Don Et Transplantation D'organes En Suisse

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Don Et Transplantation D'organes En Suisse Don et transplantation d’organes en Suisse Enjeux historiques et sociologiques (1945-2020) Sous la direction de Raphaël Hammer Vincent Barras Manuel Pascual Don et transplantation d’organes en Suisse Enjeux historiques et sociologiques (1945-2020) Sous la direction de Raphaël Hammer Vincent Barras Manuel Pascual Georg Editeur CMS / Collection Médecine Société CMS est née en 1999, placée sous la responsabilité d'un Comité de rédaction constitué de personnalités scientifiques d'orientations mul- tiples. Les volumes publiés proposent une réflexion pluridisciplinaire, se rapportant à l'ensemble des questions de santé et de médecine envisagées dans leur sens le plus large. L'accent est mis autant sur les implications pratiques que sur les enjeux théoriques, et sur le croisement pluriel des perspectives, qu'elles soient sociologiques, médicales, juridiques, éthiques ou historiques. CMS se veut le témoin engagé des débats contemporains sur la maladie, la santé et leurs implications sociales, politiques, économiques ou cultu- relles, et s'adresse à un public comprenant tout à la fois l'ensemble des professionnel·le·s de la santé et de la médecine et tou·te·s celles et ceux qui se sentent concerné·e·s par ces enjeux. Comité de rédaction Anne-Françoise Allaz, Gaspard Aebischer, Vincent Barras, Patrice Guex, Claude-François Robert, Raphaël Hammer, Bertrand Kiefer Directeur de collection Vincent Barras Remerciements Les résultats présentés dans cet ouvrage sont issus d’une recherche financée par le Fonds national suisse de la recherche scientifique, codirigée par Raphaël Hammer (Haute École de Santé Vaud, Haute École spécialisée de Suisse occidentale – HES-SO), Vincent Barras (Institut des humanités en médecine, CHUV et Faculté de biologie et de médecine, Université de Lausanne) et Manuel Pascual (Centre de transplantation d’organes, CHUV et Faculté de biologie et de médecine, Université de Lausanne), avec la collaboration scientifique d’Alexia Cochand et François Kaech. Pour leur soutien et leur concours à différentes étapes de la réa- lisation du projet, nous tenons à remercier vivement les institutions suivantes : le Fonds national suisse de la recherche scientifique, la Haute École de Santé Vaud, la Haute École spécialisée de Suisse occidentale, l’Institut des humanités en médecine, le CHUV et l’Université de Lausanne, Swisstransplant, l’Office fédéral de la santé publique, la Société suisse de néphrologie, les Archives de l’État de Berne, de Bâle et de Saint-Gall, les archives centrales des HUG, les Archives cantonales vaudoises, ainsi que le service de prêt de la Bibliothèque nationale. Enfin, nous sommes très reconnais- sants envers toutes les personnes et les collègues qui ont accepté de donner de leur temps lors des entretiens réalisés dans le cadre de cette recherche. Cet ouvrage est publié avec le soutien du Fonds national suisse de la recherche scientifique (FNS) et de la Haute école spécialisée de Suisse occidentale (HES-SO) Couverture et mise en page : Jennifer Freuler Georg Editeur Genève www.georg.ch Pour leurs textes © 2021 R. Hammer, V. Barras, M. Pascual ISBN (papier) : 9782825712276 ISBN (PDF) : 9782825712283 ISBN (XML) : 9782825712290 DOI : 10.32551/GEORG.12276 Cet ouvrage est publié sous la licence Creative Commons CC BY-NC-ND (Attribution – Pas d’Utilisation Commerciale – Pas de Modification) Sommaire Remerciements 5 Liste des auteurs 13 Introduction. Le don et la transplantation d’organes dans le regard des sciences sociales et historiques 15 Raphaël Hammer et Vincent Barras 1. De l’imaginaire à la réalité contemporaine des greffes 17 2. Enjeux symboliques et résistance culturelle 22 3. « Don » et discours publics 25 4. Aspects sociopolitiques et spécificités nationales 29 5. Le don et la transplantation d’organes en tant que « problèmes publics » 32 6. Structure de l’ouvrage 38 Partie I. L’émergence institutionnelle et publique du don et de la transplantation d’organes 41 Chapitre 1 – L’émergence et le développement de la transplantation d’organes en Suisse 43 Alexia Cochand 1.1. Les prémices de la transplantation rénale 45 1.2. Les premiers développements cliniques 50 1.3. L’émergence des transplantations hépatiques et cardiaques 53 1.4. Avancées cliniques 57 1.5. Conclusion 65 8 Don et transplantation d’organes en Suisse Chapitre 2 – La création et le fonctionnement de Swisstransplant 67 Alexia Cochand 2.1. Mise en place des structures et définition des activités (1985-1991) 68 2.2. Mise en place de la Coordination nationale 84 2.3. Professionnalisation et anticipation des changements politiques 95 2.4. Conclusion 99 Chapitre 3 – L’organisation médicale et logistique de la transplantation : le rôle de Swisstransplant 101 Alexia Cochand 3.1. La répartition des organes avant la mise en place de la Coordination nationale 102 3.2. Garantir la compétence des centres de transplantation 117 3.3. Conclusion 130 Chapitre 4 – Les questionnements éthiques sur la transplantation dans les revues médicales (1950-1980) 133 Alexia Cochand 4.1. Les revues médicales en Suisse 135 4.2. La transplantation dans les revues : panorama chronologique 138 4.3. Les questionnements éthiques 145 4.4. Conclusion 163 Chapitre 5 – Le don et la transplantation d’organes dans la presse quotidienne : du problème biologique au problème social 167 Raphaël Hammer 5.1. La médiatisation de la transplantation entre 1945 et 1998 170 5.2. Les enjeux éthiques 180 5.3. La montée en puissance du problème de la pénurie d’organes ou la publicisation du don 196 5.4. Conclusion 202 Sommaire 9 Conclusion de la partie I Régulation de la transplantation et émergence d’un problème public 205 Vincent Barras et Alexia Cochand Partie II. Le don d’organes comme enjeu de mobilisation associative 211 Chapitre 6 – L’espace associatif du don d’organes 213 Raphaël Hammer et François Kaech 6.1. Délimitation de l’espace associatif du don d’organes 214 6.2. Quelques repères historiques 216 6.3. La situation contemporaine 219 6.4. Données, méthodes d’enquête et objectifs 231 Chapitre 7 – Une cause négligée par les pouvoirs publics 237 Raphaël Hammer 7.1. Une cause peu reconnue 237 7.2. Quel modèle d’organisation pour l’échange d’organes ? 249 7.3. Organisation hospitalière et procédures médicales 261 7.4. Conclusion 267 Chapitre 8 – Les enjeux de l’information et la perception du public 269 Raphaël Hammer 8.1. Une population a priori acquise au don d’organes 270 8.2. Les causes de l’indifférence et des réticences du public 271 8.3. Sensibiliser le public 280 8.4. Conclusion 296 10 Don et transplantation d’organes en Suisse Chapitre 9 – La mobilisation des associations : soutenir les malades et le don d’organes 299 Raphaël Hammer et François Kaech 9.1. Stratégies et activités 300 9.2. Rôle et pouvoir des associations 324 Conclusion de la partie II Un espace associatif en recomposition 339 Raphaël Hammer Partie III. Enjeux actuels et perspectives 345 Vincent Barras, Manuel Pascual et Raphaël Hammer Chapitre 10 – Développements du point de vue de l’Office fédéral de la santé publique (OFSP) 349 Andrea Arz de Falco 10.1. Aperçu 349 10.2. Étude relative au potentiel de la Suisse (SwissPOD) 350 10.3. Un rapport répondant à trois postulats 351 10.4. Le plan d’action 352 10.5. Organisation du projet 353 10.6. Réalisation 354 10.7. Prolongation du plan d’action 356 10.8. Perspectives 357 Chapitre 11 – Développements du point de vue de la fondation Swisstransplant 359 Franz Immer Chapitre 12 – Évolution médicale et organisation actuelle 367 Manuel Pascual et Philippe Eckert 12.1. Travaux du Groupe des 15 en Suisse et évolution Vaud-Genève 368 Sommaire 11 12.2. Loi fédérale sur la transplantation et développements en Suisse romande et au Tessin 369 12.3. Étude de cohorte suisse de transplantation (STCS) 373 12.4. Médecine hautement spécialisée en Suisse depuis 2009 374 Références 377 Sources 377 Bibliographie 380 Liste des abréviations 393 Liste des auteurs Andrea Arz de Falco – éthicienne, responsable de l’unité de direc- tion Santé publique et vice-directrice de l’Office fédéral de la santé publique à Berne. Vincent Barras – médecin et historien, directeur de l’Institut des huma- nités en médecine (CHUV et Faculté de biologie et de médecine), professeur ordinaire à l’Université de Lausanne. Alexia Cochand – historienne, doctorante et chargée de recherche à l’Institut des humanités en médecine (CHUV et Faculté de biologie et de médecine, Université de Lausanne). Philippe Eckert – directeur général et médical du CHUV à Lausanne, ancien médecin-chef de service du Service de médecine intensive adulte, ancien président du Programme latin de don d’organes (PLDO), professeur associé à l’Université de Lausanne. Raphaël Hammer – sociologue de la santé et de la médecine, professeur à la Haute École de Santé Vaud (Lausanne), HES-SO Haute École spécialisée de Suisse occidentale. Franz Immer – directeur de la fondation Swisstransplant à Berne, méde- cin spécialisé FMH en chirurgie vasculaire cardiaque et thoracique, privat-docent de l’Université de Berne. François Kaech – sociologue et doctorant à la Faculté des sciences sociales et politiques de l’Université de Lausanne. Manuel Pascual – médecin-chef de service du Centre de transplanta- tion d’organes du CHUV, directeur médical du Centre universitaire romand de transplantation (CURT), professeur ordinaire et vice- doyen à la Faculté de biologie et de médecine de l’Université de Lausanne. Introduction. Le don et la transplantation d’organes dans le regard des sciences sociales et historiques Raphaël Hammer et Vincent Barras Aujourd’hui, le don et la transplantation d’organes se donnent essentiellement à voir comme des enjeux relevant de la médecine et de la santé publique. Les médias font régulièrement état de nouvelles découvertes scientifiques et techniques qui laissent augurer des avancées majeures dans le développement des greffes, de nature à répondre aux besoins des nombreux malades en attente d’un organe leur permettant d’échapper à la mort ou d’espérer un gain notable de qualité de vie.
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