How does the donor surgery work?
The donor's organs are removed during surgery after death. We call this the donor surgery. You can read more about it here.
The donor surgery takes place in an operating room in the hospital where the donor has passed away. A team of specialists comes to the hospital to perform this with great care. Such a team of specialists is called an Independent Retrieval Team (ZUT). The team consists of a surgeon, an assistant surgeon, an anaesthetist, an anaesthesia assistant, and two operating room assistants. The organ donation coordinator (ODC) is also involved in the donor surgery.
How does the donor surgery work?
Once the surgeons have opened the donor's abdomen, they first release the organs. This takes 1 to 1.5 hours. Then the team prepares the organs for retrieval by cooling and flushing them with a fluid. This is called perfusion. If the patient has died from brain death, the heart is stopped and the ventilator is turned off. If the donor is donating lungs, the ventilator stays on longer. This keeps the lungs healthy enough for a transplant.
After the heart has stopped, the surgeons remove the organs one by one. They only remove the organs for which consent has been given. The order of removal is always the same: heart, lungs, small intestine, liver, pancreas, and finally kidneys. This order is used because some organs can survive without oxygen-rich blood for a shorter time than others. For example, the heart can only survive for 4 to 6 hours without blood. Kidneys can remain viable for much longer. In total, the entire surgery takes three to six hours, depending on how many organs are donated.
Is anything other than organs removed?
For an organ transplantation to succeed, it is necessary to remove more than just the organs. For example, pieces of fatty tissue and blood vessels attached to the organs are also removed. These blood vessels are needed to connect the organs to the recipient's blood vessels.
Furthermore, pieces of the spleen are always removed, but not transplanted. These pieces are sent along with each organ and used to test for antibodies against the donor's organ. This test shows how high the probability is that the recipient's body will reject the donor organ. If that probability is very high, it is sometimes better to give the organ to someone else. Blood is also drawn from the donor for testing. Blood drawing usually already happens in the intensive care unit. A tube of blood goes with each organ.
What else is removed per organ?
- atthe kidneys:the ureter, sometimes also extra blood vessels and a piece of the adrenal glands because these are attached to the kidneys
- atthe liver:the gallbladder and bile ducts, blood vessels, and a part of the diaphragm, because the liver is located very close to this
- the heart: a part of the main body artery (aorta), a part of the aortic arch, and blood vessels
- the lungs: a part of the bronchial tube
- the small intestine:a part of the large intestine. This is not always transplanted as well, but this makes the removal easier, faster and safer
- atthe pancreas: the entire spleen, the duodenum, a piece of small intestine and blood vessels. The major part of the duodenum is transplanted along with it to connect the pancreas to the recipient's small intestine
Medication during the donor surgery
During the surgery of a donor who is brain-dead, medication is sometimes necessary. Think of painkillers, muscle relaxants or sleeping pills. This may sound strange because the donor has passed away. A donor is dead and cannot feel anything at all, not even pain. This is because the brain is no longer working. The medication is still needed to maintain good blood pressure or to prevent reflexes. Some reflexes originate in the spinal cord, even when the brain is no longer working.
During a donor surgery after a cardiac arrest and cessation of blood circulation, no anesthesia is necessary. This donor is no longer on a ventilator and no blood is flowing through the body anymore. This means that the spinal cord is no longer working either. As a result, there are no reflexes and medication is not needed.
What happens if the donor also donates tissues?
Tissues are generally less vulnerable than organs and can often be removed up to 24 hours after death. Therefore, if the donor also donates tissues, these are removed after the organs. This is done by a different team specialized in tissue removal. It is different if the donor donates heart valves. For this, the surgeon does remove the heart during the donor surgery.
After the surgery
Sometimes an investigation into the cause of death of the donor is conducted. This is called an autopsy. This is preferably done after the donor surgery. After the surgery, the deceased goes to the location chosen by the relatives. For example, home or to a funeral home. Laying in state is always possible.