'Some donors are real puzzles'

What does the Organ Centre do?

‘As soon as a patient dies or is dying, the doctor calls the NTS Organ Centre, first of all to consult the Donor Register. Then the donation process splits. Hospitals arrange organ donation in consultation with a transplant coordinator, and the Organ Centre arranges tissue donation. This happens 24 hours a day, 7 days a week. Organ Centre staff screen registered tissue donors. They ask a series of questions to the doctor reporting the death. They handle the intake of eye tissue donations independently, but I get involved with other tissues and complex donations.’

What is your role in donation?

‘I check whether the patient's medical picture is correct and complete. For example, the medical history must match the medications the patient was using, the cause of death must be clear, and there must be no medical risks for donation. There are strict criteria for this that are aligned with European guidelines.’

What happens after that?

‘If there is no objection to donation and no medical contraindications, the retrieval team removes the tissues. The tissue bank checks the quality. The blood is also tested for viruses such as HIV and hepatitis. I receive all this data back. Sometimes additional information from the general practitioner or specialist is needed. In the final assessment, I decide which tissues are suitable for transplantation.’

Does it end for you once the tissues have been transplanted?

‘No, because on very rare occasions a medical incident is reported after an organ or tissue transplantation. For example, if a recipient develops an infection or cancer, we investigate whether that could be due to the donor organ or tissue. If so, we must inform the doctors of other recipients. Conversely, something is occasionally found in donors that could affect the transplanted organ or tissue.’

How many doctors are there at the NTS?

‘There are 6 staff physicians of us, but not all are full-time. Continuity is important; there must always be at least 1 physician on duty at the Organ Centre, and we each have an evening and night shift 1 or 2 times a week. During those shifts, we are the telephone contact point for the Organ Centre. As a physician, you receive internal training and the onboarding period is about a year. You are assigned a mentor who works with you 1-on-1. In addition, 3 external physicians cover evening and night shifts. Some of them worked at the Organ Centre as flexible workers during their studies.’

What background do the doctors have?

‘Everyone already had a number of years of clinical experience. In various fields, from ophthalmology to gynaecology and from surgery to pathology. Through the combination of everyone's knowledge, we complement each other. We encounter many different clinical pictures, but the donor's social background is also important, and ethical issues play a role in donation. To make a total assessment, you need knowledge of various disciplines. That makes it fascinating, because medicine is then expressed in its full breadth.’

What do you do besides your shifts?

‘I also handle policy matters and am involved in medical questions from, for example, hospitals and the public. I also do research to develop and evaluate our medical guidelines. I can then give presentations about this at conferences; after all, we are also a national knowledge centre. Sometimes I allocate eye tissue and heart valves to patients on the waiting list. For complex transplant indications or emergency allocations, I check that everything is correct. I also teach Organ Centre staff, retrieval teams, and LUMC student clerks.’

So many different tasks

‘Yes, and it is precisely that variety that makes it fun. Some donors are real puzzles. We have a team meeting every week to discuss difficult cases. These are important learning moments, because we also test each other's knowledge. We keep on learning.’