How does the donor surgery work?
The donor's organs are removed during an operation after death. We call this the donor surgery. You can read more about that here.
The donor surgery takes place in an operating room at the hospital where the donor 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 anesthesiologist, an anesthesia 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 detach 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 died due to brain death, the heart is stopped and the ventilator is turned off. If the donor is donating lungs, the ventilator remains 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 retrieval is always the same: heart, lungs, small intestine, liver, pancreas, and finally the kidneys. This order exists because some organs can survive without oxygenated blood for less time than others. For example, the heart can only last 4 to 6 hours without blood. Kidneys can remain viable for much longer. In total, the entire operation takes three to six hours, depending on how many organs are being donated.
Is anything other than organs removed?
For an organ transplant to be successful, 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 likely it is that the recipient's body will reject the donor organ. If that chance is very high, it is sometimes better to give the organ to someone else. Blood is also drawn from the donor for testing. Blood collection usually happens while still in the intensive care unit. A tube of blood is sent 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 these
- the heart: a part of the 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 along with it, but it makes the removal easier, faster, and safer
- atthe pancreas:the entire spleen, the duodenum, a piece of the small intestine, and blood vessels. Most 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 brain-dead donor, medication is sometimes necessary. Think of painkillers, muscle relaxants, or sedatives. 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 functioning. The medication is still necessary to maintain proper blood pressure or to prevent reflexes. Some reflexes originate in the spinal cord, even when the brain is no longer functioning.
In a donor surgery after cardiac arrest and the cessation of blood circulation, no anesthesia is required. This donor is no longer on a ventilator, and blood is no longer flowing through the body. This means that the spinal cord is also no longer functioning. As a result, there are no reflexes, and medication is not necessary.
What happens if the donor also donates tissues?
Tissues are generally less fragile than organs and can often be removed up to 24 hours after death. If the donor also donates tissues, these are therefore removed after the organs. This is done by a different team that specializes in the removal of tissues. It is different if the donor donates heart valves. For that, the surgeon removes the heart during the donor surgery.
After the surgery
Sometimes there is an investigation into the cause of death of the donor. This is called an autopsy. This preferably happens after the donor surgery. After the surgery, the deceased goes to the place chosen by the next of kin. For example, home or a funeral home. Laying out the body is always possible.