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.
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 contraindications
Tissue donation is possible in many cases. The most important contraindications are:
- A hematological disorder (also in the past) such as leukemia, (non-) Hodgkin, Kahler, myelodysplastic syndrome, and polycythemia 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 contraindications are listed above. In all other cases or in case of doubt, call the Organ Center 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, the responsibility always lies with a professional with a BIG registration.
Call the Organ Center (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), surname, 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 completed. However, always fill out the donation form and the death forms afterwards.
Detailed information
Learn more about donor identification 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 deal with incapacity at the time of registration.
Explanation per registration
The registration of the potential donor in the Donor Register is leading for the conversation. See how to conduct the conversation for each registration.
Yes, I want to be a donor
How do you discuss a 'yes' registration?
A 'yes' registration is an active choice. The potential donor has chosen to donate themselves. How do you discuss the registration?
- Inform the next of kin about the registration.
- Ask the next of kin if they have ever spoken to the potential donor about donation.
- Explain 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, you usually have the conversation with the immediate family. Think of the partner, children, or siblings. Are they unreachable? Try to postpone the donation until someone has been reached.
According to the law, it is also permitted to inform next of kin. These are all people who play a (significant) role in the patient's life. 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 the next of kin?
- Use regular channels: search the patient's personal belongings to find contact information.
- If that doesn't work, ask the police to reach the next of kin through their channels.
- In the meantime, you may already perform preparatory actions for the donation.
Are the next of kin 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?
A 'yes' in the Donor Register constitutes consent for donation. This registration is leading. The intention is for the donation to proceed. It may happen that surviving relatives are convinced that the registration does not match the patient's wishes. In that case, they can substantiate this:
- Substantiating does not involve providing proof, but rather setting out and explaining.
- Your professional judgment as a doctor counts. You decide whether or not to proceed with the donation based on this conversation.
Note:Only surviving relatives up to the 2nd degree can refute the registration in the Donor Register. Others are not legally permitted to do so.
- 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 the next of kin have personal difficulties with donation?
The next of kin may indicate that they personally have difficulties with the donation. Try to understand and ask further questions about where the objections stem from: are there certain assumptions about the procedure, or is there something related to their philosophy of life or culture?
- Read how to handle these objections (Model protocol 4.11)
No objection to donation
How do you discuss the ‘no objection’ registration?
Everyone aged 18 and over is in the Donor Register. If you do not actively make a choice yourself, you are registered as having given consent based on a ‘no objection’ registration in the Donor Register. You have been informed of this through 3 letters from the government.
- Inform the next of kin about the registration.
- Ask the next of kin if they have ever spoken to the patient about donation.
- Explain the procedure.
- Watch the animation below and use the example sentence to explain the registration.
With whom do you have the conversation?
In practice, you usually have the conversation regarding a 'no objection' registration with the immediate family. Think of the partner, children, or siblings. Are they unreachable? Then try to postpone the donation until someone has been reached.
According to the law, it is also permitted to inform next of kin. These are all people who play a (significant) role in the patient's life. 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 the next of kin?
- Use regular channels: search the patient's personal belongings to find contact information.
- If that doesn't work, ask the police to reach the next of kin through their channels.
- In the meantime, you may already perform preparatory actions for the donation.
Are next of kin unreachable or can the donation no longer be postponed? Then no donation will take place.
Are the next of kin 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 for the donation to proceed.
It may happen that the next of kin are convinced that the registration does not correspond with the patient's wishes. In that case, they can make this plausible:
- Substantiating does not involve providing proof, but rather setting out and explaining.
- Your professional judgment as a doctor counts. You decide whether or not to proceed with the donation based on this conversation.
Note: Only next of kin up to the 2nd degree can refute the registration in the Donor Register. Others are not legally permitted to do so.
- Who are surviving relatives up to the 2nd degree?(Model protocol 4.7)
- Objection by next of kin to nature of registration (Model protocol 4.10)
Do the next of kin have personal difficulties with donation?
The next of kin may also indicate that they personally have difficulties with the donation. Try to understand and ask further questions about where the objections stem from: are there certain assumptions about the procedure, or is there something related to their philosophy of life or culture?
- Read how to handle these objections (Model protocol 4.11)
My partner or family decides for me
How do you discuss the wish for a partner or family member to decide?
With the registration 'My partner or family decides for me', the patient leaves the decision to their partner or family.
How do you discuss the registration?
- Inform the partner or family about the registration.
- Ask if this registration was known to the partner or family.
- Provide information about the procedure.
- Give time to process all 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 have the conversation?
You conduct the donation conversation with surviving relatives up to the 2nd degree. There are 3 categories:
- Spouse, registered partner, or other life partner of the patient.
- Adult blood relatives up to the 2nd degree: (adopted) children, (adopted) 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, 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 for permission from a person in a subsequent category.
- Is there no surviving relative from category 1, or is that person unreachable? Then you approach a person from category 2, and so on.
- You make reasonable efforts to reach surviving relatives in 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 unreachable?
You do everything possible to reach surviving relatives. If no surviving relatives can be found, the donation will not proceed. You may not ask for permission from those close to the patient, because those close to the patientnothave the authority to decide.
Can consent still be withdrawn?
The partner or family members can withdraw consent until the moment the deceased is taken to the operating room/mortuary for tissue donation.
I designate one person to decide
How do you discuss this if the patient leaves the decision to one person?
When registering 'I designate one person to decide', the patient leaves the decision to the designated person.
The person named in this registration is leading. For the law, it does not matter how long ago the specific person had contact with the patient.
- Inform this person about the registration.
- Ask if this registration was known to the designated person.
- Provide information about the procedure.
- Give time to process all 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 have 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 do everything possible to reach this person. If you have not succeeded? Then you can ask the surviving relatives the donation question.Who are surviving relatives up to the 2nd degree?
If there are no surviving relatives, the donation will not proceed. You may not ask for consent from next of kin. They are, after all,notauthorized to decide.
Can consent still be withdrawn?
The designated person (authorized decision-maker) can withdraw consent until the moment the deceased is taken to the operating room/mortuary for tissue donation.
No, I do not want to become a donor
What do you do in case of a 'no' registration?
The patient has explicitly indicated not wanting 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 the next of kin with a clear explanation. Realize that this is a lot of information and completely new information for most people.
- Listening is more important than speaking. Address concerns and answer questions.
- Dose the medical information and use as little jargon as possible.
- Ensure realistic expectations regarding the duration of the procedure.
Do you expect questions related to philosophy of life, religion, or culture?
Contact a spiritual counselor or medical social worker from your hospital. Ask them to join the conversation if necessary.
Additional explanation to use in your conversation
Explanation of procedure duration
- Explain that the procedure takes time. Let them know that it is customary for the next of kin to be able to have the donor back after 8 to a maximum of 30 hours after death.
- Mention some factors that can cause it to take this long, such as the availability of an operating room and team, the need to collect additional information from a (family) doctor, and the removal of the tissues.
Explanation of laying out, funeral, and rituals
- Explain that laying out, burial, or cremation can be done in the usual way. Laying out at home is also possible.
- Explain in general terms what someone looks like after tissue removal and provide advice on clothing. See also:tissue removal
- If desired, provide information about thanatopraxy or ritual washing:
- Thanatopraxy is a light embalming 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 cloths and tissue donation is no longer possible. Before the washing, it is sometimes still possible.
- Explain that it only becomes clear which tissues are suitable for transplantation after retrieval and screening.
What information from the family is needed to register the donor?
- To register the donor, you need specific information, such as travel abroad in the past year. View the tissue questionnaire: questions that the Organ Center asks during registration.
- Is the donation extramural? Ask for the name and contact details of the funeral home.
- Ask if the next of kin would like to receive a letter from the NTS stating which tissues were retrieved. If so, ask for the mailing address for this letter.
Concluding the donation conversation
- Summarize what you have discussed. Or ask a relative present at the conversation to do so.
- State the conclusion: donation or 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
Extensive explanation of the donation conversation and the legal framework?
Interesting training for you
3. Registering a tissue donor
After the donation discussion, you can register a tissue donor with the Organ Center. Read on this page how to properly prepare for the registration call.
Registration questionnaire
To ensure the quality and safety of the tissue for the recipient, the Organ Center will ask you a number of questions.
Donor registration questionnaire
- Collect the information needed to answer the questions.
- Try to ask the questions to the next of kin all at once as much as possible.
Examination checklist
A proper examination of the donor is important before registration.View the examination checklist.
Register the tissue donor
- You can register a tissue donor 24 hours a day.
- The call takes 15 to 20 minutes. Keep the collected information at hand.
- Call the Organ Center: 071-579 57 95.
Completing the donation form
Always complete the donation form and death forms afterwards and follow your hospital's instructions.
More information
4. Preparing for tissue retrieval
Tissue retrieval often takes place in the mortuary of the hospital where the donor passed away. Sometimes this is at a funeral home. Bone and tendon tissue are always retrieved in an operating room. This is arranged by the WUON retrieval team.
Points of attention before tissue retrieval
- Cool the body within 6 hoursCool the body in a cold storage room within 6 hours of death. This allows for tissue retrieval up to 24 hours after death.
Is cooling not possible within 6 hours? Then it is not always possible to retrieve (all) tissues. Contact the Organ Center to discuss the possibilities: 071 579 57 95 - Elevate the headPlace the head higher than the abdomen to prevent congestion.
- Wait with post-mortem careThe retrieval team first performs examinations and draws blood. Afterward, the team retrieves the tissues. Wait with caring for and dressing the donor until after the retrieval.
- Do not place eye capsDo 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 retrieval
After these preparations, tissues can be retrieved. Tissue retrieval is performed by a WUON (Tissue Retrieval Organization Netherlands) retrieval team.
The retrieval team receives a call to go to the location where the tissue retrieval will take place. The team is specially trained to perform this donation procedure and brings all necessary materials.
Eye tissue
When donating eye tissue, the retrieval team always removes the entire eye. They always remove both eyes. After the removal, they place prostheses and the eyelids are closed. Sometimes, bruising may be visible around the eyes. The funeral director or the retrieval team will restore this cosmetically.
Skin
The retrieval team can remove 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 the next of kin can no longer wash the deceased after skin donation.
Heart valves
The heart valves are removed via a sternotomy, using a Y-incision. The retrieval team always removes the entire heart for a heart valve donation. This is transported to the tissue bank, where the valves are dissected. The incision wound is closed, sutured, and covered with a bandage after donation. If high-necked clothing is worn over this, nothing will be visible.
Bone tissue, cartilage, and tendons
Bone tissue, cartilage, and tendons must be removed in an operating room because the bone procedure takes longer, which better ensures sterility.
Bone tissue, cartilage, and tendons are removed from the legs, upper arms, and pelvis. Sometimes, a different bone segment is removed. The latter only happens if there is a patient on the waiting list for it. Removal of rib cartilage only occurs 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 bandages. If clothing is worn over this, nothing will be visible. However, it is advised not to dress the donor in shorts, a short skirt, or short-sleeved clothing, as the bandages may be visible. Next of kin cannot 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. Upon approval, the tissues are processed and stored.
Detailed information
Want to know more about the removal of specific tissues?
Reimbursements after tissue retrieval
The additional costs incurred by funeral homes and mortuaries during a tissue donation procedure are covered by the NTS. Next of kin of a donor should never receive a bill for these additional costs.
6. Aftercare following donation
Good aftercare for surviving relatives helps with the grieving process. Clear explanations and good information provision can mean a lot in this regard. On our website, you will find extensive information and support for surviving relatives who have dealt with organ or tissue donation of a loved one.
Questions? Call the Organ Center
Call the Organ Center to consult the Donor Register or to register a tissue donor. Also in case of doubt or if you have questions.
Available 24 hours a day