Tissue donation: explanation for next of kin
Has the doctor spoken to you about tissue donation? On this page, you can read how this works and what you can expect.
Which tissues are involved?
In tissue donation, a deceased person donates tissue. This can include:
- Eye tissue
- Skin
- Heart valves
- Bone, cartilage, and tendon tissue
After retrieval, this tissue goes to a tissue bank. Doctors use these tissues to help patients. This can improve their quality of life.
Before the tissue retrieval
The doctor first wants to know the deceased's status in the Donor Register. They discuss the registration with the next of kin and provide an explanation about tissue donation.
What should you pay attention to as a surviving relative?
Mention your wishes during the conversation with the doctor regarding:
- Tattoos
Sometimes a doctor has to cut through a tattoo. Do you have any objections to this? Please indicate this. - Light embalming
It may be that light embalming is desired. This is called thanatopraxy. It ensures that the body remains presentable for longer. This form of embalming is possible, except in the case of skin donation. Discuss with the doctor what takes priority: the deceased's wish for skin donation or thanatopraxy. - Ritual washing
During a ritual washing, water is used to purify the body and the soul. Tissue donation is no longer possible after this. It is sometimes still possible before the washing. Would you like a ritual washing for the deceased? If so, discuss the possibilities available after tissue donation with the doctor.
Consent for research
Sometimes it turns out after removal that the tissue is not suitable for transplantation. It can then be used for research. However, this is only allowed if the deceased gave permission for this in the Donor Register or if the next of kin give permission.
If there is no consent, the unsuitable tissue is destroyed. The retrieval team never removes tissue solely for research purposes.
Registering the donor with the NTS
Before tissue donation can begin, a lot of information is needed to assess whether the deceased can donate tissues.
For this, the doctor looks up medical information about the health of the deceased and sometimes also asks the next of kin a few questions.
Afterwards, they call the Dutch Transplant Foundation (NTS) to register the donor.
Procedure of the retrieval
A special team retrieves the tissues and draws blood for testing. The deceased must be cooled within 6 hours of death.
Tissue donation always takes place in a funeral home or hospital:
- Retrieval of eye tissue, skin, and heart valves usually takes place in the mortuary of a funeral home or in a hospital.
- For bone, cartilage, and tendon tissue, the retrieval always takes place in an operating room.
The retrieval can start up to 24 hours after death.
How much time does tissue retrieval take?
The removal of tissues is done carefully and therefore takes time. As a result, it can up to 30 hours after deathtake before the deceased's body is available to the next of kin.
Sometimes, in the event of an unnatural or unexpected death, an investigation into the cause is required. This is called an autopsy. Tissue donation always takes place before the autopsy. The doctor will inform you about this.
Why does tissue retrieval sometimes take so long?
There is not always a room immediately available for the retrieval at the funeral home or hospital. It may also be that all the special teams that retrieve tissues are already out on calls. As a result, it may take a while before a team is present at the retrieval location.
After the retrieval
After the tissue retrieval, the deceased goes to the place chosen by the next of kin. For example, to their home or a funeral home. Laying out the body is always possible. The team ensures that the deceased looks neat after the donation.
Read here per tissue what is retrieved and what you should take into account regarding care.
Eye tissue
With eye tissue donation, the retrieval team removes the eyeballs and replaces them with eye prostheses. They then close the eyes. This makes the face look normal again.
Care
Sometimes a bruise occurs: a blue discoloration around the eye. A funeral director will use makeup to ensure this is not visible.
Heart valves
The tissue bank needs the entire heart to examine whether the heart valves are in good condition. Therefore, when donating heart valves, the retrieval team removes the entire heart. Sometimes a piece of the large blood vessels around the heart is also removed at the same time. The retrieval team makes a Y-shaped incision in the chest to remove the heart. They then suture the wound and cover it with adhesive strips.
Care
We recommend choosing clothing with a neckline that is not too low when laying out the body. This way, the adhesive strips will not be visible.
Bone tissue, cartilage, and tendons
With the donation of bone tissue, cartilage, and tendon tissue, the retrieval team removes these from the upper arms, legs, and/or pelvis. Only if heart valve donation also takes place does the retrieval team also remove the cartilage from the ribs.
The retrieval team makes incisions to remove the tissues. The team replaces the bones with biodegradable prostheses. This keeps the shape of the body as much the same as possible. After the retrieval, the retrieval team sutures the wounds and covers them with adhesive strips.
Care
With the donation of bone tissue, cartilage, and tendons, it is not recommended for next of kin to care for the deceased themselves. This is because the arms and legs are less stable than before.
The funeral director or next of kin can no longer wash the deceased's body after skin donation. We recommend choosing clothing with long sleeves and long trousers or a skirt when laying out the body. Cremation and burial remain possible, including at a natural burial ground.
Skin
With skin donation, the retrieval team removes skin from the back, legs, buttocks, and sides of the deceased. These are very thin layers of skin. From the back, they can sometimes also take a thicker layer of skin tissue. They take this layer from the shoulder blades down to the lower back.
After the skin is removed, the deceased is dressed in a special suit. The suit is necessary because the body may lose fluid after the removal. Regular clothing can be worn over this special suit.
Care
With skin donation, it is not recommended for next of kin to care for the deceased themselves. The funeral director or next of kin can no longer wash the deceased's body after skin donation.
We recommend choosing clothing with long sleeves and long trousers or a skirt when laying out the body. Burial in a natural burial ground is no longer possible.
What happens to the tissues after removal?
After removal, the donated tissues go to a tissue bank. This is an organization that examines the tissues and assesses their quality.
After approval, the tissues are processed and stored. The storage period for donated tissue varies from 4 weeks to 5 years.
How does donated tissue help a patient?
Donor tissue can help many patients. As soon as a patient needs tissue, the doctor submits a request to the tissue bank for their patient.
Sometimes there is more tissue in stock than is needed for Dutch patients. In that case, the tissue bank looks for a recipient abroad. This prevents tissue banks from having to discard tissue. The Netherlands also receives tissue from foreign tissue banks to be able to help people in the Netherlands.
Eye tissue: cornea and sclera
We use two parts of the eye: the cornea and the sclera.
- A cornea can become cloudy due to a disease or condition. With donated cornea, someone can see again.
- The sclera is the outer white layer of the eye. The sclera can be used to preserve a damaged eye.
Heart valves
A heart valve can help patients lead a normal life again. The patients are newborn babies with a congenital heart defect, adults with a malfunctioning heart valve, and patients with an acute infection of the heart valve.
They urgently need a new heart valve. It is also examined whether certain parts of the large blood vessels of the heart (patches) can be used for transplantation. These patches are used to repair a patient's blood vessels.
Bone, cartilage, and tendon tissue
- BoneWith bone from a donor, doctors can replace bone that is damaged, for example due to cancer or during hip surgeries.
- CartilageDoctors use donor cartilage to repair damaged joints. Think, for example, of knee tissue. This can help patients move better and can provide pain relief.
- TendonsWith tendons, doctors can repair damaged joints. For example, in patients with rheumatism. Tendon tissue is also used to repair torn tendons in, for example, knees or shoulders.
Skin
Donor skin is needed for people with burns and other skin injuries. Doctors use donor skin as a type of bandage. Donor skin results in less pain, fewer infections, and less scarring.
Eventually, the donor skin falls off the healed wound by itself. If a thick piece of skin is used, it does grow onto the recipient.
Would you like to know the results of the tissue donation?
If you would like to know the results of the donation, you can tell the doctor.
After about one week, you will receive a letter from the NTS stating which tissues were donated, along with a brochure containing information about the use of donated tissue.
You will not be told who received the tissues. That remains anonymous. This is laid down by law.
No need for information?
You can also indicate to the doctor that you do not wish to receive information about the donation. In that case, you will not receive a letter from the NTS.
You will also not receive information if the retrieval did not take place. Sometimes a retrieval does not go ahead because the donor's blood is unsuitable or the retrieval team discovers something that poses a problem for donation.
If you would like more information at a later time, you can always send an email to the NTS: nabestaanden@transplantatiestichting.nl. Clearly state the details of the deceased.
No extra costs for the next of kin
Of course, you do not have to pay anything extra for the tissue donation procedure. You only pay for the costs that are always associated with a death.
Thank-you letter from the recipient
It very occasionally happens that people who have received tissues send a thank-you letter. At that point, the NTS will ask you if you would like to receive the letter. The letter is anonymous and you will receive it via the NTS.
Questions about donation?
Do you have specific questions about the tissue donation of the deceased? Ask the doctor involved in the donation.