Donation when the heart has stopped
One of the forms of organ donation is donation after circulatory death. The blood circulation and breathing have then 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.
What is the procedure for a DCD donation?
The DCD procedure involves the following steps:
Stopping treatment
When someone is in the intensive care unit, the doctors do everything they can to make that person better again. But sometimes that does not succeed and it becomes clear that someone can never recover. According to the law, the doctors must then stop the treatment. This means that the breathing apparatus is also switched 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 stopping of the heart is more than two hours, organ donation is no longer possible.
Five minutes waiting time
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 blood circulation stop, blood no longer flows through the body. As a result, the organs no longer receive oxygen and quickly become less suitable for transplantation. Therefore, it is important that the donor goes to the operating room immediately after death.
For the loved ones, this means that saying goodbye 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. In the DCD procedure, donation is possible of the heart, kidneys, liver, lungs, and pancreas.
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, supplying them with oxygen and nutrients. This maintains good quality and allows the organs to be preserved for longer.
The perfusion machine has been used for years for organs such as the extracted liver and kidneys. Since 2021, Dutch hospitals have also been using the machine after the heart has been extracted. As a result, the heart receives oxygen and blood, causing it to beat again inside the machine. Thanks to this method, more donor hearts are available for people who need them.
Transplantation
After extraction, the organs are transported 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, where loved ones can take their time saying goodbye.
Frequently asked questions
When do doctors decide to stop a patient's treatment?
When someone is on life support in the intensive care unit, it may become clear that they will not recover. Continuing treatment is then no longer meaningful. By law, doctors must stop the 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 when it is 100% certain that a person will not recover. Doctors would also stop treatment if the patient were not an organ donor.
How does saying goodbye to the patient work in DCD?
When the doctor turns off the ventilator, family or loved ones are almost always present. Afterward, they can stay with their loved one until the moment of death. The doctor can monitor the patient via a screen from another room, allowing loved ones to be with their loved one in complete peace.
After the heart and blood circulation stop, the doctor must wait five minutes. Loved ones can also remain with the donor during this time. Afterward, the doctor can ascertain death with certainty.
Once death has been pronounced, the deceased donor must be quickly taken to the operating room, otherwise the organs will not remain viable for transplantation. Consequently, loved ones have only a short time to say goodbye at that moment. After the operation, the deceased donor is returned to the intensive care unit, where loved ones are given all the time they need to be with their loved one again.