The Federal Act on the Transplantation of Organs, Tissues and Cells (Transplantation Act) specifies the legal requirements for organ transplantation. With regard to the determination of death, reference is made in the Transplantation Ordinance to the medical ethical guidelines of the SAMS.
The criterion for death given in the Act (French | German) is based on the neurological definition according to which a person is dead if the functions of his or her brain, including the brainstem, have ceased irreversibly. For the determination of death, the Transplantation Ordinance (French | German) makes reference to the SAMS guidelines «Determination of death with regard to organ transplantation and preparations for organ removal». The legislation thus makes, not the definition of death, but the procedure whereby death is to be determined, subject to the current state of medical science.
Revision of the guidelines
After the Swiss citizens approved the extended presumed consent proposal («erweiterte Widerspruchslösung»), the new legislation is expected to come into force in 2025. By this date, the SAMS guidelines «Determination of death with regard to organ transplantation and preparations for organ removal» are also to be revised. For this purpose, the Central Ethics Committee (CEC) of the SAMS has appointed a subcommittee with a broad interprofessional and interdisciplinary composition. On the one hand, this subcommittee will work out the necessary changes with regard to the changeover to presumed consent. On the other hand, it will examine whether further adjustments are needed based on practical experience with the previous guidelines, new medical developments, and/or ethical considerations.
The aim of the revised guidelines is to continue to ensure that death is diagnosed reliably and safely, that the will of the deceased person is taken into account, and that the relatives are supported during this difficult phase.
The work of the subcommittee has started at the end of May 2023. Information on the process of drafting and revising guidelines can be found in the document «Formation Process of Guidelines».
Members of the subcommittee
Dr Mathias Nebiker, Aarau, Intensive Care Medicine (Chair)
lic. theol., dipl. biol. Sibylle Ackermann, SAMS, Ethics (ex officio)
PD Dr Vanessa Banz, Bern, Visceral and Transplantation Surgery
Natascha Böhmer, Zürich, Donor Care Management/Intensive Care
PD Dr Barbara Brotschi Aufdenblatten, Zürich, Paediatric Intensive Care
Dr Christian Brunner, Luzern, Intensive Care Medicine
Professor Miodrag Filipovic, St Gallen, SAMS Executive Board member, Intensive Care Medicine
lic. phil. Sibylle Glauser, Bern, Psychology
Dr Antje Heise, Thun, CEC member, Intensive Care Medicine
Professor Samia Hurst, Genève, Ethics
Angelika Lehmann, Basel, Intensive Care Nursing
Professor Paolo Merlani, Lugano, Intensive Care Medicine
Dr Tanja Michel-Dillier, Sachseln, Representation by Relatives/Surrogate Decision-Making
Dr iur. Veronika Moser, FOPH representative, Law (observer)
Dr Jan Novy, Lausanne, Neurology
Dr phil. nat. Susanne Nyfeler, FOPH representative, Presumed Consent Project Management (observer)
Dr iur. Dario Picecchi, Luzern, Law
Professor Hervé Quintard, Genève, Intensive Care Medicine/Neurocritical Care
Dr Marco Rusca, Lausanne, Intensive Care Medicine
Professor Werner Z’Graggen, Bern, Neurology
Factsheet: Considerations concerning the system of presumed consent and the explicit consent system
To support forming an opinion, the SAMS had published a factsheet in view of the vote in May 2022. It offers ethical, medical and legal principles on transplantation medicine and on the presumed or explicit consent system.