How does organ donation work?
Organ donation is carried out with great care for the donor and their loved ones, and according to a fixed step-by-step plan. Read here how organ donation works.
Organ donation in 8 steps
If someone is in the intensive care unit and cannot recover, doctors examine whether this patient can become an organ donor. The doctor follows a step-by-step plan before organs may potentially be donated. Want to know exactly how that works? Watch the video or read the step-by-step plan below.
Step 1: The Donor Register is consulted
When it becomes clear that someone cannot recover and treatment is futile, the doctor discusses this with the loved ones. Only when it has been decided to stop treatment and it is clear that the patient is going to pass away, does the doctor call the Donor Register. This states whether someone does or does not want to donate organs and tissues.
Only a doctor is allowed to request the patient's choice. This is only permitted when it is clear that the patient will pass away within a few hours. The Donor Register is accessible to doctors day and night.
Step 2: Doctor talks to the loved ones
The doctor then tells the partner and family of the patient what choice is recorded in the Donor Register. We call this the donation conversation. If the patient has filled in that they do not want to be an organ donor, they will not become a donor. If the patient is registered in the Donor Register with consent, the doctor lets the loved ones know. If the patient has chosen for the family and partner to decide, they are given time to make this decision. During the conversation, the doctor also has time to answer the questions of the loved ones.
In preparation for organ donation, the treatment team performs a number of tests. For example, they test the blood and urine and keep the body at the right temperature.
Step 3. The organ donation coordinator comes to the hospital
To ensure the donation process goes as smoothly as possible, an organ donation coordinator (ODC) comes to the hospital.
These are the tasks of an organ donation coordinator:
- Having tests performed regarding the suitability of the organs
- Collecting all data of the donor
- Registering the organs suitable for transplantation with Eurotransplant (the organization that allocates organs for transplantation)
- Maintaining contact with the loved ones and answering questions
- Calling in specialists for the donor surgery
Step 4. The organs are examined
A doctor always examines whether the organs are suitable for transplantation. They do this using a CT scan. The organ donation coordinator, a nurse, or a doctor asks the donor's loved ones questions. These questions are about how the patient lived. For example, whether someone smoked, and what illnesses the patient may have had. This is important information to determine whether someone can be a donor.
Step 5. The doctor determines death
The doctor can determine that someone is dead in two ways.
Method 1: Determining brain death
A person is brain dead when all brain functions have stopped and will not recover. To determine this, doctors use a special step-by-step plan called the Brain Death Protocol. This is the same in every hospital in the Netherlands. This protocol is enshrined in law. By following the steps in the Brain Death Protocol, doctors are certain that someone is brain dead. The time at which it is established that someone is brain dead is the official time of death.
Method 2: Determining that the heart and circulation have stopped
Organ donation can also take place after the heart and circulation have stopped. Determining this involves several steps. First, the doctors, together with the family, decide to stop treatment because recovery is no longer possible. This also means that artificial ventilation is turned off. After that, the heart stops and the patient dies. As soon as the heart stops, doctors always wait five minutes. Only then can they officially determine that the patient has died.
Step 6: Preparing for the surgery
Method 1: After brain death
The loved ones are given time to say goodbye to their dear one. Meanwhile, the medical team begins preparing for the donor surgery. They ensure that the organs remain in good condition, for example, by keeping the body at the right temperature and artificially taking over the circulation. This keeps the organs suitable for extraction and transplantation.
Method 2: After the heart and circulation have stopped
When the heart has stopped, doctors wait five minutes. After that, they officially determine that the donor has died. Because blood and oxygen no longer reach the organs, they quickly become damaged. Therefore, the donor goes straight to the operating room. At that moment, loved ones have only a short time to say goodbye. After the surgery, they can take all the time they need to say goodbye in peace. The organ donation coordinator (ODC) arranges for a retrieval team of specialists to come to the hospital for the donor surgery.
Step 7. The donor surgery
The team of specialists begins by removing the organs in the hospital where the donor is located. The surgery to remove the organs usually takes about six hours. If someone also donates tissues, the surgery may take longer.
Read more about donor surgery here
Step 8. After the organ removal
After the surgery, the body of the deceased is returned to the surviving relatives. They can then say their final goodbyes. The doctors always ensure that the donor's body looks neat and cared for.
The organ donation coordinator contacts the relatives after six to eight weeks to tell them which organs were successfully transplanted. This only happens if the surviving relatives wish it. Relatives are told the age category and gender of the recipient. This is always done anonymously. The donor's relatives do not know who receives the organs. The organ recipients also do not know from whom they received the organ. This is stipulated by lawin the Netherlands.
Frequently asked questions
Am I really dead if I am a donor?
Yes. Organs and tissues are only removed when doctors are 100 percent sure that someone has died. The determination of death is done according to strict rules and by multiple doctors.
Do the donor's relatives receive support during the donation process?
Yes. The organ donation coordinator is in contact with the donor's relatives throughout the entire process. This coordinator answers all questions and explains what is happening.
Can my family and loved ones say goodbye if I am a donor?
Yes, there is always time to say goodbye.Before and after the donor surgery, family and loved ones can be with the donor. After the donation procedure, the family decides themselves what happens next. For example, where the body is laid in repose and when the funeral takes place.
Do doctors still do their best for me if I am a donor?
Yes!A doctor always does everything possible to save a patient's life.They never let someone die to keep someone else alive. Only when someone truly can no longer recover and death is expected does the doctor discuss organ donation with the relatives. In the Netherlands, the doctor who determines death is not involved at all in any potential transplant.
Why is organ donation only possible if someone dies in the hospital?
Organ donation is only possible if someone passes away in the hospital's intensive care unit while on a ventilator. This is because the organs need oxygenated blood to remain suitable for transplantation. In the hospital, someone who has passed away can be kept on a mechanical ventilator. This ensures that enough oxygen-rich blood continues to flow to the organs.
In donation after the heart and circulation have stopped (DCD donation), organ donation is only possible if the donor is taken to the operating room immediately after death. If someone dies outside the hospital, this is not possible and the organs are no longer suitable for transplantation.