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 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 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.
Explanatory notes on the 2017 revision of the guidelines
The guidelines on the determination of death were revised concurrently with the revision of the Transplantation Act. The draft guidelines underwent public consultation between December 2016 and February 2017. In response to feedback from the consultation, the stand-off period for the formal determination of death after permanent cardiac arrest was reduced from 10 to 5 minutes. As this change provoked criticism, the reasons for the decision are explained here:
- Switzerland is one of the few countries where cardiac arrest has to be diagnosed, not by absence of pulse on palpation, but by echocardiography (heart ultrasound). This examination demonstrates conclusively that blood flow supplying oxygen to the brain has ceased. If the brain is deprived of oxygen for three minutes, irreversible damage occurs.
- In addition, after the stand-off period, brain death has to be formally diagnosed in accordance with the SAMS guidelines. Here, too, the requirement for this procedure marks Switzerland out from most other countries.
- The guidelines specify who is authorised to establish the diagnosis of brain death; the requirements are very stringent.
Further information was provided in the SAMS Newsletter of 10 November 2017, which is available (in German) in the online archive.