Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 150 No. 5153 (2020)

In the eye of the hurricane: the Swiss COVID-19 pandemic stepwise shutdown approach in organ donation and transplantation

Cite this as:
Swiss Med Wkly. 2020;150:w20447



Coronavirus disease 2019 (COVID-19) pandemic has an ongoing severe impact on health care, but there is a lack of information on COVID-19 and its effect on organ donation and solid organ transplantation. Early in the pandemic, Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, set up a national stepwise shutdown approach to avoid a collapse of transplant activities during phases of the pandemic with sufficient available healthcare capacities. The approach allowed regional adaptation of transplant-associated activities depending on available healthcare capacities, instead of implementing a rigid centralistic system. The aim of this study was to describe the stepwise shutdown approach and to determine whether this flexible approach would be helpful for avoiding complete cessation of transplant activities during a pandemic.


A retrospective nationwide study was conducted to evaluate donor procurement and solid organ transplantation activity in Switzerland during the COVID-19 pandemic (1 January to 31 May 2020). To assess the impact of the flexible stepwise shutdown plan on overall transplantation activity in Switzerland, we compared total and individual numbers of transplanted organs during the first wave of the pandemic with the transplant activity immediately before the pandemic.


The pandemic evolved heterogeneously across Swiss cantons, severely affecting western cantons and the Ticino. Overall, there was a reduction in deceased donor transplants in Switzerland of 16.7% in March and April 2020 (during the pandemic) compared with January and February 2020 (prior to the pandemic), the decline mostly driven by kidney transplants (−27.6%) and to a lesser extent by transplants of vital organs (heart, lungs, liver) (−5.9%). In May 2020, solid organ transplantation activity in Switzerland again exceeded the average of pre-pandemic months (January and February), with 35 transplanted organs, but the increase from April to May 2020 was exclusively driven by liver and kidney transplants.


The Swiss stepwise shutdown approach in organ donation and transplantation helped to maintain a limited national organ procurement and vital organ transplant activity, avoiding a complete nationwide shutdown of organ donation and transplant activity. We therefore propose a flexible shutdown approach that regulates transplant activities dependent on regional healthcare resources rather than uniform centralistic regulations. This approach proved to be especially useful during a regional heterogeneously evolving pandemic.


  1. Aslam S, Mehra MR. COVID-19: Yet another coronavirus challenge in transplantation. J Heart Lung Transplant. 2020;39(5):408–9. doi:.
  2. Hage R, Steinack C, Benden C, Schuurmans MM. COVID-19 in patients with solid organ transplantation: a systematic review. Transplantology. 2020;1(1):1–15. doi:.
  3. Woolley AE, Mehra MR. Dilemma of organ donation in transplantation and the COVID-19 pandemic. J Heart Lung Transplant. 2020;39(5):410–1. doi:.
  4. Loupy A, Aubert O, Reese PP, Bastien O, Bayer F, Jacquelinet C. Organ procurement and transplantation during the COVID-19 pandemic. Lancet. 2020;395(10237):e95–6. doi:.
  5. Distante C, Piscitelli P, Miani A. COVID-2019 outbreak progression in Italian regions: approaching the peak by the end of March in Northern Italy and first week of April in Southern Italy. Int J Environ Res Public Health. 2020;17(9):3025. doi:.
  6. COVID-19 in Switzerland, 2020 February 24 [Online]. [Accessed 2020 July 10.] Available from:
  7. COVID-19 information for Switzerland, 2020 May 29. [Online]. [Accessed 2020 May 29]. Available from:
  8. Moeckli B, Peloso A, Oldani G, Orci LA, Banz V, Dutkowski P, et al. The Swiss approach to the COVID-19 outbreak. Am J Transplant. 2020;20(7):1935–6. doi:.
  9. Weiss J, Elmer A, Béchir M, Brunner C, Eckert P, Endermann S, et al.; Comité National du Don d’Organes (CNDO). Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges. BMC Health Serv Res. 2018;18(1):876. doi:.

Most read articles by the same author(s)

1 2 > >>