Assessing the potential of international organ exchange — the Swiss experience

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Little is known about the impact of international organ exchange on national transplant programmes. This study evaluates the relevance of hearts and lungs offered by the European Organ Exchange Organisations to Swisstransplant, Switzerland's national organ procurement organisation. The study is a retrospective analysis of donor characteristics of 290 hearts and 199 lungs, offered by the European Organ Exchange Organisations between 1 January 2004 and 31 December 2008 to Swisstransplant. It assesses the responses (acceptance/reasons for refusal) from the Swiss heart and lung transplant centres. Among the 290 hearts offered by the foreign transplant organisations, eight (2.8%) were accepted by a Swiss transplant centre. This corresponds to 5.8% of the Swiss heart transplant activity during the observation period. In the lung group (n = 199), five (2.5%) were accepted, equalling 2.8% of the transplant activity. As for the reasons for refusal, approximately one-fifth and one-sixth of both the heart and lung offers were refused for medical and logistic reasons, respectively. For more than half of the offers, there was either no compatible recipient on the Swiss waiting list, or the reason for refusal was not specified. Notably, 47.6% of the offers in the heart group and 46.7% of the lung offers originated from donors aged less than 16 years. International organ exchange is a very valuable and effective way to allocate a maximum of medically suitable organs to recipients on the waiting list. Organ exchange is lifesaving, especially in children, and also in patients with rare blood groups. A professional structure within the national organ procurement organisations, and a close cooperation between them on an international level, is crucial to achieve organ exchange on a high-quality level in Europe.