The Federal Council starts the voting campaign for May 15th. The main argument that opting out of organ donation increases the donor rate is on shaky foundations.
In the future, organ donation will be the rule that must be contradicted and no longer the exception.
After two years of extensive Corona press conferences, Alain Berset made a lightning appearance in front of the media on Tuesday. The Health Minister heralded the Federal Council’s voting campaign to amend the Transplantation Act, which will be voted on on May 15th. The bill is as ethically significant as it is sensitive and did not receive the weight it deserved in the deliberations in Parliament.
If the Federal Council and Parliament have their way, everyone in Switzerland should in future be considered an organ donor unless they expressly refuse to do so during their lifetime and have their objection to organ removal entered in a national register. The consent solution that currently applies is to become the extended objection solution. This means that family members can veto organ removal in cases where the family member’s wishes are not known. If no relatives are present, no organs will be removed. Switzerland would not be alone with the objection solution, several countries in and outside of Europe are already familiar with this regulation.
Family members are the focus
A heterogeneous, non-partisan committee has called the referendum against the change in the law. In his view, it is ethically and legally unacceptable to remove organs from a person unless their consent has been given unequivocally. Opponents see the danger of uninformed people being duped and becoming organ donors against their will.
Berset assured that it would not come to that and that no one’s organs would be removed against their will. With a wide-ranging information campaign, the Federal Council wants to ensure that the population is aware of the objection solution. According to Berset, the change to the extended contradiction solution is not a revolution, and the change is not as important as one might think. At the same time, it will make a big difference to today.
Berset emphasized that the relatives will continue to play a crucial role in the future and could prevent the operation. In contrast to today, however, when talking to the relatives, it is assumed that the deceased person consented to the organ removal, otherwise they would have made their objection known. In other words: in the future, organ donation will be the norm that must be contradicted, and no longer the exception. It remains to be seen, however, whether this change in the initial situation will induce the relatives to raise fewer objections to organ removal than before.
No immediate effect
This leads to the question of whether the change to the opt-out solution will actually increase the number of donor organs. This is by no means as clear as one might think. A 2018 study commissioned by the Federal Office of Public Health at the University of Zurich came to the conclusion that there is no clear evidence of a direct causal effect on the donor rate. However, there are indications that the contradiction model can have a positive influence on the donor rate.
These findings, which are confirmed by further comparative studies between countries with consent and those with objection, have not changed to this day. There is no direct effect of the objection solution on the number of donor organs. An employee of the Federal Office of Public Health also admitted this at the media conference: The contradiction solution was “one factor among several that can have a positive effect”. It is therefore uncertain what the paradigm shift in transplantation medicine will actually bring. At the same time, it is clear that the central argument for introducing the opt-out solution is on shaky ground.