On Wednesday, 15 November, in Switzerland, the Transplantation Act changed the guidelines of the Académie suisse des sciences médicales (ASSM) (Swiss Academy for Medical Sciences) on “Determining death with regard to organ transplantation and preparations for organ removal”: the stand-off time for determination of death due to cardiac arrest is now reduced to 5 minutes instead of 10, which was previously the case. This is an “important decision for transplant surgery“, which “fuels criticism“.
Indeed, several organisations [1] have written to the Federal Council to express their concerns, stating that, “halving the stand-off time will shake the population’s confidence in organ donation regulations“. Organs can be harvested in the event of brain death but also following cardiac arrest. According to these organisations, “the irreversible shutting down of all brain functions is the criterion for establishing a person’s death“. Although “irreversible brain damage occurs five minutes after cardiac arrest“, some of the brain cells “survive for up to ten minutes or even longer“.
The signatories are asking the Federal Council “not to pass the Transplantation Act” until the ASSM has changed “its guidelines on this controversial point”.
For its part, the Swiss Academy justifies the reduction in the “stand-off time to diagnosis of death” by improving the “diagnostic tools”: death is confirmed by an ultrasound scan of the heart and by “taking the pulse“. An ultrasound scan is then carried out to certify that “the brain is no longer receiving a supply of oxygen“. According to Jürg Steiger, transplant specialist at Basel University Hospital and President of the ASSM Ethics Committee, “Without oxygen, neurological cell death occurs in less than five minutes“.
[1] The Swiss Hippocratic society, Human Life International Switzerland, the Swiss Bioethics’ Society and the Swiss Association of Catholic Doctors.
20 minutes Suisse (06/11/2017) ; ARC Info Suisse (06/11/2017)