potential Donor
Figure 13a shows the outcomes for possible, potential, eligible and utilised donor as a percentage
of all deaths. It visualises the results displayed in table 14.
Figure 13a: Outcomes from all deaths
Figure 13b shows the outcomes for possible, potential, eligible and utilised donor as a percentage
of deaths from a selected cause (CVA, head trauma, anoxia).
Figure 13b: Outcomes from death selected causes
RESULTS Comparison of Networks
SwissPOD Study Report 28
Ad figure 13a: Of the total 3664 patients, 198 (5.4%) were potential donors, i.e., suspected to
fulfil brain death criteria. St. Gallen network with 19 potential donors, representing 10.1% of all
189 deaths had the highest conversion rate followed by the PLDO with 78 potential donors,
representing 7.3% of all 1072 deaths; Bern network with 43 potential donors, representing 7.4%
of all 585 deaths; Basel network with 25 potential donors, representing 5.0% of all 500 deaths;
Luzern with 7 potential donors, representing 3.2% of all 219 deaths; and Zürich network with 26
potential donors, representing 2.4% of all 1099 deaths.
Ad figure 13b: Of the total 1339 patients who died from a death selected cause, 194 (14.5%) were
potential donors, i.e., suspected to fulfil brain death criteria. St. Gallen network with 19 potential
donors, representing 26.0% of all 73 deaths from a selected cause had the highest conversion
rate, followed by Bern with 42 potential donors, representing 17.4% of all 241 deaths from a
selected cause; the PLDO with 76 potential donors, representing 16.7% of all 456 deaths from a
selected cause; Basel network with 24 potential donors, representing 15.8% of all 152 deaths
from a selected cause; Luzern with 7 potential donors, representing 9.9% of all 71 deaths from a
selected cause; and Zürich network with 26 potential donors, representing 7.5% of all 346 deaths
from a selected cause.
4.8.3. Donation Efficiency
Donation efficiency shows how a hospital or network converts their potential for donation. It is
calculated from the patients who donated their organs for transplantation where at least one
solid organ was retrieved and transplanted plus the patients where an operative incision was
made with the intent of organ retrieval, divided by the number of patients who died of a death
selected cause (CVA, head trauma or anoxia).
Figure 14: Donation efficiency
Figure 14 shows the percentage of patients who became an organ donor from death selected
causes (CVA, head trauma, anoxia; CH: n=1339 [36.5% of all ICU adult deaths]).
Data shows that St. Gallen network with a donation efficiency index of 13.7%, Basel network with
11.8% and Luzern network with 8.5% are better performing in the conversion of their pool of
potential donors than Bern and the PLDO networks with both 7.9%, and Zürich network with
2.0%. Data shows that there is no direct correlation with the conversion of patients who died
from a death selected cause to a patient who donated organs for transplantation; this is
demonstrated with Basel network that had the lowest percentage of deaths from death selected
causes but one of the highest donation efficiency rates, thus making the most of their potential
(see Discussion section).
RESULTS Comparison of Networks
SwissPOD Study Report 29
4.8.4. Conversion Rates
Conversion rates of ICU adult deaths by network are shown by step of the donation process and
are calculated as a percentage of all deaths.
Table 14: Conversion rates
Basel Bern Luzern PLDO St. Gallen Zürich CH
ICU adult deaths
(number equalling 100% in each
column)
500 585 219 1072 189 1099 3664
Possible donor
(patients with signs of brain damage)
151
(30.2%)
232
(39.7%)
56
(25.6%)
400
(37.3%)
89
(47.1%)
276
(25.1%)
1204
(32.9%)
Potential donor
(patients suspected to fulfil brain death
criteria)
25
(5.0%)
43
(7.4%)
7
(3.2%)
78
(7.3%)
19
(10.1%)
26
(2.4%)
198
(5.4%)
Eligible donor
(patients who had brain death
diagnosed)
20
(4.0%)
31
(5.3%)
6
(2.7%)
56
(5.2%)
12
(6.3%)
8
(0.7%)
133
(3.6%)
Utilised donor
(organs procured for transplantation)
18
(3.6%)
18
(3.1%)
6
(2.7%)
36
(3.4%)
10
(5.3%)
6
(0.6%)
94
(2.6%)
Table 14 shows the conversion rates of ICU adult deaths by network. There are important
variations in all steps of the donation process which demonstrate that each network is losing
potential at different levels.
The percentage of potential donors who became utilised donors is 47.5% on average for adult
ICU deaths. Luzern network has the highest conversion rate with 85.7% followed by Basel with
72.0%, St. Gallen with 52.6%, the PLDO with 46.2%, Bern with 41.9%, and Zürich with 23.1%.
Conversion rates were equally analysed by hospital type, for hospitals with neurosurgical
facilities and for those without neurological facilities by network. One would presume that
patients with a neurological pathology would be treated in a reference centre with neurosurgical
facilities (table 15).
Eligible Donor
Bern network had 31 patients diagnosed brain dead, representing 5.3% (25.0 pmp) of all deaths;
the PLDO had 56 patients diagnosed brain dead, representing 5.2% (23.6 pmp) of all deaths;
St. Gallen had 12 patients diagnosed brain dead, representing 6.3% (21.7 pmp) of all deaths;
Basel network had 20 patients diagnosed brain dead, representing 4.0% (18.5 pmp) of all deaths;
Luzern network had 6 patients diagnosed brain dead, representing 2.7% (12.1 pmp) of all deaths
and Zürich network had 8 patients diagnosed brain dead, representing 0.7% (3.6 pmp) of all
deaths (table 14).
Utilised Donor
There were 94 patients out of all ICU adult deaths who donated organs for transplantation,
representing 2.6% (11.8 pmp) of all ICU deaths. St. Gallen network had 10 utilised donors
representing 5.3% (18.1 pmp) of all deaths; Basel network had 18 donors corresponding to 3.6%
(16. 7 pmp) of all ICU deaths; the PLDO had 36 donors equivalent to 3.4% (15.2 pmp) of all deaths;
Bern network had 18 donors representing 3.1% (14.5 pmp); Luzern network with 6 donors
corresponding to 2.7% (12.1 pmp) of all deaths and Zürich with 6 donors representing 0.6%
(2.7 pmp) of all deaths (table 14).
RESULTS Comparison of Networks
SwissPOD Study Report 30
Table 15: Comparison of hospitals with neurosurgical facilities vs. hospitals with no neurosurgical facilities by network
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Adult ICU deaths with a
neurological pathology 232 128 104 245 185 60 72 54 18 467 355 112 76 75 1 354 215 139 1446 1012 434
% 100.0% 55.2% 44.8% 100.0% 75.5% 24.5% 100.0% 75.0% 25.0% 100.0% 76.0% 24.0% 100.0% 98.7% 1.3% 100.0% 60.7% 39.3% 100.0% 70.0% 30.0%
pmp 118.5 96.3 148.9 48.3 109.2 36.4 149.9 47.3 135.8 1.8 97.0 62.7 127.2 54.6
Possible DBD donor with a
neurological pathology* 122 104 18 210 176 34 47 38 9 371 286 85 67 66 1 241 163 78 1058 833 225
% 52.6% 44.8% 7.8% 85.7% 71.8% 13.9% 65.3% 52.8% 12.5% 79.4% 61.2% 18.2% 88.2% 86.8% 1.3% 68.1% 46.0% 22.0% 73.2% 57.6% 15.6%
pmp 96.3 16.7 141.7 27.4 76.8 18.2 120.7 35.9 119.5 1.8 73.5 35.2 104.7 28.3
Potential DBD donor 25 25 0 42 40 2 7 7 0 78 72 6 19 19 0 26 17 9 198 180 17
% 10.8% 10.8% 0.0% 17.1% 16.3% 0.8% 9.7% 9.7% 0.0% 16.7% 15.4% 1.3% 25.0% 25.0% 0.0% 7.3% 4.8% 2.5% 13.7% 12.4% 1.2%
pmp 23.2 0.0 32.2 1.6 14.2 0.0 30.4 2.5 34.4 0.0 7.7 4.1 22.6 2.1
Eligible DBD donor 20 20 0 31 29 2 6 6 0 56 53 3 12 12 0 8 8 0 133 128 5
% 8.6% 8.6% 0.0% 12.7% 11.8% 0.8% 8.3% 8.3% 0.0% 12.0% 11.3% 0.6% 15.8% 15.8% 0.0% 2.3% 2.3% 0.0% 9.2% 8.9% 0.3%
pmp 19 0 23 2 12 0 22 1 22 0 4 0 16 1
Utilised DBD donor 18 18 0 18 17 1 6 6 0 36 35 1 10 10 0 6 6 0 94 92 2
% 7.8% 7.8% 0.0% 7.3% 6.9% 0.4% 8.3% 8.3% 0.0% 7.7% 7.5% 0.2% 13.2% 13.2% 0.0% 1.7% 1.7% 0.0% 6.5% 6.4% 0.1%
pmp 16.7 0.0 13.7 0.8 12.1 0.0 14.8 0.4 18.1 0.0 2.7 0.0 11.6 0.3
Basel network Bern network Luzern network PLDO network St. Gallen network Zürich network Total
Table 15 shows that on average 70.0% of all adult ICU deaths died in a reference centre (hospital with neurosurgical facilities). Data shows there are variations
by network ranging from 55.2% in Basel to 98.7% in St. Gallen. The high percentage in St. Gallen could be explained by the fact that there are only a couple of
hospitals in this network and that patients are systematically referred to a reference centre.
The percentage of possible donors dying in a non reference centre equally vary by network with only 1.3% of possible donors in St. Gallen dying in a non
reference centre compared with Zürich network who has 22.0% of their patients dying in a non reference centre. The interpretation of this data should be
treated with caution. However, it may suggest that there could be a lack of awareness in the detection of a possible donor in networks and that the option for
donation was not considered and that these patients are not referred to a reference centre.
RESULTS Comparison of Networks
SwissPOD Study Report 31
Table 16: Variations in transfer policies
Network Number of
reference
centres
(hospitals with
neurosurgical
facilities)
ICU adult
deaths
Number of adult ICU deaths with a
neurological pathology (death
selected causes; CVA, head
trauma, anoxia) transferred from a
hospital with no neurosurgical
facilities to a reference centre
Percentage of patients with
death selected causes
transferred from a hospital
with no neurosurgical
facilities to a reference
centre
Basel 2 194 / 140 6 / 20 3.1% / 14.3%
Bern 1 282 55 19.5%
Luzern 1 194 6 3.1%
PLDO 4 108 / 62 /
229 / 238
5 / 9 / 14 / 27 4.6% / 14.5% / 6.1% / 11.3%
St. Gallen 1 63 2 3.2%
Zürich 2 63 / 295 2 / 26 3.2% / 8.8%
Table 16 shows the variations in transfer policies among the networks. It shows the percentage of
patients, who died from a death selected cause (CVA, head trauma or anoxia), transferred from a
hospital with no neurosurgical facilities to one with neurosurgical facilities (reference centre).
Data shows that networks have different transfer policies for patients with neurological
pathologies. Additionally there is to mention, that transfers to reference centres do not
necessarily only occur within the network a hospital is affiliated to (e.g., a hospital affiliated to
the PLDO network may transfer patients to Bern or Basel university hospital).
4.8.5. Reasons for Non-Donation
Of the 3664 audited deaths, 1204 (32.9%) were possible donors. Out of these, 1071 (89.0%) did
not become an eligible donor. There are various reasons for losses in the donation process.
Table 17: Reasons for non-donation
Basel Bern Luzern PLDO St. Gallen Zürich CH
Total number of possible and potential
donors who did not become an eligible
donor (number equalling 100% in each
column)
131 201 50 344 77 268 1071
Contra-indication to organ donation 42
(32.1%)
42
(20.9%)
13
(26.0%)
76
(22.1%)
22
(28.6%)
69
(25.7%)
264
(24.6%)
Not expected to fulfil brain death
criteria
62
(47.3%)
117
(58.2%)
22
(44.0%)
198
(57.6%)
26
(33.8%)
117
(43.7%)
542
(50.6%)
Objection to donation 12
(9.2%)
23
(11.4%)
5
(10.0%)
15
(4.4%)
17
(22.1%)
25
(9.3%)
97
(9.1%)
Coroner objection to donation - - - 2
(0.6%)
- - 2
(0.2%)
No next of kin/no donor card 1
(0.8%)
2
(1.0%)
1
(2.0%)
2
(0.6%)
- 3
(1.1%)
9
(0.8%)
Cardiac arrest with failed resuscitation 11
(8.4%)
17
(8.5%)
7
(14.0%)
27
(7.8%)
5
(6.5%)
27
(10.1%)
94
(8.8%)
Multi-organ failure 2
(4.0%)
6
(1.7%)
3
(3.9%)
3
(1.1%)
14
(1.3%)
End stage therapeutic treatment 3
(2.3%)
- - 19
(5.5%)
- 9
(3.4%)
31
(2.9%)
Considered as a DCD Maastricht
category type III donor
- - - - 4
(5.2%)
14
(5.2%)
18
(1.7%)
RESULTS Comparison of Networks
SwissPOD Study Report 32
As shown in Table 17, the principal reasons for not diagnosing brain death were: not expected to
meet brain death criteria, absolute or relative contra-indication to donation and objection.
For patients who were not expected to meet brain death criteria, important variations between
networks can be observed. Bern network had the highest rate with 117 patients (58.2%) of their
201 drop-offs, against St. Gallen who had 26 patients (33.8%) of their 77 drop-offs.
Equally, variations are shown for patients with a contra-indication for organ donation with Basel
network who documented 42 patients (32.1%) against Bern network with 42 representing
(20.9%) of audited deaths.
Lastly, data revealed that objection to donation before brain death diagnosis was an important
loss with large variations by network. A possible explanation for this could be that the request for
organ donation is occurring at different time points. St. Gallen had the highest rate with 17
(22.1%) of their 77 drop-offs compared to the PLDO with only 15 (4.4%) of their 344 drop-offs.
RESULTS Comparison of Networks
SwissPOD Study Report 33
4.8.6. Consent Rate
Figure 15 displays the percentage of consent vs. objection in seeking permission for donation by
network for ICU adult deaths. 320 patients out of 3664 audited deaths (8.7%), representing
40.2 pmp, were considered for organ donation. Of the 320 considered for donation, permission
was sought in 249 (77.8%) cases and resulted in 121 (48.6%) consents for donation and 128
(51.4%) objections.
Figure 15: Consent rate
60.6%
39.3%
54.5% 60.0%
41.9%31.6%
39.4%
60.7%
45.5% 40.0%
58.1%68.4%
0%
20%
40%
60%
80%
100%
Basel Bern Luzern PLDO St. Gallen Zürich
Consent (ICU adults CH average: 48.6%) Objection
With the average consent rate of 48.6% (ICU adult deaths), objection to donation is one of the
main reasons for non-donation in Switzerland. Three networks have a consent rate over 50%,
Basel and the PLDO with 60.6% and 60.0% respectively, and Luzern with 54.5%.
Basel network considered 39 patients (7.8%) 0f all deaths for organ donation. There were 33
documented cases where permission for donation was sought, resulting in 20 (60.6%) consents
for donation and 13 (39.4%) objections.
Bern network considered 71 patients (12.1%) 0f all deaths for organ donation. There were 56
cases where permission for donation was sought, resulting in 22 (39.3%) consents for donation
and 34 (60.7%) objections.
Luzern network considered 15 patients (6.8%) 0f all deaths for organ donation. There were 11
cases where permission for donation was sought, resulting in 6 (54.5%) consents for donation
and 5 (45.5%) objections.
The PLDO network considered 96 patients (9.0%) 0f all deaths for organ donation. There were 80
cases where permission for donation was sought, resulting in 48 (60.0%) consents for donation
and 32 (40.0%) objections.
St. Gallen network considered 40 patients (21.2%) 0f all deaths for organ donation. There were 31
cases where permission for donation was sought, resulting in 13 (41.9%) consents for donation
and 18 (58.1%) objections.
Zürich network considered 59 patients (5.4%) 0f all deaths for organ donation. There were 38
cases where permission for donation was sought, resulting in 12 (31.6%) consents for donation
and 26 (68.4%) objections.
RESULTS Comparison of Networks
SwissPOD Study Report 34
Figure 16a: Consent and objection by level vs. total approaches
Figure 16b: Consent and objection by level vs. total consents and total objections
ICU adult data shows that objection to donation was observed during all phases of the donation
process. Figures 16a/b show the percentage of objections and consents for the levels possible,
potential and eligible donor by network. This demonstrates that approach to the next of kin is
occurring at different time points and can be an explanation for the differences in conversion
rates.
RESULTS Comparison of Networks
SwissPOD Study Report 35
Possible Donor: The distribution of objections and consents at the possible donor level in the
networks are:
Basel sought permission for donation in 33 cases; from these 33 cases, 11 (33.3%) were sought at
this level, resulting in 10 (30.3%) objections and 1 (3.0%) consents (figure 16a). Objections at this
level represent 76.9% of the 13 total objections and consents at this level represent 5.0% of the
20 total consents (figure 16b).
Bern sought permission for donation in 56 cases; from these 56 cases, 16 (28.6%) were sought at
this level, resulting in 16 (28.6%) objections and no consents (figure 16a). Objections at this level
represent 47.1% of the 34 total objections (figure 16b).
Luzern sought permission for donation in 11 cases; from these 11 cases, 8 (72.8%) were sought at
this level, resulting in 4 (36.4%) objections and 4 (36.4%) consents (figure 16a). Objections at this
level represent 80.0% of the 5 total objections and consents at this level represent 66.7% of the 6
total consents (figure 16b).
The PLDO sought permission for donation in 80 cases; from these 80 cases, 10 (12.5%) were
sought at this level, resulting in 8 (10.0%) objections and 2 (2.5%) consents (figure 16a).
Objections at this level represent 25.0% of the 32 total objections and consents at this level
represent 4.2% of the 48 total consents (figure 16b).
St. Gallen sought permission for donation in 31 cases; from these 31 cases, 15 (48.4%) were
sought at this level, resulting in 12 (38.7%) objections and 3 (9.7%) consents (figure 16a).
Objections at this level represent 66.7% of the 18 total objections and consents at this level
represent 23.1% of the 13 total consents (figure 16b).
Zürich sought permission for donation in 38 cases; from these 38 cases, 19 (50.0%) were sought
at this level, resulting in 16 (42.1%) objections and 3 (7.9%) consents (figure 16a). Objections at
this level represent 61.5% of the 26 total objections and consents at this level represent 25.0% of
the 12 total consents (figure 16b).
Potential Donor: The distribution of objections and consents at the potential donor level in the
networks are:
Basel sought permission for donation in 33 cases; from these 33 cases 20 (60.6%) were sought at
this level, resulting in 2 (6.1%) objections and 18 (54.5%) consents (figure 16a). Objections at this
level represent 15.4% of the 13 total objections and consents at this level represent 90.0% of the
20 total consents (figure 16b).
Bern sought permission for donation in 56 cases; from these 56 cases, 23 (41.1%) were sought at
this level, resulting in 8 (14.3%) objections and 15 (26.8%) consents (figure 16a). Objections at
this level represent 23.5% of the 34 total objections and consents at this level represent 68.2% of
the 22 total consents (figure 16b).
Luzern sought permission for donation in 11 cases; from these 11 cases, 3 (27.3%) were sought at
this level, resulting in 1 (9.1%) objections and 2 (18.2%) consents (figure 16a). Objections at this
level represent 20.0% of the 5 total objections and consents at this level represent 33.3% of the 6
total consents (figure 16b).
The PLDO sought permission for donation in 80 cases; from these 80 cases, 39 (48.8%) were
sought at this level, resulting in 8 (10.0%) objections and 31 (38.8%) consents (figure 16a).
Objections at this level represent 25.0% of the 32 total objections and consents at this level
represent 64.6% of the 48 total consents (figure 16b).
St. Gallen sought permission for donation in 31 cases; from these 31 cases, 15 (48.4%) were
sought at this level, resulting in 5 (16.1%) objections and 10 (32.3%) consents (figure 16a).
Objections at this level represent 27.8% of the 18 total objections and consents at this level
represent 76.9% of the 13 total consents (figure 16b).
RESULTS Comparison of Networks
SwissPOD Study Report 36
Zürich sought permission for donation in 38 cases; from these 38 cases, 18 (47.4%) were sought
at this level, resulting in 9 (23.7%) objections and 9 (23.7%) consents (figure 16a). Objections at
this level represent 34.6% of the 26 total objections and consents at this level represent 75.0% of
the 12 total consents (figure 16b).
Eligible Donor: The distribution of objections and consents at the eligible donor level in the
networks are:
Basel sought permission for donation in 33 cases; from these 33 cases, 2 (6.0%) were sought at
this level, resulting in 1 (3.0%) objections and 1 (3.0%) consents (figure 16a). Objections at this
level represent 7.7% of the 13 total objections and consents at this level represent 5.0% of the 20
total consents (figure 16b).
Bern sought permission for donation in 56 cases; from these 56 cases, 17 (30.4%) were sought at
this level, resulting in 10 (17.9%) objections, and 7 (12.5%) consents (figure 16a). Objections at
this level represent 29.4% of the 34 total objections and consents at this level represent 31.8% of
the 22 total consents (figure 16b).
Luzern sought permission for donation in 11 cases; from these 11 cases, none were sought at this
level.
The PLDO sought permission for donation in 80 cases; from these 80 cases, 31 (38.8%) were
sought at this level, resulting in 16 (20.0%) objections and 15 (18.8%) consents (figure 16a).
Objections at this level represent 50% of the 32 total objections and consents at this level
represent 31.3% of the 48 total consents (figure 16b).
St. Gallen sought permission for donation in 31 cases; from these 31 cases, 1 (3.2%) were sought
at this level, resulting in 1 (3.2%) objections and no consents (figure 16a). Objections at this level
represent 5.6% of the 18 total objections (figure 16b).
Zürich sought permission for donation in 38 cases; from these 38 cases, 1 (2.6%) were sought at
this level, resulting in 1 (2.6%) objections and no consents (figure 16a). Objections at this level
represent 3.8% of the 26 total objections (figure 16b).
In summary, of the total 128 objections, 66 (51.6%) were reported for a possible donor; 33
(25.8%) were documented for a potential donor and 29 (22.7%) for an eligible donor after brain
death diagnosis.
At the possible donor level the 66 (51.6%) of total objections were divided as follows: Luzern 4
(80%) out of 5 objections, Basel 10 (76.9%) out of 13 objections, St. Gallen 12 (66.7%) out of 18
objections, Zürich 16 (61.5%) out of 26 objections, Bern 16 (47.1%) out of 34 objections, and the
PLDO 8 (25.0%) out of 32 objections.
At the potential donor level the 33 (25.8%) of total objections were divided as follows: Zürich 9
(34.6%) out of 26 objections, St. Gallen 5 (27.8%) out of 18 objections, the PLDO 8 (25.0%) (of
which 2 were coroner objections) out of 32 objections, Bern 8 (23.5%) out of 34 objections;
Luzern 1 (20.0%) out of 5 objections, and Basel 2 (15.4%) out of 13 objections.
At the eligible donor level the 29 (22.7%) of total objections were divided as follows: the PLDO 16
(50.0%) out of 32 objections, Bern 10 (29.4%) out of 34 objections, Basel 1 (7.7%) out of 13
objections, St. Gallen 1 (5.6%) out of 18 objections, Zürich 1 (3.8%) out of 26 objections, and
Luzern with no reported objections at this step.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 37
4.9. Comparison of University Hospitals / Transplant Centres (adult ICU)
There are five university hospitals in Switzerland; Basel (Universitätsspital Basel), Bern
(Universitätsspital Bern), Genève (Hôpitaux Universitaires de Genève), Lausanne (Centre
Hospitalier Universitaire Vaudois) and Zürich (Universitätsspital Zürich). St. Gallen (Kantonsspital
St. Gallen) is a transplant centre. These six hospitals are the principal reference centres in
Switzerland.
Results for the comparison of university hospitals / transplant centres are shown exclusively for
the 1412 ICU adult deaths. Paediatric and A&E deaths have been excluded due to small data
samples and a variety of hospital procedures.
4.9.1. Possible Donor
Data shows that the patients diagnosed brain dead come from three categories of diagnoses:
cerebrovascular accident (CVA), head trauma (HT), anoxia (ANOX). These death selected causes
are examined individually by university hospital / transplant centre and show the percentage of
these patients diagnosed brain dead.
Figure 17: Percentage of total deaths by death selected cause by university hospital /
transplant centre
Figure 17 shows that these reference centres have important differences in the number of deaths
by death selected causes. Bern had largest population with 175 patients (62.1%) of ICU deaths
with a death selected cause of CVA, head trauma or anoxia; Lausanne had 121 (50.8%) of deaths;
Genève had 103 (45.0%) of deaths; St. Gallen had 72(41.4%) of deaths; Zürich had 121 (41.0%) of
deaths and Basel had 70 (36.1%) of ICU deaths.
With the exception of 1 patient, all patients diagnosed brain dead came from a death selected of
CVA, head trauma or anoxia, data was analysed to assess the conversion of this patient
population to brain death diagnosis by university hospital / transplant centre.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 38
Figures 18a/b to 23a/b show (a) the percentage of death selected causes out of ICU adult deaths,
(b) the percentage of patients brain death diagnosed by death selected cause.
Figure 18a: Basel university hospital
Admission diagnosis of patients who died
on an adult ICU
Figure 18b: Basel university hospital
Brain death diagnosis by death selected
cause
Figure 18a shows that 70 (36.1%) of the 194 audited ICU deaths came from a death selected
cause; CVA 31 (16.0%), head trauma 5 (2.6%) or anoxia 34 (17.5%).
Figure 18b shows that the 11 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 7 (63.6%) of brain deaths came from the CVA group, 2 (18.2%) from head
trauma, and 2 (18.2%) from anoxia.
Figure 19a: Bern university hospital
Admission diagnosis of patients who died
on an adult ICU
Figure 19b: Bern university hospital
Brain death diagnosis by death selected
cause
Figure 19a shows that 175 (62.1%) of the 282 audited ICU deaths, came from a death selected
cause; CVA 85 (30.2%), head trauma 30 (10.6%) or anoxia 60 (21.3%).
Figure 19b shows that the 29 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 20 (68.9%) of brain deaths came from the CVA group, 7 (24.2%) from
head trauma, and 2 (6.9%) from anoxia.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 39
Figure 20a: Genève university hospital
Admission diagnosis of patients who died
on an adult ICU
Figure 20b: Genève university hospital
Brain death diagnosis by death selected
cause
Figure 20a shows that 103 (45.0%) of the 229 audited ICU deaths came from a death selected
cause; CVA 42 (18.3%), head trauma 10 (4.4%) or anoxia 51 (22.3%).
Figure 20b shows that the 18 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 9 (50.0%) of brain deaths came from the CVA group, 4 (22.2%) from head
trauma, and 5 (27.8%) from anoxia.
Figure 21a: Lausanne university hospital
Admission diagnosis of patients who died
on an adult ICU
Figure 21b: Lausanne university hospital
Brain death diagnosis by death selected
cause
Figure 21a shows that 121 (50.8%) of the audited 238 ICU deaths came from a death selected
cause; CVA 46 (19.3%), head trauma 7 (2.9%) or anoxia 68 (28.6%).
Figure 21b shows that the 19 patients who were diagnosed brain dead came from one of these
deaths selected causes (the total of brain death diagnosed patients is 20, but 1 patient who died
of meningitis is excluded). 12 (63.2%) of brain deaths came from the CVA group, 3 (15.8%) from
head trauma, and 4 (21.1%) from anoxia.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 40
Figure 22a: St. Gallen cantonal hospital
Admission diagnosis of patients who died
on an adult ICU
Figure 22b: St. Gallen cantonal hospital
Brain death diagnosis by death selected
cause
Figure 22a shows that 72 (41.4%) of the 174 audited ICU deaths came from a death selected
cause; CVA 34 (19.5%), head trauma 5 (2.9%) or anoxia 33 (19.0%).
Figure 22b shows that the 12 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 10 (83.3%) of brain deaths came from the CVA group, 0 from head
trauma, and 2 (16.7%) from anoxia.
Figure 23a: Zürich university hospital
Admission diagnosis of patients who died
on an adult ICU
Figure 23b: Zürich university hospital
Brain death diagnosis by death selected
cause
Figure 23a shows that 121 (41.0%) of the 295 audited ICU deaths came from a death selected
cause; CVA 52 (17.6%), head trauma 26 (8.8%) or anoxia 43 (14.6%).
Figure 23b shows that the 4 patients who were diagnosed brain dead all came from one of these
deaths selected causes. 1 (25.0%) of brain deaths came from the CVA group, 2 (50.0%) from head
trauma, and 1 (25.0%) from anoxia.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 41
4.9.2. Outcomes
Potential Donor
Figure 24a shows the outcomes for possible, potential, eligible and utilised donor as a percentage
of all deaths. It visualises the results displayed in table 18.
Figure 24a: Outcomes from all deaths
Figure 24b shows the outcomes for possible, potential, eligible and utilised donor as a
percentage of deaths from a selected cause (CVA, head trauma, anoxia).
Figure 24b: Outcomes from death selected causes
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 42
Ad figure 24a: Of the total 1412 patients, 130 (9.2%) were potential donors, i.e., suspected to
fulfil brain death criteria. Bern had the highest conversion rate with 41 potential donors,
representing 14.5% of all 282 deaths; followed by St. Gallen with 19 potential donors,
representing 10.9% of all 174 deaths; Genève with 25 potential donors, representing 10.9% of all
229 deaths; Lausanne with 24 potential donors, representing 10.1% of all 238 deaths; Basel with
12 potential donors, representing 6.2% of all 194 deaths; and Zürich with 9 potential donors,
representing 3.1% of all 295 deaths.
Ad figure 24b: Of the total 662 patients who died from a death selected cause, 126 (19.0%) were
potential donors, i.e., suspected to fulfil brain death criteria. St. Gallen cantonal hospital with 19
potential donors, representing 26.4% of all 72 deaths from a selected cause had the highest
conversion rate, followed by Genève university hospital with 24 potential donors, representing
23.3% of all 103 deaths from a selected cause; Bern with 40 potential donors, representing 22.9%
of all 175 deaths from a selected cause; Lausanne with 23 potential donors, representing 19.0% of
all 121 deaths from a selected cause; Basel with 11 potential donors, representing 15.7% of all 70
deaths from a selected cause; and Zürich university hospital with 9 potential donors,
representing 7.4% of all 121 deaths from a selected cause.
4.9.3. Donation Efficiency
Donation efficiency shows how a hospital converts their potential for donation. It is calculated
from the patients who donated their organs for transplantation where at least one solid organ
was retrieved and transplanted plus the patients where an operative incision was made with the
intent of organ retrieval, divided by the number of patients who died of a death selected cause
(CVA, head trauma or anoxia).
Figure 25: Donation efficiency
Figure 25 shows the percentage of the patients who were organ donors from death selected
causes (CVA, head trauma, anoxia). In the university hospitals / transplant centres, patients with
death selected causes (n=662) account for 46.9% of all ICU adult deaths.
Data shows that Basel university hospital with a donation efficiency index of 14.3%; St. Gallen
with 13.9%; Lausanne with 10.7% and Bern with 10.3% ,are better performing in the conversion
of their pool of potential donors than Genève with 9.7% and Zürich with 3.3% who are under the
average index of 9.8% for university hospitals. Data shows that there is no direct correlation with
the conversion of patients who died from a death selected cause to a patient who donated
organs for transplantation; this is demonstrated with Basel university hospital that had the
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 43
lowest percentage of deaths from death selected causes but one of the highest donation
efficiency rates, thus making the most of their potential (see Discussion section).
4.9.4. Conversion Rates
Conversion rates of ICU adult deaths by university hospital / transplant centre are shown by step
of the donation process and are calculated as a percentage of all deaths.
Table 18: Conversion rates
Basel Bern Genève Lausanne St. Gallen Zürich Average
ICU adult deaths
(number equalling 100% in each
column)
194 282 229 238 174 295 1412
(total)
Possible donor
(patients with signs of brain damage)
74
(38.1%)
184
(65.2%)
96
(41.9%)
111
(46.6%)
88
(50.6%)
104
(35.3%)
657
(46.5%)
Potential donor
(patients suspected to fulfil brain
death criteria)
12
(6.2%)
41
(14.5%)
25
(10.9%)
24
(10.1%)
19
(10.9%)
9
(3.1%)
130
(9.2%)
Eligible donor
(patients who had brain death
diagnosed)
11
(5.7%)
29
(10.3%)
18
(7.9%)
20
(8.4%)
12
(6.9%)
4
(1.4%)
94
(6.7%)
Utilised donor
(organs procured for transplantation)
10
(5.2%)
17
(6.0%)
10
(4.4%)
13
(5.5%)
10
(5.7%)
3
(1.0%)
63
(4.5%)
Table 18 shows the conversion rates of ICU adult deaths by university hospital / transplant centre.
There are important variations in all steps of the donation process which demonstrate that each
hospital is losing potential at different levels.
The percentage of potential donors who became utilised donors is 48.5% on average for adult
ICU deaths in university hospitals / transplant centres. Basel has the highest conversion rate with
83.3% followed by Lausanne with 54.2%, St. Gallen with 52.6%, Bern with 41.5%, Genève with
40.0% and Zürich with 33.3%.
Eligible Donor
Bern had 29 patients brain death diagnosed, representing 10.3% of all deaths; Lausanne had 20
patients brain death diagnosed (including 1 patient who died of meningitis), representing 8.4% of
all deaths; Genève had 18 patients brain death diagnosed, representing 7.9% of all deaths;
St. Gallen had 12 patients brain death diagnosed, representing 6.9% of all deaths; Basel had 11
patients brain death diagnosed, representing 5.7% of all deaths and Zürich had 4 patients brain
death diagnosed, representing 1.4% of all deaths (table 18).
Utilised Donor
There were 63 patients who donated organs for transplantation, representing 4.5% of all ICU
deaths in university hospitals. Bern university hospital had 17 utilised donors corresponding to
6.0% of all ICU deaths; St. Gallen had 10 donors representing 5.7% of all ICU deaths; Lausanne
had 13 donors representing 5.5% of all ICU deaths; Basel had 10 donors representing 5.2% of all
ICU deaths; Genève had 10 donors representing 4.4% of all ICU deaths and Zürich had 3 donors,
representing 1.0% of all ICU deaths (table 18).
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 44
4.9.5. Reasons for Non-Donation
Of the 1412 audited deaths, 657 (46.5%) were possible donors. Out of these, 563 (85.7%) did not
become an eligible donor. There are various reasons for losses in the donation process.
Table 19: Reasons for non-donation
Basel Bern Genève Lausanne St. Gallen Zürich Average
Total number of possible and potential
donors who did not become an eligible
donor (number equalling 100% in each
column)
63 155 78 91 76 100 563
(total)
Contra-indication to organ donation 26
(41.3%)
27
(17.4%)
13
(16.7%)
29
(31.9%)
22
(28.9%)
24
(24.0%)
141
(25.0%)
Not expected to fulfil brain death criteria 20
(31.7%)
93
(60.0%)
52
(66.7%)
48
(52.7%)
25
(32.9%)
37
(37.0%)
275
(48.8%)
Objection to donation 10
(15.9%)
22
(14.2%)
3
(3.8%)
4
(4.4%)
17
(22.4%)
19
(19.0%)
75
(13.3%)
No next of kin/no donor card 1
(1.6%)
1
(0.6%)
- 1
(1.1%)
1
(1.0%)
4
(0.7%)
Coroner objection to donation - - 2
(2.6%)
- - - 2
(0.4%)
Cardiac arrest with failed resuscitation 6
(9.5%)
12
(7.7%)
3
(3.8%)
5
(5.5%)
5
(6.6%)
5
(5.0%)
36
(6.4%)
End stage therapeutic treatment - - 5
(6.4%)
4
(4.4%)
3
(3.9%)
2
(2.0%)
14
(2.5%)
Considered as a DCD Maastricht category
type III donor
- - - - 4
(5.3%)
12
(12.0%)
16
(2.8%)
As shown in Table 19, the principal reasons for not diagnosing brain death were: not expected to
meet brain death criteria, absolute or relative contra-indication to donation and objection.
For patients who were not expected to meet brain death criteria, important variations between
university hospitals / transplant centres can be observed. Genève had the highest rate with 52
patients, (66.7%) of their 78 drop-offs, against Basel who had 20 patients (31.7%) of their 63 drop-
offs.
Equally, variations are shown for patients with a contra-indication for organ donation with Basel
university hospital who documented 26 patients (41.3%) of their 63 drop-offs, against Bern with
27, representing (17.4%) of drop-offs.
Lastly, data revealed that objection to donation before brain death diagnosis was an important
loss with large variations by university hospital / transplant centres. A possible explanation for
this could be that the request for organ donation is occurring at different time points. St. Gallen
had the highest rate with 17 (22.4%) of their 76 drop-offs compared to Genève with only 3 (3.8%)
of their 78 drop-offs.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 45
4.9.6. Consent Rate
Figure 26 displays the percentage of consent vs. objection in seeking permission for donation by
university hospital / transplant centre for ICU adult deaths. 212 patients out of 1412 audited
deaths (15.0%) were considered for organ donation. Of the 212 considered for donation,
permission was sought in 179 (84.4%) cases and resulted in 80 (44.7%) consents for donation and
99 (55.3%) objections.
Figure 26: Consent rate
Objection to donation is the principal reason for non-donation in Switzerland. The university
hospitals / transplant centres show a similar pattern to their respective networks, indicating that
the majority of approaches to the next of kin are made in these reference centres. The average
consent rate in the university hospitals / transplant centres is 44.7%.
Basel considered 25 patients (12.9%) 0f all deaths for organ donation. There were 22
documented cases where permission for donation was sought, resulting in 12 (54.5%) consents
for donation and 10 (45.5%) objections.
Bern considered 57 patients (20.2%) 0f all deaths for organ donation. There were 52 cases where
permission for donation was sought, resulting in 21 (40.4%) consents for donation and 31 (59.6%)
objections.
Genève considered 29 patients (12.7%) 0f all deaths for organ donation. There were 27 cases
where permission for donation was sought, resulting in 16 (59.2%) consents for donation and 11
(40.8%) objections.
Lausanne considered 26 patients (10.9%) 0f all deaths for organ donation. There were 24 cases
where permission for donation was sought, resulting in 14 (58.3%) consents for donation and 10
(41.7%) objections.
St. Gallen considered 40 patients (23.0%) 0f all deaths for organ donation. There were 31 cases
where permission for donation was sought, resulting in 13 (41.9%) consents for donation and 18
(58.1%) objections.
Zürich considered 35 patients (11.9%) 0f all deaths for organ donation. There were 23 cases
where permission for donation was sought, resulting in 4 (17.4%) consents for donation and 19
(82.6%) objections.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 46
Figure 27a: Consent and objection by level vs. total approaches
Figure 27b: Consent and objection by level vs. total consents and total objections
Study data shows that objection to donation is observed during all steps of the donation process.
Figures 27a/b show the variations of objection by step for a possible, potential and eligible donor
by university hospital / transplant centre. It demonstrates that approach to the next of kin is
occurring at different time points. This is one of the principal explanations for the differences in
conversion rates.
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 47
Possible Donor: The distribution of objections and consents at the possible donor level in the
university hospitals / transplant centres are:
Basel sought permission for donation in 22 cases; from these 22 cases, 16 (72.8%) were sought at
this level, resulting in 10 (45.5%) objections and 6 (27.3%) consents (figure 27a). Objections at this
level represent 100.0% of the 10 total objections and consents at this level represent 50.0% of the
12 total consents (figure 27b).
Bern sought permission for donation in 52 cases; from these 52 cases, 14 (26.9%) were sought at
this level, resulting in 14 (26.9%) objections and no consents (figure 27a). Objections at this level
represent 45.2% of the 31 total objections (figure 27b).
Genève sought permission for donation in 27 cases; from these 27 cases, 3 (11.1%) were sought at
this level, resulting in 2 (7.4%) objections and 1 (3.7%) consents (figure 27a). Objections at this
level represent 18.2% of the 11 total objections and consents at this level represent 6.3% of the 16
total consents (figure 27b).
Lausanne sought permission for donation in 24 cases; from these 24 cases, 2 (8.3%) were sought
at this level, resulting in 2 (8.3%) objections and no consents (figure 27a). Objections at this level
represent 20.0% of the 10 total objections (figure 27b).
St. Gallen sought permission for donation in 31 cases; from these 31 cases, 15 (48.4%) were
sought at this level, resulting in 12 (38.7%) objections and 3 (9.7%) consents (figure 27a).
Objections at this level represent 66.7% of the 18 total objections and consents at this level
represent 23.1% of the 13 total consents (figure 27b).
Zürich sought permission for donation in 23 cases; from these 23 cases, 14 (60.9%) were sought
at this level, resulting in 14 (60.9%) objections and no consents (figure 27a). Objections at this
level represent 73.7% of the 19 total objections (figure 27b).
Potential Donor: The distribution of objections and consents at the potential donor level in the
university hospitals / transplant centres are:
Basel sought permission for donation in 22 cases; from these 22 cases, 6 (27.3%) were sought at
this level, resulting in no objections and 6 (27.3%) consents (figure 27a). Consents at this level
represent 50.0% of the 12 total consents (figure 27b).
Bern sought permission for donation in 52 cases; from these 52 cases, 22 (42.3%) were sought at
this level, resulting in 8 (15.4%) objections and 14 (26.9%) consents (figure 27a). Objections at
this level represent 25.8% of the 31 total objections and consents at this level represent 66.7% of
the 21 total consents (figure 27b).
Genève sought permission for donation in 27 cases; from these 27 cases, 14 (51.8%) were sought
at this level, resulting in 3 (11.1%) objections and 11 (40.7%) consents (figure 27a). Objections at
this level represent 27.3% of the 11 total objections and consents at this level represent 68.8% of
the 16 total consents (figure 27b).
Lausanne sought permission for donation in 24 cases; from these 24 cases, 10 (41.6%) were
sought at this level, resulting in 2 (8.3%) objections and 8 (33.3%) consents (figure 27a).
Objections at this level represent 20.0% of the 10 total objections and consents at this level
represent 57.1% of the 14 total consents (figure 27b).
St. Gallen sought permission for donation in 31 cases; from these 31 cases, 15 (48.4%) were
sought at this level, resulting in 5 (16.1%) objections and 10 (32.3%) consents (figure 27a).
Objections at this level represent 27.8% of the 18 total objections and consents at this level
represent 76.9% of the 13 total consents (figure 27b).
Zürich sought permission for donation in 23 cases; from these 23 cases, 9 (39.1%) were sought at
this level, resulting in 5 (21.7%) objections and 4 (17.4%) consents (figure 27a). Objections at this
RESULTS Comparison of University Hospitals / Transplant Centres
SwissPOD Study Report 48
level represent 26.3% of the 19 total objections and consents at this level represent 100.0% of the
4 total consents (figure 27b).
Eligible Donor: The distribution of objections and consents at the eligible donor level in the
university hospitals / transplant centres are:
Basel sought permission for donation in 22 cases; from these 22 cases, none were sought at this
level.
Bern sought permission for donation in 52 cases; from these 52 cases, 16 (30.8%) were sought at
this level, resulting in 9 (17.3%) objections and 7 (13.5%) consents (figure 27a). Objections at this
level represent 29.0% of the 31 total objections and consents at this level represent 33.3% of the
21 total consents (figure 27b).
Genève sought permission for donation in 27 cases; from these 27 cases, 10 (37.0%) were sought
at this level, resulting in 6 (22.2%) objections and 4 (14.8%) consents (figure 27a). Objections at
this level represent 54.5% of the 11 total objections and consents at this level represent 25.0% of
the 16 total consents (figure 27b).
Lausanne sought permission for donation in 24 cases; from these 24 cases, 12 (50%) were sought
at this level, resulting in 6 (25.0%) objections and 6 (25.0%) consents (figure 27a). Objections at
this level represent 60% of the 10 total objections and consents at this level represent 42.9% of
the 14 total consents (figure 27b).
St. Gallen sought permission for donation in 31 cases; from these 31 cases, 1 (3.2%) were sought
at this level, resulting in 1 (3.2%) objections and no consents (figure 27a). Objections at this level
represent 5.6% of the 18 total objections (figure 27b).
Zürich sought permission for donation in 23 cases; from these 23 cases, none were sought at this
level.
In summary, of the total 99 objections, 54 (54.5%) were reported for a possible donor; 23 (23.2%)
were documented for a potential donor and 22 (22.2%) for an eligible donor after brain death
diagnosis.
At the possible donor level the 54 (54.5%) of total objections were divided as follows: Basel 10
(100.0%) out of 10 objections, Zürich 14 (73.7%) out of 19 objections, St. Gallen 12 (66.7%) out of
18 objections, Bern 14 (45.2%) out of 31 objections, Lausanne 2 (20.0%) out of 10 objections, and
Genève 2 (18.2%) out of 11 objections.
At the potential donor level the 23 (23.2%) of total objections were divided as follows: St. Gallen
5 (27.8%) out of 18 objections, Zürich 5 (26.3%) out of 19 objections, Genève 3 (27.3%) (of which 2
were coroner objections) out of 11 objections, Bern 8 (25.8%) out of 31 objections, and Lausanne
2 (20.0%) out of 10 objections.
At the eligible donor level the 22 (22.2%) of total objections were divided as follows: Lausanne 6
(60.0%) out of 10 objections, Genève with 6 (54.5%) out of 11 objections, Bern 9 (29.0%) out of 31
objections, St. Gallen 1 (5.6%) out of 18 objections, and Zürich and Basel had no objections at this
level.
DISCUSSION
SwissPOD Study Report 49
5. Discussion
The basic intention of the Swiss Transplantation Law with regard to organ donation, is to provide
authoritative directives (adapted from the Spanish Model [3,4]) for the structures of the donation
process, with the objective to increase organ donation activity. Yet, despite these measures
taken, the number of deceased organ donors in Switzerland has remained largely constant. Since
the low donation rate in Switzerland (one of the lowest in Europe, see figure 28 below) has an
immediate impact on the number of patients on the waiting list, it comes as no surprise that it
has risen by 23% from 870 patients by the end of 2007 to 1074 patients in 2011 [5], meaning that
waiting list mortality remains a major concern.
The SwissPOD study was initiated to expose the causes of the overall low donation rate in
Switzerland, and explain the differences between networks. In view of the fact that the detection
and referral of potential donors is required by law, there was a 100% participation rate from the
87 intensive care units (ICU) accredited by the Swiss Society of Intensive Care Medicine SSICM;
furthermore, 52 accident and emergency departments (A&E) also participated. This shows the
hospitals authorities’ commitment to the improvement of the situation by providing an insight to
their data and processes. In the future, the SwissPOD database, developed for this study, will
continue to be used as a quality assurance tool.
SwissPOD is the first comprehensive, nationwide study which gives an overview of the donation
process and its outcomes for patients dying in an ICU or A&E. The present report only provides a
summary of the results. The reasons for non-donation are multiple and are documented in all
levels of the donation process. Our findings concerning the variations in donation rates between
networks and hospitals are multifactorial, and therefore need to be analysed in-depth
posteriorly.
In summary, the SwissPOD study shows four major findings, discussed in detail below:
(1) An overall objection rate to organ donation of 52.6%.
(2) An overall conversion rate of 45.4%.
(3) Structural differences on an organisational level among the networks, resulting in a
variation in donation rates.
(4) Varying degrees of awareness for the detection and referral of a possible donor, mainly in
smaller hospitals.
Potential for organ donation and donation rate
Study data analysis showed that the estimated maximum capacity in Switzerland for organ
donation after brain death from patients deceased in ICU and A&E is 290 donors per year,
equalling 36.5 per million of population (pmp). The actual capacity for organ donation is
dependent on the number of patients diagnosed brain dead in a hospital. The estimated capacity
for donation is measured by the number of patients who are suspected to fulfil brain death
criteria and include a limited number of drop-offs such as patients documented as not being
identified as a potential donor and a number of patients or next of kin who objected to donation.
It is noteworthy that this capacity does not include patients who died on general hospital wards,
intermediate care units and out-of-hospital. There may be an unquantifiable additional potential
of donors out of this patient group.
During the study period, there were 98 donations after brain death (DBD), representing 2.2% of
all audited deaths, and 6 donations after circulatory death (DCD). This equals an actual donation
rate of 12.3 pmp (13.1 pmp with DCD included). Remarkably, a study by Wesslau et al who
evaluated the donor potential in the north-east donor region of Germany (7.69 million
inhabitants which is almost identical to Switzerland's with 7.95 million, and a similar donation
rate) estimated their pool of potential donors to be 40.7 pmp [6].
DISCUSSION
SwissPOD Study Report 50
Over the last 10 years, the Swiss organ donation rate has remained relatively static, ranging from
75 deceased donors in 2002 (10.3 pmp) to 103 donors in 2009 (13.2 pmp) [5]. Contrariwise, other
European countries, that one or two decades ago showed similar donation rates to Switzerland’s,
increased the numbers of donors substantially [3,7]. We are aware that variations in donor rates
may occur in shorter time periods, as shown in Croatia recently. Therefore, Swisstransplant
analysed the donor rates in the decade before the Transplantation Law came into force
(1.7.1997–30.6.2002 [period A] and 1.7.2002–30.6.2007 [period B]) and compared it with the 5
years after (1.7.2007 to 30.6.2012 [period C]). This evaluation revealed that the average donor
rate was 85.6 donors per year in period A; 83.4 donors per year in period B; and 95.6 donors per
year in period C. Looking at the evolution among the networks, the increase in period C,
compared to periods A and B was mainly due to the PLDO (+29 donors [+18.7%]), Basel (+25
donors [+61.0%]), and St. Gallen (+5 donors [+12.8%]) networks. The other networks remained at
an unchanged or even decreasing donor rate. The increase shown in the PLDO network can be
explained with the creation of a structure and the implementation of processes in accordance to
the legal requirements. Consequently, the assumption that by implementing structures and
processes for donor awareness in non procurement hospitals in the German-speaking networks
of Switzerland will have an impact on the donation rate, appear reasonable. These structural and
awareness issues (findings 3 and 4) are discussed in more detail below.
Our study findings show that the actual capacity for donation (patients brain death diagnosed vs.
all deaths) per million of population by network varies between 3.6 pmp and 25.0 pmp. Bern has
the highest rates with 25.0 pmp, followed by the PLDO with 23.6 pmp, St. Gallen with 21.7 pmp,
Basel with 18.5 pmp, Luzern with 12.1 pmp and Zürich with 3.6 pmp. However, findings show that
the actual donation rate (utilised donors vs. all deaths) by network per million of population is
18.1 pmp for St. Gallen, 16.7 pmp for Basel, 15,2 pmp for the PLDO, 14.5 pmp for Bern, 12.1 pmp
for Luzern and 2.7 pmp for Zürich. This confirms the increase in donation rates shown over the
past few years for Basel university hospital, Aarau cantonal hospital and St. Gallen cantonal
hospital due to local initiatives.
Audited data shows that patients diagnosed brain dead during the study period came from three
categories of diagnoses: cerebrovascular accident (CVA), head trauma and anoxia. All of the 76
hospitals had patients who died from these death selected causes (figure 2a/b). However, there
was a large variation between networks (figures 7a/b–12a/b) and university hospitals / transplant
centres (figures 18a/b–23a/b) for patients dying on an adult ICU with one of these pathologies
and the transfer of these patients from non transplant centres. Basel, Luzern and Zürich
networks showed that roughly 30% of all ICU deaths came from one of these death selected
causes, compared to the PLDO, Bern and St. Gallen networks with approximately 40%.
There may be a correlation between the differences in percentage of patients who died of a
death selected cause in university hospitals / transplant centres and the number of transfers to
one of these hospitals from a hospital with no neurosurgical facilities.
As shown in table 16, the highest number of transfers was to Bern university hospital (19.5%).
They also have the highest percentage of patients dying of a death selected cause with 62.1%
(figure 17). Zürich university hospital with 8.8% of patients transferred to their hospital also had a
much lower number of patients dying of a death selected cause (41.0%). This can be due to
different transfer policies.
However, this can not be said generally as transfer policies may show an impact in large networks
with a high number of hospitals with no neurosurgical facilities, but not necessarily in small
networks. It is to assume that patients with a death selected cause in small networks are usually
directly admitted to the reference centre, which would result in a smaller number of transfers.
Our observations concerning the referral of patients from hospitals without neurosurgical
facilities to reference centres are in line with a Dutch study showing that hospitals with a
neurosurgery department had an increased number of donors as compared to those without
neurosurgical facilities [8].
DISCUSSION
SwissPOD Study Report 51
Taking into account the important variations of death selected causes by networks and looking at
the statistics for the identification and referral of a possible organ donor, one may conclude that
hospitals within the PLDO, Bern and St. Gallen networks have put into place good practices
which enable this awareness for donation. Basel network has the lowest death rate by selected
cause, which could be explained that patients dying from these diagnoses are not admitted to
ICU or not transferred from hospitals with no neurosurgical facilities. Interestingly, a Dutch study
showed that 17 out of 100 dead from accidents or suicides became donors, whereas only 4.9 out
of 100 dead from a CVA became a donor [8]. Similar results are found in a recent US study, where
CVA accounted for 5.5% of donors [9]. Our findings showed that we were above these results
with 11.2% of our CVA deaths resulting in the donation of organs.
However, our limited data collection (restricted to ICU and A&E deaths) excludes the possibility
to quantify how many patients are dying outside of an ICU or A&E with one of these pathologies
in Switzerland. Study data strongly suggests that a number of patients with these death selected
causes are never admitted to an ICU from A&E or that they were admitted to an ICU but
transferred to a general ward for end of life care. In parallel to study data, we examined all Swiss
inhabitant deaths by networks from these death selected causes. Data from the Swiss Federal
Statistical Office showed that all types of death were distributed similarly in all networks, which
confirms as a benchmark that there are not more or less deaths from selected types of causes for
different regions in Switzerland. Thus, the fact that there are differences in the types of death
that can lead to brain death diagnosis in ICUs suggests that these deaths are occurring
elsewhere. There can be a number of explanations for this, such as lack of awareness for organ
donation and the option for donation was not considered; no available bed on an ICU or the need
for a bed. Another reason could be that older patients with (severe) cerebral lesions but
spontaneously breathing were not intubated and, thus, were transferred to a general ward
instead of the ICU. It could also be that a patient had expressed his wish in life for no active
treatment in the event of a life threatening pathology. This could result that the patient would
not be admitted to an intensive care unit. This can also be the reason for a non transfer of a
patient from a non reference centre to a reference centre for treatment where one would expect
this type of pathology to be treated. Furthermore, it would be incorrect to presume that all these
patients could have been brain death diagnosed. Yet, as past and present audits from the PLDO
network indicate, one can consider that a small proportion of these patients are probably non
identified donors due to lack of awareness for organ donation, and that the option for donation
was not considered. Since 2008, and the development of the PLDO network, approximately one
third of organ donors have been detected by their non transplant centres against a minority of
certain networks in the German-speaking area.
(1) Objection rate
Our study showed that objection to donation was one of the main reasons for non-donation in
Switzerland. Of the 350 patients considered for donation in total, permission was sought in 268
(76.6%) cases. This resulted in 127 consents (47.4%) and 141 objections (52.6%) to organ
donation (tables 11, 12). When looking at the subgroup of 320 ICU adult deaths considered for
donation, permission was sought in 249 (77.8%) cases, and resulted in 121 (48.6%) consents for
donation and 128 (51.4%) objections (figure 15).
Due to a lack of published data from major European countries (e.g., Austria, France, Germany),
it is difficult to compare objection rates within Europe. However, data from Italy, Spain and the
United Kingdom show considerable variation. The refusal rate, calculated as a percentage of the
number of next of kin approached for seeking permission for donation, is 19% in Spain, 31.5% in
Italy and 43% in the UK [10]. The study from the north-east region of Germany and studies from
the UK and the US showed objection rates of 73%, 41% and 46%, respectively [6,11,12]. In a
recent Dutch study, the objection rate was estimated to amount to approximately 60% [13],
Danish data showed 49% next of kin refusals [14].
DISCUSSION
SwissPOD Study Report 52
Remarkably, there is considerable discrepancy between actual donation rates and people’s
attitudes toward organ donation. In figure 28, bars show the number of deceased organ donors
(including non heart beating donors) per million of population in selected European countries
[10]. The line above displays survey data, showing the percentage of people who answered “yes”
to the question “If you were asked in a hospital to donate an organ from a deceased close family
member, would you agree?” [15] or “I would (rather) agree to donate my organs after death”[16],
respectively.
Figure 28: Donation rates vs. attitude towards donation in selected European countries
Several studies emphasise on the time point of the next of kin approach having a crucial impact
on consent by next of kin [17–21]. The fact that in our study, objection to donation was observed
during all phases of the donation process (as shown in figures 16a/b for networks and 27a/b for
university hospitals / transplant centres), demonstrates that approach to the next of kin in view of
seeking permission for donation is occurring at different time points. Actually, there was a co-
variation of an early approach for requesting organ donation and objection. Out of 91 approaches
at the possible donor level, 71 (78.0%) objected to donation. There were 118 approaches at the
potential donor level, resulting in 37 (31.4%) objections. Out of 59 approaches at the eligible
donor level, 33 (55.9%) objected to donation. Our data shows that early approaches were more
frequently documented in the networks of the German-speaking area compared to the PLDO
network. A possible explanation for this finding may lay in an ethical issue, as at end-of-life-care,
when all life saving measures have been taken but failed, the discussion with the next of kin is
based on “how to die with dignity”. This discussion is essential and gives the line for patient
management for possible organ donors, leading either to end stage therapeutic treatment or to
organ donation with its preliminary measures in view of maintaining organ viability.
(2) Conversion rates and donation efficiency
As pointed out by Barber et al, who evaluated the potential for organ donation in the United
Kingdom, the donor rate per million of population may not be an entirely appropriate measure
for comparing different countries. They emphasised that several factors may influence the
number of potential donors that are available. These include the provision of intensive care beds,
neurosurgical practice and the death rates from intra-cerebral bleeding and road traffic
accidents. Therefore, they suggest considering the donor rate in terms of a “percentage of the
potential” or the “conversion rate” [11].
DISCUSSION
SwissPOD Study Report 53
Our Swiss study data showed an overall conversion rate of 45.4%, (calculated as the percentage
of potential donors who become an organ donor). The conversion rate in the study by Wesslau et
al was 47% [6]. These are similar results to those found by Barber et al for the UK (45%) and the
46% in a large US study by Sheehy et al [11,12]. Our data equally shows that Swiss ICUs are
generally doing an excellent job in considering the option of donation at end of life care. 350
patients out of the 4524 audited deaths (7.7%) representing 44.0 pmp were considered for organ
donation. However, the conversion of these patients to organ donors show variations by
networks (table 14) and by university hospital / transplant centre (table 18) with losses in all steps
of the donation process.
The donation efficiency index (figure 14 for networks, 25 for university hospitals / transplant
centres), calculated as a percentage of patients who donated organs from the number of deaths
from death selected causes (CVA, head trauma and anoxia). This indicator shows large
differences with Basel network that has the lowest percentage of deaths from death selected
causes but the highest donation efficiency with 11.8%, thus making the most of their potential.
The differences documented show the lower efficiency indexes for Bern, Luzern and Zürich
networks due to their high objection rates.
(3) Structural differences
Article 56(2) of the Transplantation Law (SR 810.21) states that the cantons are in charge of
implementing appropriate structures in relation to transplantation. Among others, these include
the appointment of staff responsible for local coordination and training programmes. This study,
in addition to patient information, collected information on hospital infrastructure, hospital
policies as well as directives and guidelines for caring for a potential donor. Data revealed that
there are considerable variations by network. In some of the networks, there are hospitals
without guidelines or institutional directives on brain death. Less than 50% of hospitals in Bern
and Zürich networks declared having guidelines or institutional directives on brain death
compared to 100% of the PLDO network public hospitals (see hospital characteristics in the
annex). There is also a difference between the networks concerning the number of hospitals that
procure organs for transplantation and the availability of an on-site transplant coordinator. The
PLDO network has 7 procurement hospitals with an on-call transplant coordinator who can be
dispatched to any requesting establishment. Basel and Zürich networks have 2 procurement
hospitals with an on-call transplant coordinator to these institutions, whilst Bern, Luzern and
St. Gallen networks only have one procurement hospital with no transplant coordinator working
outside of the university or cantonal hospitals. Additionally, the PLDO network finances local
donor coordinators in each hospital with an ICU. To our knowledge, in the German-speaking area
the networks and their affiliated cantons have not yet fully implemented these structures.
However, individual teams such as in Basel university hospital and Aarau cantonal hospital, and in
St. Gallen cantonal hospital have increased their donation rates over the last five years due to
local initiatives. They did so by implementing processes, based on guidelines developed by the
heads of ICUs from these hospitals.
When considering the necessary structural improvements required for an increasing donation
rate, it is noticeable that only the cantons associated to the PLDO network have complied and
implemented the standards required by law. They did so by financing local donor coordinators,
nurses and physicians from the intensive care unit in each hospital. Conversely, in the networks
of the German-speaking area, due to lack of financial resources, the local donor coordinators
often – if not always – are the heads of ICUs. This could mean that implementing structures and
processes with the resources available may be difficult.
Apart from a few local initiatives, there was little organisational improvement in the cantons of
the German-speaking area within the last five years. As a consequence, the differences in
donation rates between the regions that had existed before the coming into force of the national
DISCUSSION
SwissPOD Study Report 54
Transplantation Law prevail, even though there was hope that the law would ameliorate the
overall situation.
(4) Varying degrees of awareness for the detection and referral of a possible donor
Out of the total 4524 audited deaths, 350 patients (7.7%, representing 44.0 pmp) were
considered for organ donation (i.e., the option for donation was discussed at end of life care).
This shows that there is awareness for donation in the ICUs, although this awareness is more
prominent in the reference centres or university hospitals / transplant centres than in smaller
hospitals. This is demonstrated with the observed increase in donation rates for Basel, the PLDO
and St. Gallen networks in the last five years, with a rise in the referral of patients from non
procurement centres to reference centres. This was less predominant in Bern and Zürich
network, as revealed in the Swiss Organ Allocation System (SOAS). As a side effect of the
SwissPOD study, there has been a marked increase in awareness towards the end of the study
period. Enhancing awareness seems to be a very effective measure in order to improve donation
rates. This is also confirmed by several studies that evaluated the impact of a best practice
system in the United States (the US Organ Donation Breakthrough Collaborative) and showed its
positive effect on awareness of organ donation and, ultimately, consent and conversion rates
[22–25].
Conclusions
Limitations of the study: We are well aware of the fact that a comparison of the results from the
networks and hospitals must be carried out with maximal scrutiny, because the variations result
from a large number of factors that need to be taken into account. Furthermore, the
interpretation of the results needs to be handled with caution due to a number of small networks
and hospitals with limited data samples over the one year period. A&E data has not been detailed
in this report as data showed no common standardised structures, polices or procedures.
Another limitation of the study lies in the fact that it does not include patients who died on
general hospital wards, intermediate care units and out-of-hospital.
In conclusion, we were able to show that the high refusal rate (and thus the low donation rate) in
Switzerland results from various factors or causes that require detailed further analysis. The
reasons for non-donation are multiple and are documented in all steps of the donation process.
However, all networks and hospitals equally show that there is room for improvement in one or
more steps. This report only provides a summary of the results and an in-depth analysis of the
data will be carried out posteriorly. We strongly advise that the issues identified in our study
should be addressed within the networks and hospitals as well as in the public.
In-hospital actions have been anticipated by the Comité National du Don d’Organes (CNDO),
which started an educational program in 2011 with the aim to improve the communication to the
next of kin when seeking permission for donation. Furthermore, expert groups created
documents with recommendations to every step of the donation process (Swiss Donation
Pathway). These recommendations will be available for hospital staff. As from summer 2013,
specialised teams for requesting organ donation will be available on call. These teams, who have
the aim to provide competent and transparent information to the family, will act as a support to
local hospitals assisting in the communication to the next of kin in the context of organ donation.
It is essential for the cantons in the German-speaking area to finance the required personnel
(local donor coordinator) in each hospital with an ICU and the structures required so as to fulfil
the tasks described by the Transplantation Law. Funding of training and education of local
coordinators must be guaranteed in order to establish a national standard for the networks under
the hat of the CNDO. Quality control is required by the law for all hospitals, and should lead to a
continuous improvement of donor detection and referral at each level of the donation process.
DISCUSSION
SwissPOD Study Report 55
Acknowledgments
We are very grateful to all those who have contributed to this study, particularly to the local
donor coordinators who have collected and entered the data. To all the heads of intensive care
and accident & emergency who have accepted to participate to the study. To the Swiss Society
of Intensive Care Medicine (SSICM), the Schweizerische Gesellschaft für Notfall- und
Rettungsmedizin (SGNOR), Head of networks & their general donor coordinators for their
support.
Contributors:
Code book and audit form: Caroline Spaight, Isabelle Keel, David Egger
Implementation of the study and management of data collection: Caroline Spaight, Isabelle Keel
Referral person for data collection in Ticino: Eva Ghanfili
Documentation: Caroline Spaight
Database: Yvan Schmutz, Thierry Berset
Translation of documents/database: Caroline Spaight; Marie-Pierre Chambet (French); Isabelle
Keel (German); Luca Imperatori, E.Ghanfili, Tatjana Crivelli, Andreina Bocchi, Diane Moretti
(Italian)
Extraction/analysis of data: Caroline Spaight, Isabelle Keel
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SwissPOD Study Report 56
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ANNEX
SwissPOD Study Report 58
7. Annex
7.1. Hospital Characteristics by Network
Basel Bern Luzern PLDO St. Gallen Zürich
Number of hospitals 6 12 6 19 2 23
Type of hospital
university hospital / transplant centre 1 1 - 2 1 1
hospital with neurosurgery 1 3 2 2 - 7
hospital without neurosurgery 4 8 4 15 1 15
Number of hospital beds 2574 2802 2802 6168 935 5997
Hospital infrastructure enabling to care for a potential
donor/retrieve organs
care for a potential donor (yes/no) 6/0 11/1 6/0 18/1 2/0 21/2
retrieve organs (yes/no) 2/4 1/11 2/4 9/10 1/1 2/21
Hospital policy to transfer a potential donor to another
establishment (yes/no)
5/1 11/1 5/1 14/5 1/1 22/1
Number of hospitals with guidelines/institutional
directives for
possible donors after brain death (DBD) 4 5 5 17 2 13
possible donors after circulatory death (DCD) 1 - - 2 1 1
tissue donation - 2 2 3 - 3
Type of consent policy for donation
written and signed consent 2 1 1 8 1 2
oral consent 3 10 5 8 1 15
n.a. 1 1 - 3 - 6
Hospital facilities & specialties
0perating theatres (no. of hospitals) 6 12 6 19 2 23
Radiology (no. of hospitals) 6 12 6 19 2 23
Neurology (no. of hospitals)
neurologist available 24/7 2 2 2 5 1 6
neurologist in-house limited availability 2 2 - 5 1 4
neurologist not in-house but available on call 1 5 4 7 - 8
no neurological facilities / n.a. 1 3 - 1/1 - 4/1
Neurosurgery (no. of hospitals)
neurosurgeon available 24/7 2 2 2 3 1 6
neurosurgeon in-house limited availability - 1 - - - 1
neurosurgeon not in-house but available on call - 1 1 5 - 2
no neurosurgical facilities 4 8 3 11 1 14
Availability of a transplant coordinator (TC)
in-house TC 1 1 - 2 1 1
TC available (on call) on site if requested 1 - 1 9 - 1
no TC 4 11 5 8 1 21
ANNEX
SwissPOD Study Report 59
7.2. Participating hospitals
Basel Network
Kantonsspital Baden
St. Claraspital, Basel
Universitätsspital Basel
Universitäts-Kinderspital Basel UKBB
Kantonsspital Bruderholz, Basel
Kantonsspital Liestal
Kantonsspital Aarau
Bern Network
SRO Langenthal
Inselspital - Universitätsspital Bern
Regionalspital Emmental AG, Burgdorf
Regionalspital Interlaken - Spitalverbund fmi
Spitalzentrum Biel
Hirslanden Klinik Beau-Site, Bern
Lindenhofspital Bern
Klinik Sonnenhof, Bern
Spital STS AG Simmental-Thun-Saanenland, Spital Thun
Bürgerspital Solothurn
Kantonsspital Olten
Spital Bern-Tiefenau
Luzern Network
LUKS Kinderspital Luzern
LUKS Luzern
LUKS Sursee
Hirslanden Klinik St. Anna, Luzern
Kantonsspital Uri, Altdorf
LUKS Wolhusen
Paraplegikerzentrum Nottwil
Kantonsspital Nidwalden
PLDO Network
Centre Hospitalier Universitaire Vaudois
Hôpitaux Universitaires de Genève
Hôpitaux Fribourgeois - Hôpital Cantonal Fribourg
Hôpital Neuchâtelois-Pourtalès
Hôpital Neuchâtelois - La Chaux-de-Fonds
Hôpital du Chablais - Hôpital de Monthey
Centre Hospitalier du Centre du Valais - Hôpital de Sion
Centre Hospitalier du Centre du Valais - Hôpital de
Martigny
Centre Hospitalier du Centre du Valais - Hôpital de Sierre
Hôpital de la Riviera - Vevey, Le Samaritan
Etablissements Hospitaliers du Nord Vaudois - Hôpital
d'Yverdon
Ensemble Hospitalier de la Côte - Hôpital de Morges
Groupement Hospitalier de l'Ouest Lémanique - Hôpital
de Nyon
Hôpital Intercantonal de la Broye - Hôpital de Payerne
Hôpital du Jura - Hôpital de Delémont
Ospedale Regionale di Bellinzona e Valli
Ospedale Regionale di Mendrisio
Ospedale Regionale di Lugano
Ospedale Regionale di Locarno
Cardiocentro Ticino, Lugano
Hirslanden Clinique Cécil, Lausanne
Hôpital de la Tour, Genève
St. Gallen Network
Ostschweizer Kinderspital St. Gallen
Kantonsspital St.Gallen
Kantonsspital Herisau
Zürich Network
Spital Schwyz
Spital Lachen
Kantonsspital Thurgau AG, Münsterlingen
Kantonsspital Thurgau AG, Frauenfeld
Kantonsspital Schaffhausen
Spital Bülach
GZO Wetzikon
Stadtspital Triemli, Zürich
Spital Männedorf
Stadtspital Waid, Zürich
Klinik Hirslanden, Zürich
Spital Limmattal, Schlieren
Spital Uster
Spital Zollikerberg
See Spital, Horgen
Kantonsspital Winterthur
Universitäts Spital Zürich
Universitätskinderklinik, Zürich
Hirslanden Klinik im Park, Zürich
Kantonsspital Zug
Hirslanden Klinik Aarau
Kantonsspital Glarus
Kantonsspital Graubünden, Chur
Spital Oberengadin, Samedan