Donation after the heart has stopped
One form of organ donation is donation after circulatory death. The circulation and breathing have stopped. Doctors call this 'death after circulatory arrest'. Organ donation is then called Donation after Circulatory Death (DCD). More than half of all organ donations in the Netherlands are DCD donations.
How does the DCD procedure work?
The DCD procedure consists of the following steps:
Stopping treatment
When someone is in the intensive care unit, doctors do everything they can to make that person better. But sometimes that does not work and it becomes clear that the person will never recover. According to the law, the doctors must then stop the treatment. This means that the ventilator is also turned off. Together with the family, the doctors determine the time at which this happens.
Death of the patient
After the ventilator is turned off, the patient's heart stops. The patient then dies. Sometimes this takes a while. Does the patient die within two hours? Then organ donation is usually possible. If the time between turning off the ventilator and the heart stopping is more than two hours, organ donation is no longer possible.
Five-minute waiting period
After the heart has stopped, doctors must always wait five minutes. This is necessary to be sure that the heart will not start beating again. Doctors call this the 'no touch' period. Only after those five minutes can the doctor determine with certainty that the patient has died.
To the operating room
When the heart and circulation have stopped, no more blood flows through the body. As a result, the organs no longer receive oxygen and quickly become less suitable for transplantation. That is why it is important that the donor goes to the operating room immediately after death.
For the loved ones, this means that the farewell at that moment is very brief. That can be difficult. After the donor surgery, they can still say goodbye in peace.
Donor surgery
In the operating room, a team of doctors is ready to start the donor surgery. Which organs they remove depends on the choice of the donor (and/or family) and the suitability of the organs. With the DCD procedure, donation of the heart, kidneys, liver, lungs, and pancreas is possible.
How does the donor surgery work?
Perfusion: keeping the organs in good condition
After or during the removal, the organs are connected to a perfusion machine. This is necessary to keep them suitable for transplantation. The machine pumps fluid through the organs, providing them with oxygen and nutrients. This keeps the quality good and allows the organs to be preserved for longer.
The perfusion machine has been used for years for organs such as the removed liver and kidneys. Since 2021, Dutch hospitals have also been using the machine after the heart has been removed. As a result, the heart receives oxygen and blood, causing it to start beating again in the machine. Thanks to this method, more donor hearts are available for people who need them.
Transplantation
After removal, the organs are taken to the transplant center. There, they are placed into the recipient's body. The body of the deceased donor is returned to the intensive care unit. There, loved ones can say goodbye in peace.
Frequently asked questions
When do doctors decide to stop a patient's treatment?
When someone is on a ventilator in the intensive care unit, it may become clear that they can no longer recover. It is then no longer meaningful to continue treatment. According to the law, doctors must stop treatment in such cases. They always discuss this with the family and loved ones. Together, they determine the time at which treatment will be stopped and the ventilator turned off.
The decision to stop treatment is completely separate from organ donation. Doctors only stop treatment if it is 100% certain that someone will not recover. The doctors would stop treatment even if the patient were not an organ donor.
How does saying goodbye to the patient work with DCD?
When the doctor turns off the ventilator, it almost always happens with the family or loved ones present. Afterward, they can stay with their loved one until the moment of death. The doctor can monitor the patient via a monitor in another room. This allows loved ones to be with their loved one in peace.
After the heart and circulation have stopped, the doctor must wait five minutes. During this time, loved ones can also remain with the donor. After that, the doctor can confirm death with certainty.
Once death has been confirmed, the deceased donor must be taken to the operating room quickly. Otherwise, the organs will not remain in good condition for transplantation. Therefore, loved ones have only a short time to say goodbye at that moment. After the surgery, the deceased donor is returned to the intensive care unit. There, loved ones are given all the time they need to be with their loved one again.