Model Protocol

Overview of all changes in the Model Protocol for post-mortem organ and tissue donation.

This Model Protocol is an example protocol for hospitals. Hospitals can use it to check their own hospital protocol and adjust it if necessary.

Normative chapters

This Model Protocol meets the requirements that the law imposes on a hospital protocol. The chapters in the protocol have different legal statuses. If a chapter has a normative basis – and therefore cannot be deviated from – this is explicitly stated.

Authorities

This Model Protocol does not always indicate which officials are authorized to perform a specific task. The hospital must determine this itself. This may vary per hospital.

See also fill-in form in which the authorized officials can be listed.

Enabling tissue donation should be the starting point for healthcare institutions, but they are not obliged to make donation possible. A doctor does not have to consult the Donor Register if this procedure is not possible in the healthcare institution. If it is possible, there must be a donation protocol in the healthcare institution. If there are no contraindications for tissue donation, the attending physician determines, based on their own professional responsibility, whether the Donor Register is consulted. This also applies to the general practitioner if the patient dies at home.

• The ‘Guide to the Quality and Safety of Organs for Transplantation’ is a comprehensive European guideline with the latest insights and standards for organ donation and transplantation, based on recent scientific research.
• Publication: EDQM, Council of Europe – 9th edition (2025).

Download the guideline

For readability, the masculine pronoun 'he' is used in this protocol. Naturally, this can also be read as 'she/her' and 'they/them'.

Patient

A person who has been admitted to the hospital, whose death is expected soon or who has died, and who may be a potential donor.

Next of kin

Under the Organ Donation Act (Wod), next of kin may in certain cases have decision-making authority. Next of kin have the option to object to the nature of the registration or to the donation. This primarily concerns the partner. In their absence or if they cannot be reached: blood relatives (1st and 2nd degree). And in their absence or if they cannot be reached: relatives by affinity (1st and 2nd degree). There is no distinction between the 1st and 2nd degree.

Note: In the Wod, the term 'next of kin' is also used for situations in which the patient has not yet died. This also applies to this protocol.

Read who exactly falls under the next of kin (4.7)

Loved ones

People who played a (significant) role in the patient's life, such as a neighbor or a close friend, including (but not limited to) next of kin up to the 2nd degree.

Note: The Wod makes a clear distinction between 'loved ones' and 'next of kin'. When it comes to informing about the registration and the follow-up steps, the official may address all loved ones. However, as soon as consent for donation is required, only the next of kin have decision-making authority. Furthermore, only the next of kin may object to the nature of the registration or to the donation. A loved one who is not next of kin may not do this.

Donation discussion

The entirety of discussions with loved ones in the context of a potential donation. The donation discussion takes place prior to any tissue and/or organ retrieval and after the 'bad news conversation' has been held.
The donation discussion consists of 2 parts:

• Initial part: discussion in which the official discusses the registration in the Donor Register with the loved ones. In this discussion, the official also provides information about donation and—if applicable—asks the next of kin up to the 2nd degree or a specific person for consent for donation.
• Specific part: discussion in which the official provides more information about which specific organs, tissues, and retrieved bodily material are medically suitable for donation. For this, they ask the loved ones for information about the patient's social and medical history. The official also discusses the planning of the procedure in this discussion.

Note: The above division into the 'initial part' and the 'specific part' of the donation discussion was made to provide more structure and clarity. However, such a separation cannot be made so strictly in practice, because the same items can occur in both parts. In that case, the initial part and the specific part are combined into one discussion. This also depends on the specific information needs of the loved ones.

Official

Person who conducts the initial part of the donation discussion. The official can be a doctor or another medical professional.

Incapacitated

This concerns incapacity with regard to organ and tissue donation. An incapacitated person is someone who is 'not capable of a reasonable appreciation of the interests involved' and who cannot 'weigh the significance of the facts in light of their own priorities'.

In the case of donation, a person is considered legally incompetent if they are unable to understand what donation entails and/or to foresee the consequences of donation. As a result, this person lacks the basis upon which legally competent persons base their choice. People with an intellectual disability are not necessarily legally incompetent when it comes to donation. Whether someone is legally incompetent is a medical assessment, not a legal one.

See 3.4.1. for children under 12 years of age

Duty of verification

The duty of verification concerns the patient's legal competence. In the new donor law, it was decided to explicitly record the duty of verification. The relevant article contains the conditions that must be met before the procedure for the removal of organs/tissues begins. One of these conditions is that the designated official must verify the patient's legal competence at the time of registration.

To make plausible

In the case of a 'yes' or 'no objection' registration, surviving relatives can make it plausible (4.10) that the registration does not correspond to the patient's wishes.

Are the surviving relatives convinced that the 'yes' or 'no objection' registration is incorrect? Then they must make this known and explain it to the official. How they do this is not subject to formal requirements. The law speaks of 'making it plausible', without further definition. It is not about 'proving', but about 'setting out' and 'explaining'. The official asks the surviving relatives to explain why they believe the registration does not correspond to the patient's wishes.

If they can explain this sufficiently convincingly, the registration can become invalid and the information from the surviving relatives applies. It is up to the professional judgment of the official to decide whether they can trust that the registration corresponds to the patient's wishes.

Resident

A natural person who is registered in the Personal Records Database (BRP). In practice, this means that this person has their actual place of residence in the Netherlands.

Donation Quality Standard

Quality standard drawn up in the context of the amendment to the Organ Donation Act in 2020. This quality standard focuses on consulting the Donor Register and the subsequent conversation with relatives and surviving family members. The existing practice regarding donation is recorded in the standard, and the new components of the Wod (Organ Donation Act) have been translated into practice. The quality standard is integrated into chapters 3 and 4 of this model protocol.

To the Quality Standard

These abbreviations appear in the Model Protocol.

The most important laws and guidelines for donation in the Netherlands are:

• EU Directive 2010/45/EU (pdf, 810 kb)
• EU Directive 2004/23/EC (pdf, 246 kb)
• Organ Donation Act
• Safety and Quality of Body Material Act
• Safety and Quality of Body Material Decree
• Safety and Quality of Body Material Regulation

• Appendix 1: Contact details for donation professionals and official authorizations. This is a blank version. Each hospital completes its own overview.
• Appendix 2: Brain death determination form
• Appendix 3: National cross-organ hepatitis B protocol (2.7)

The Model Protocol for Post-mortem Organ and Tissue Donation is a publication of the Dutch Transplant Foundation (NTS).

• Haagse Schouwweg 6 - 2332 KG - Leiden.
• PO Box 2304 - 2301 CH - Leiden.
• info@transplantatiestichting.nl

All rights reserved. Nothing from this publication may be reproduced, in any form or by any means, without prior permission from the Dutch Transplant Foundation.

The publication was produced in collaboration with: the Ministry of Health, Welfare and Sport, (various working groups within) the Dutch Transplantation Society and the Dutch Society for Intensive Care.

This publication was made possible in part by financial support from the Ministry of Health, Welfare and Sport.