'Some donors are real puzzles'

What does the Organ Center do?

'As soon as a patient dies or is at risk of dying, the doctor calls the NTS Organ Center, 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 Center arranges tissue donation. This happens 24 hours a day, 7 days a week. Employees of the Organ Center screen the registered tissue donors. They ask a list of questions to the doctor reporting the death. For eye tissue donation, they handle the intake independently, but for other tissues and complex donations, I get involved.'

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 there are 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 the data back. Sometimes additional information from the GP 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 very occasionally a medical incident is reported after an organ or tissue transplant. If a recipient, for example, 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 sometimes found in donors that could have an effect on the transplanted organ or tissue.'

How many doctors are there at the NTS?

'There are 6 staff doctors, but not all are full-time. Continuity is important; there must always be at least 1 doctor on duty at the Organ Center, and we each have an evening and night shift once or twice a week. Then we are the telephone point of contact for the Organ Center. As a doctor, you receive internal training and the onboarding period is about a year. You get a mentor who works with you 1-on-1. Three external doctors also work evening and night shifts. Sometimes they worked as flexible workers at the Organ Center 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 gynecology 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 history is also important and ethical issues play a role in donation. To be able to make a total assessment, you need knowledge of various fields. That makes it fascinating, because medicine is then expressed in its full breadth.'

What do you do besides the shifts?

'I also do policy work and am involved in medical questions from, for example, hospitals and the public. I also conduct research for the development and evaluation of our medical guidelines. I can then give presentations about this at conferences; we are also a national knowledge center, after all. Sometimes I allocate eye tissue and heart valves to patients on the waiting list. For complex indications for transplantation or emergency allocations, I check that everything is correct. I also provide education to employees of the Organ Center, to the retrieval teams, and to medical students from the LUMC.'

So, many different tasks

'Yes, and it is precisely that variety that makes it fun. Some donors are real puzzles. We have weekly team meetings about difficult cases. These are important learning moments, because we also test each other. We keep on learning.'