Tissue donation procedure
On this page you will find step-by-step instructions and all the information you need for the tissue donation procedure in the hospital.
Tissue donation procedure within the hospital
Are you dealing with the (expected) death of a patient within the hospital? Follow the steps on this page.
Tissue donation outside the hospital?
There is a separate page for the extramural procedure for this.
1. Potential donor? Consult the Donor Register
Are you dealing with the (expected) death of a patient within the hospital? Follow the steps below.
Check contra-indications
Tissue donation is possible in many cases. The most important contra-indications are:
- A haematological disorder (including in the past) such as leukaemia, (non-)Hodgkin's, Kahler's, myelodysplastic syndrome, and polycythaemia vera
- A degenerative neurological disorder of unknown origin such as all forms of dementia, Parkinson's, MS, and ALS
- BMI > 40
Consult the Donor Register
The most important contra-indications are listed above. In all other cases or if in doubt, call the Organ Centre to consult the Donor Register. This is possible 24 hours a day.
A BIG registration is required for the consultation. The hospital can also grant this authority to employees without a BIG registration. However, responsibility always lies with a professional with a BIG registration.
Call the Organ Centre (24/7)
Information you need to consult the Donor Register
- Attending physician: BIG registration number and telephone number.
- Patient: citizen service number (BSN), gender, initial(s), last name, and date of birth.
Tissue donation not possible?
- Are there contraindications or is there a 'No' in the Donor Register? If so, inform the next of kin.
- The procedure is then complete. However, always complete the donation form and the death forms afterwards.
Detailed information
Learn more about donor recognition and consulting the Donor Register.
2. Tissue donation conversation
Is tissue donation possible? If so, conduct a donation conversation in which you inform the next of kin of a potential tissue donor about the registration in the Donor Register and explain the procedure.
The information below concerns the most common situation: a potential donor aged 16 or older who has decision-making capacity. In the Model Protocol, you will find instructions on how to handle lack of decision-making capacity at the time of registration.
Explanation per registration
The registration of the potential donor in the Donor Register is leading for the conversation. Review how to conduct the conversation per registration.
Yes, I want to become a donor
How do you discuss the 'yes' registration?
A 'yes' registration is an active choice. The potential donor chose donation themselves. How do you discuss the registration?
- Inform the next of kin about the registration.
- Ask the loved ones whether they have ever discussed donation with the potential donor.
- Provide an explanation of the procedure.
- Watch the animation below and use the example sentence to explain the registration.
Who do you have the donation conversation with?
In practice, the conversation is usually held with the immediate family. Think of the partner, children, or brother/sister. Are they unreachable? Then try to postpone the donation until someone has been reached.
According to the law, it is also permitted to inform loved ones. These are all people who play a (major) role in the patient's life. Therefore, these are often family members, but they can also be other people who know the patient well and are actively involved in their life.
What can you do to reach loved ones?
- Use the regular channels: search the patient's personal belongings to find contact details.
- Does this not work? Then ask the police to reach the loved ones via their channels.
- In the meantime, you are already allowed to perform preparatory actions for the donation.
Are loved ones unreachable or can the donation no longer be postponed? Then no donation will take place.
Are the surviving relatives convinced that the registration is incorrect?
In the event of a 'yes' in the Donor Register, there is consent for donation. This registration is leading. The intention is to let the donation proceed. It can happen that surviving relatives are convinced that the registration does not match the patient's wish. Then they can substantiate this:
- Substantiating is not about proof, but about setting out and explaining.
- Your professional judgment as a physician counts. You decide whether or not to let the donation proceed based on this conversation.
Please note:Only surviving relatives up to the 2nd degree can refute the registration in the Donor Register. Others are legally not allowed to do this.
- Who are surviving relatives up to the 2nd degree?(Model protocol 4.7)
- Objection from next of kin to the nature of the registration (Model protocol 4.10)
Do surviving relatives have personal difficulty with donation?
The surviving relatives may indicate that they have personal difficulty with the donation. Try to understand and probe further to find out where the objections come from: are there certain assumptions about the procedure, or is there an issue related to religion, philosophy of life, or culture?
- Read how to deal with these objections (Model protocol 4.11)
No objection to donation
How do you discuss the 'no objection' registration?
Everyone aged 18 and over is listed in the Donor Register. If you do not actively fill in a choice yourself, you are registered with consent based on a 'no objection' registration in the Donor Register. You were informed of this by 3 letters from the government.
- Inform the next of kin about the registration.
- Ask the relatives if they have ever discussed donation with the patient.
- Provide an explanation of the procedure.
- Watch the animation below and use the example sentence to explain the registration.
With whom do you conduct the conversation?
In practice, the conversation regarding a 'no objection' registration is usually conducted with the immediate family. Think of the partner, children, or brother/sister. Are they unreachable? Then try to postpone the donation until someone has been reached.
According to the law, it is also permitted to inform loved ones. These are all people who play a (major) role in the patient's life. Therefore, these are often family members, but they can also be other people who know the patient well and are actively involved in their life.
What can you do to reach loved ones?
- Use the regular channels: search the patient's personal belongings to find contact details.
- Does this not work? Then ask the police to reach the loved ones via their channels.
- In the meantime, you are already allowed to perform preparatory actions for the donation.
Are relatives unreachable or can the donation no longer be postponed? Then no donation will take place.
Are surviving relatives convinced that the registration is incorrect?
With a 'no objection' registration in the Donor Register, there is consent for donation. This registration is leading. The intention is to proceed with the donation.
It may happen that surviving relatives are convinced that the registration does not correspond to the patient's wishes. In that case, they can substantiate this:
- Substantiating is not about proof, but about setting out and explaining.
- Your professional judgment as a physician counts. You decide whether or not to let the donation proceed based on this conversation.
Please note: Only next of kin up to the 2nd degree can refute the registration in the Donor Register. By law, others are not allowed to do this.
- Who are surviving relatives up to the 2nd degree?(Model protocol 4.7)
- Objection by next of kin to the nature of the registration (Model protocol 4.10)
Do surviving relatives have personal difficulty with donation?
The surviving relatives may also indicate that they have personal difficulty with the donation. Try to understand and probe further to find out where the objections come from: are there certain assumptions about the procedure, or is there an issue related to religion, philosophy of life, or culture?
- Read how to deal with these objections (Model protocol 4.11)
My partner or family decides for me
How do you discuss the wish for your partner or family to decide?
With the registration 'My partner or family decides for me', the patient leaves the decision up to their partner or family.
How do you discuss the registration?
- Inform the partner or family about the registration.
- Ask whether this registration was known to the partner or family.
- Provide information about the procedure.
- Give time to process all the information, read it through, and think about the decision.
- Watch the animation below and use the example sentence to explain the registration.
With whom do you conduct the conversation?
The donation conversation is conducted with surviving relatives up to the 2nd degree. There are 3 categories:
- Spouse, registered partner, or other life companion of the patient.
- Adult blood relatives up to the 2nd degree: (adopted) children, (adopt) parents, brothers, sisters, grandparents, and grandchildren.
- Adult relatives by marriage up to the 2nd degree: children of the spouse (or registered partner), parents-in-law (and grandparents-in-law), brothers-in-law, sisters-in-law, sons-in-law, daughters-in-law, and step-grandchildren.
The order determines the decision-making authority:
- First contact a person from category 1. This person makes the choice. You do not need to ask permission from a person in a subsequent category.
- Is there no surviving relative from category 1, or can they not be reached? Then you approach a person from category 2, and so on.
- You make reasonable efforts to reach surviving relatives from a category, but you do not have to reach everyone.
Read more in the Model Protocol (4.7): Who are surviving relatives up to the 2nd degree?
Surviving relatives not reachable?
You do everything you can to reach surviving relatives. If no surviving relatives can be found, the donation will not proceed. You may not ask permission from loved ones, because loved onesdo nothave decision-making authority.
Can consent still be withdrawn?
The partner or family members can withdraw consent until the moment the deceased is taken to the operating room/morgue for tissue donation.
I designate one person to decide
How do you handle it when the patient leaves the decision to a single person?
With the registration 'I designate one person to decide', the patient leaves the decision to the designated person.
The person named in this registration is leading. Legally, it does not matter how long ago this specific person was in contact with the patient.
- Inform this person about the registration.
- Ask whether this registration was known to the designated person.
- Provide information about the procedure.
- Give time to process all the information, read it through, and think about the decision.
- Watch the animation below and use the example sentence to explain the registration.
With whom do you conduct the conversation?
The designated person is present during the conversation. You provide the information necessary to make an informed decision.
Is the designated person unreachable?
You make every effort to reach this person. Were you unsuccessful? Then you can present the donation request to the surviving relatives.Who are surviving relatives up to the 2nd degree?
If there are no surviving relatives, the donation will not proceed. You may not ask relatives for consent. After all, they arenotauthorized to make decisions.
Can consent still be withdrawn?
The designated person (with decision-making authority) can withdraw consent until the moment the deceased is taken to the operating room/morgue for tissue donation.
No, I do not want to become a donor
What do you do in the case of a 'no' registration?
The patient has explicitly indicated that they do not want to be a donor. There is no consent for donation.
Donation will never proceed with this registration.
- Inform the next of kin that there is no consent for donation.
- Watch the animation below and use the example sentence to explain the registration.
How do you explain the procedure?
Will the donation proceed? Provide clear explanations to the next of kin. Realize that this is a lot of information and completely new to most people.
- Listening is more important than speaking. Address concerns and answer questions.
- Pace the medical information and use as little jargon as possible.
- Ensure realistic expectations about the duration of the procedure.
Do you expect questions from a philosophical, religious, or cultural perspective?
Contact a spiritual counselor or medical social worker from your hospital. Invite them to the conversation if necessary.
Extra explanation to use in your conversation
Explanation of the duration of the procedure
- State that the procedure takes time. Let them know that it is customary for the next of kin to receive the donor back 8 to a maximum of 30 hours after death.
- Mention several factors that can cause it to take this long, such as the availability of a recovery room and team, having to retrieve additional information from a (general) physician, and the extraction of tissues.
Explanation regarding laying in state, funeral, and rituals
- Tell them that laying in state, burial, or cremation can be done in the usual manner. Laying in state at home is also possible.
- Explain in broad terms what someone looks like after tissue retrieval and give clothing advice. See also: tissue retrieval
- If desired, provide information about thanatopraxy or ritual washing:
- Thanatopraxy is a mild embalming process and is possible in combination with tissue donation. It is not possible with skin or bone tissue donation.
- After a ritual washing, the body is wrapped in shrouds and tissue donation is no longer possible. Before the washing, it is sometimes still possible.
- Explain that it is only clear after removal and screening which tissues are suitable for transplantation.
What information from the family is needed for donor registration?
- To register the donor, you need specific information, such as travels abroad in the past year. View the tissue questionnaire: questions that the Organ Centre asks upon registration.
- Is the donation extramural? Ask for the name and contact details of the funeral home.
- Ask if the surviving relatives wish to receive a letter from the NTS stating which tissues have been retrieved. If so? Ask for the postal address for this letter.
Concluding the donation conversation
- Summarize what you have discussed. Or ask a relative present at the conversation to do this.
- State the conclusion: donation / no donation.
- Ask if this is correct and if everything is clear.
Tip! Provide information to take home
Afterward, provide information to take home or share the online information.
Detailed information
Detailed explanation of the donation conversation and the legal framework?
Interesting training for you
3. Register tissue donor
After the donation conversation, you can register a tissue donor with the Organ Center. Read on this page how to properly prepare for the registration conversation.
Registration questionnaire
To guarantee the quality and safety of the tissue for the recipient, the Organ Center will ask you a number of questions.
Donor registration questionnaire
- Gather the information needed to answer the questions.
- Try to ask the family members the questions all at once as much as possible.
Inspection checklist
A good inspection of the donor is important prior to registration.View the checklist for the inspection.
Register the tissue donor
- Tissue donors can be registered 24 hours a day.
- The conversation takes 15 to 20 minutes. Keep the collected information at hand.
- Call the Organ Center:071-579 57 95.
Complete donation form
Always complete the donation form and death forms afterwards and follow your hospital's instructions.
More information
4. Preparing for tissue recovery
Tissue recovery often takes place in the mortuary of the hospital where the donor has passed away. Sometimes this is in a funeral home. Bone and tendon tissue are always recovered in an operating room. This is arranged by the recovery team of WUON.
Points of attention prior to tissue recovery
- Cool the body within 6 hours
Cool the body in a cold room within 6 hours of death. Tissue recovery is then possible up to 24 hours after death.
Unable to cool within 6 hours? Then it is not always possible anymore to recover (all) tissues. Contact the Organ Center to discuss the options: 071 579 57 95 - Elevate the head
Position the head higher than the abdomen to prevent congestion. - Wait with care
The recovery team will first perform examinations and draw blood. Afterwards, the team will recover the tissues. Wait with caring for and dressing the donor until after the recovery. - Do not place eye caps
Do not place eye caps and do not use eye spray. This applies to all tissue donors.
Are you a mortuary employee? View the instructions here
Detailed information
Need more practical information about the preparation?
5. Tissue recovery
Following these preparations, tissues can be recovered. The recovery of tissues is performed by a recovery team from WUON (Tissue Recovery Organization Netherlands).
The recovery team receives a call to go to the location where the tissue recovery will take place. The team is specially trained to carry out this donation procedure and brings all necessary materials.
Eye tissue
During eye tissue donation, the recovery team always removes the entire eye. They always remove both eyes. After the removal, they place prostheses and the eyelids are closed. Sometimes some blue discoloration can be seen around the eyes. The funeral director or recovery team restores this cosmetically.
Skin
The recovery team can take skin from the back, sides, legs, and buttocks. These are usually thin layers of skin. Sometimes a thicker layer is also taken from the back. After the removal, the donor is dressed in a suit that covers the body. The suit is necessary because the body may lose fluid after the removal. Usually this suit is not visible after dressing. Sometimes it is slightly visible at the neck and wrists. The funeral director or loved ones can no longer wash the deceased after skin donation.
Heart valves
The heart valves are removed via a sternotomy, using a Y-incision. The recovery team always removes the entire heart for a heart valve donation. This is transported to the tissue bank and the valves are dissected there. The incision wound is closed, sutured, and covered with a plaster after donation. If high-necked clothing is worn over this, nothing can be seen of it.
Bone tissue, cartilage, and tendons
Bone tissue, cartilage, and tendons must be removed in an operating room because the bone procedure takes longer and this better guarantees sterility.
Bone tissue, cartilage, and tendons are removed from the legs, upper arms, and pelvis. Sometimes another piece of bone is removed. The latter only happens if a patient is on the waiting list for this. Removal of rib cartilage only happens in combination with heart valve donation and takes place after the heart has been removed.
The removed bone tissue is replaced by naturally degradable prostheses. The incision wounds are sutured and covered with plasters. If clothing is worn over this, nothing can be seen of it. However, it is discouraged to dress the donor in shorts, a short skirt, or short-sleeved clothing, as the plasters may then be visible. Loved ones can no longer wash the deceased themselves after a bone donation. Due to the prostheses, the body is less stable and feels different during dressing.
After removal: tissue bank
After removal, the tissues go to the tissue banks. The tissue bank assesses the quality. After approval, the tissues are processed and stored.
Detailed information
Want to know more about the removal of specific tissues?
Reimbursements after tissue removal
The additional costs incurred by funeral homes and mortuaries during a tissue donation procedure are covered by the NTS. Loved ones of a donor must never receive a bill for these additional costs themselves.
6. Aftercare following donation
Good aftercare for surviving relatives helps with the grieving process. Clear explanations and good information can mean a lot in this regard. On our website, you will find extensive information and support for surviving relatives who have dealt with the organ or tissue donation of a loved one.
Questions? Call the organ centre
Call the Organ Centre to consult the Donor Register or to register a tissue donor. Also if in doubt or if you have questions.
Available 24 hours a day