Organ chain: donation and transplantation
Discover how the organ chain is organized in the Netherlands and which professionals collaborate from donor identification to transplantation.
In the Netherlands, donation and transplantation are strictly separated to guarantee the independence of and trust in both procedures, and to prevent traceability between donor and recipient.
Alignment of processes: role of NTS
The process from donation to transplantation is, of course, carefully coordinated. From identifying an organ donor in the hospital to successful transplantation and aftercare: in every step of the organ chain, the work of organizations and professionals is aligned.
Commissioned by the Ministry of Health, Welfare and Sport (VWS), the NTS manages this coordination of processes and cooperation within the organ chain nationally to ensure optimal progress and to monitor the chain.
In addition, through the Organ Centre, the NTS performs statutory tasks derived from the Organ Donation Act. The NTS also has various operational tasks, such as managing waiting lists and procuring logistics for the transport of retrieval teams and organs (from the donor hospital to transplant centers).
Organizations and officials in the chain
Below is a general outline of which organizations and officials play a role in the process steps from organ donation to transplantation.
Organ donation procedure
Organ donation starts at the moment when acute care physicians (emergency department or intensive care unit) decide that treatment will be stopped because further treatment of a patient is no longer medically meaningful.
The patient is expected to pass away, and the physician calls the Organ Centre of the NTS to check the patient's status in the Donor Register. This is followed by a process that may end with registering the donor with Eurotransplant.
Donor identification, consultation, and screening
Acute care physicians and Organ Centre donation professional
The NTS has an Organ Centre that is available 24/7 for physicians to check a patient's status in the Donor Register. The donation professional at the Organ Centre consults the Donor Register to verify the patient's choice regarding organ and tissue donation.
If the patient is registered with consent or has left the choice to their next of kin, the donation professional puts the physician in contact with the organ donation coordinator (ODC). The physician is also advised on the next steps to take.
The physician discusses the expectation of the patient's impending death with the family.
More about consulting the Donor Register
Guidance on the organ donation procedure
Organ Donation Coordinator (ODC)
Organ Donation Coordinators (ODCs) specialize in guiding the organ donation procedure. They operate from university hospitals and are available 24/7 in all donor hospitals.
The ODC is called in once contact with the Organ Centre has established that a patient does not rule out donation in the Donor Register. The ODC assists the physician with:
- Determining the medical suitability of the donor
- Investigating any legal aspects
- Logistical aspects
- Preparation of the donation discussion
The ODC initiates tests to map out the medical suitability of each individual organ. The ODC also initiates donor management activities. This is necessary to maintain or even improve organ function as much as possible. Furthermore, the ODC coordinates the logistical planning of the retrieval procedure.
Examination: laboratory and CT scan
Early in the donation process, blood is drawn from the donor and sent to a designated HLA (Human Leukocyte Antigen) laboratory and virology laboratory.
The HLA laboratory performs tissue typing and the virology laboratory conducts the agreed virology tests. This is necessary to assess the suitability of organs for specific recipients in order to minimize the risk of organ rejection after transplantation.
In addition, a CT scan is performed on (potential) organ donors in the Netherlands to better assess the condition of the organs and the anatomy of organs and blood vessels.
Donation discussion
Acute care physician
If the patient is registered in the Donor Register with consent or has left the choice to their next of kin, the physician involved informs the potential donor's next of kin about the registration in the Donor Register during a donation conversation. This only takes place after the physician has spoken with the family about the impending death due to the lack of further treatment options.
The acute care physician (an intensivist, neurologist, or emergency physician) explains the donation procedure. The ODC can, if desired, assist the physician in preparing for the donation conversation with the next of kin and during the conversation itself.
More about donation conversation
Video: what does a donation intensivist do?
Donation intensivist Farid Abdo talks about his work and guiding the family: 'You contribute to a sense of meaning for the family, because the donor organs can save other people's lives.'
Determining death and donor treatment
Intensivist
The patient's death is determined through careful examinations.
Subsequently, the intensivist, possibly with the support of the organ donation coordinator, starts the donor treatment aimed at maintaining or even improving the function of the organs as much as possible.
If necessary, the intensivist can involve the specialized donation intensivist from their own hospital in this process.
Registering the donor and starting logistics
Organ donation coordinator
Once all examinations have been completed and the patient appears suitable as an organ donor, the organ donation coordinator (ODC) registers the organ donor with Eurotransplant for allocation.
The ODC also coordinates the logistics surrounding the donation procedure and communication with the next of kin regarding the process. The intensive care nurse involved in the patient's treatment also maintains contact with the next of kin.
Allocation: fair distribution of organs
Eurotransplant
Speed and precision are of vital importance to find a suitable patient on the waiting list. The NTS is ultimately responsible for the fair allocation of these post-mortem organs.
The NTS has mandated this organ allocation task to Eurotransplant (ET), a collaboration of eight European countries. Thanks to this close European cooperation, we increase the chance of a good match for recipients - even across national borders.
Allocation guidelines
The rules for organ allocation are laid down in Eurotransplant guidelines. Read how this works and view the allocation guidelines.
Video: allocation at Eurotransplant
Josipa Penic is an allocation officer and team leader at Eurotransplant. She provides a glimpse into her work.
Retrieval and transport of organs
The process of organ retrieval (donor surgery) and the transport of the various organs and the surgical team is a race against time. This starts with the transport of the retrieval team to the donor hospital. Great speed is also required for the transport of donor organs to recipient patients.
Process per organ
The process and the professionals involved vary per organ.
Abdominal organs: Independent Retrieval Team (ZUT)
For the retrieval of abdominal organs (kidneys, liver, and pancreas) from the donor, a specialized team comes into action: the Independent Retrieval Team (ZUT). A retrieval team consists of 2 surgeons, one of whom is a specialized retrieval surgeon. In addition, the team consists of an anesthesiologist, an anesthesia assistant, two operating room assistants, and an organ donation coordinator. If necessary, an organ perfusionist also participates.
The Netherlands is divided into 3 retrieval regions, each with its own ZUT team. As soon as they are called up, they travel in a specially equipped ZUT van to the hospital where the donor is located. This van is equipped with all materials for the retrieval surgery.
The donor hospital only needs to make an operating room available. This makes the process efficient and relieves the operating staff of the donor hospital. After the retrieval surgery, the organs are prepared for transport and transported to the recipient's transplant center. This is a major logistical job, often under great time pressure.
Heart and lung: retrieval by thoracic team
If heart and/or lung donation also takes place, a separate surgical team from the recipient's hospital comes to the donor hospital. This team retrieves the heart and/or lungs themselves and then travels to the transplant center to perform the transplant.
Small intestine: removal by team from UMCG
The retrieval of a small intestine for transplantation is very rare. This is done by a surgical team from the University Medical Center Groningen (UMCG) that comes to the donor hospital. This team retrieves the small intestine themselves and then travels to the transplant center to perform the transplant.
Video: What does a retrieval surgeon do?
Mijntje Nijboer is a transplant physician and also a retrieval surgeon. This work is teamwork: 'We sometimes call someone out of bed at 3 a.m. who is not on call. Nobody grumbles, that is the strength of our team.'
Transport of organs
By road
After retrieval, the organs and surgical teams are transported as quickly as possible to the hospital where the transplantation will take place. This is a major logistical task, often under great time pressure.
The NTS is the designated emergency service for this. The NTS has contracted two transport companies in the Netherlands to carry out these special organ transports by road or air:Witte Kruis and Kijlstra.
Each organ is transported in a separate vehicle. The priority vehicles feature their own striping, or stripes that mark the vehicle as an emergency service.
By air
During international exchange of organs, it may be necessary to transport organs by plane. Kidneys usually travel on a scheduled flight. For the other organs, this is done by charter flight. Our collaboration partner Exxaero is responsible for this.
Role of the Organ Perfusionist–Transplant Coordinator (OPTC)
An Organ Perfusionist – Transplant Coordinator (OPTC) is also involved in the retrieval and transplantation of lungs, heart, and liver. After the registration of an organ donor, Eurotransplant calls the OPTC to offer an organ to the recipient on the match list. An exception to this is the kidney: for this, the nephrologist is called.
In consultation with the transplant physician, the OPTC assesses whether the donor organ is suitable and whether it will be accepted for a recipient, and ensures that the donor organs remain cooled and provided with oxygen after retrieval (organ perfusion). This makes it possible to keep the organ viable for longer and improve its quality. It is also possible to test organs to see if they are suitable for transplantation.
The OPTC has been around since 2023. An interview (October 2023) shares the experiences.
Transplantation
Once a donor organ has been retrieved, the final step comes into view: transplantation. This is the step we do it all for. And one in which many parties play an essential role.
The process is not yet completely finished. After the transplantation, the recipient is closely monitored during a follow-up phase. The attending physician monitors the transplanted patient.
- How is the patient doing in the long term?
- How is the donor organ functioning?
To this end, the physician provides medical data to the Dutch Organ Transplantation Registry (NOTR). Using the follow-up data collected nationally within this registry, the quality of transplantation care is monitored at an aggregated level and scientific research is conducted.
Transplantation centers in the Netherlands
In the Netherlands, transplantations are performed at the transplantation centers of the University Medical Centers (UMCs). After the transplantation, the centers provide patient check-ups and track the outcomes.
Each center has its own specialisms, but works closely with the other centers in the country. By pooling knowledge and experience, the centers jointly ensure the best possible care. This is coordinated via the organ advisory committees (OACs).
Which transplantations take place in which transplantation centers?
- Kidneys: Groningen, Leiden, Rotterdam, Utrecht, Amsterdam, Nijmegen and Maastricht
- Pancreas: Groningen and Leiden
- Liver: Groningen, Leiden and Rotterdam
- Heart and lungs: Groningen, Utrecht and Rotterdam
- Small intestine: Groningen
Transplant surgeon
The transplant surgeon performs the surgery with a team and is responsible for the aftercare and check-ups of the patient.
Organ Perfusionist – Transplant Coordinator (OPTC)**
During the transplantation process, the OPTC monitors organ quality and assists with the transplantation process.
National coordination of the donation process
Nationally, regionally, and at the hospital level
Whether it concerns national donation policy or managing processes and organization, the NTS collaborates with various parties to ensure proper coordination regarding organ donation.
To this end, coordinating roles have also been established within and between hospitals to make the donation process as efficient as possible. All of this takes place on behalf of and in coordination with the Ministry of Health, Welfare and Sport (VWS).
NVIC: Donation Committee
The Dutch Society for Intensive Care (NVIC) has a Donation Committee. This committee advises the NVIC board in the field of organ donation and serves as a 'donation advisory committee' for the NTS.
The committee deals with medical-content issues, such as the determination of brain death, donation after euthanasia, and guidelines for medical procedures related to organ donation.
UMCNL
The UMCNL represents the 7 university medical centers.
Within the organ chain, the UMCNL is responsible for properly organizing and qualitatively guaranteeing all activities and for filling crucial positions.
The UMCNL has appointed a business operations manager who coordinates the activities of organ donation coordinators, including scheduling and training.
University medical centers (UMCs)
The NTS enters into a service-level agreement with the university medical centers (UMCs). This agreement stipulates, among other things, that the UMCs sign a covenant with the core hospitals in the region (hospitals where organ donation occurs with some regularity) and that they appoint various officials to coordinate and supervise donation care. The UMCs also ensure regional coordination of donation policy, aligned with national policy, and quality assurance of the donation policy.
View the core and satellite hospitals in the Netherlands here
Supervisor (SV)
The supervisor (SV) is the manager of a donation region. Together with the coordinating donation intensivist and the Regional Team Leader, they are responsible for donation policy and the operational management of the donation organization. The supervisor works in the university medical center. The supervisor provides medical-content guidance to the organ donation coordinators.
(Coordinating) Donation Intensivist ((C)DI)
A donation intensivist (DI) is appointed in every core hospital. They act as the point of contact for doctors in the acute care pathway when dealing with organ donation. The DI also supervises the execution and evaluation of organ donation in the region and ensures that new donation policy is implemented.
In addition, a Coordinating Donation Intensivist (CDI) is active in each donation region. They support the donation intensivists in the region, ensure knowledge sharing and regional donation policy together with the regional team leader and supervisor, and act as an expert on behalf of the region in consultations. The CDI is also a member of the donation committee of the Dutch Society for Intensive Care (NVIC).
Regional team leader (RTL)
The regional team leader (RTL) is affiliated with the university medical center in the donation region and is the operational link between the locally working donation professionals and the NTS. The RTL ensures the optimal functioning of the regional donation organization, together with the supervisor and CDI, and aligns regional policy with national policy. The RTL is the team leader of the organ donation coordinators and is managed by the supervisor.
Organ donation coordinator (ODC)
The organ donation coordinator (ODC) is responsible for the policy and organizational coordination and support of organ donation procedures in hospitals within and outside their own region. The ODC works under the responsibility of the supervisor.
Donation coordinator (DC)
Within the core hospital, the donation coordinator (DC) is the point of contact for the implementation of national donation policy. The DC does this in collaboration with the donation intensivist. The DC also analyzes the hospital's organ and tissue donation data. Furthermore, in collaboration with the organ donation coordinator, the DC ensures the continuity of the knowledge level within the core hospital regarding organ and tissue donation.
Organ and Tissue Donation Committee (COWD)
Each core hospital has an Organ and Tissue Donation Committee (COWD) in which professionals involved in the donation process evaluate how regional donation policy is applied within the hospital and what improvements in policy are possible. The hospital committee also promotes organ and tissue donation within the hospital and reports to the regional UMC.
Regional Consultation on Organ and Tissue Donation (Rodow)
In this consultation, regional donation policy including quality standards is coordinated, cooperation between hospitals is aligned, and national changes are implemented. This consultation is supported by the NTS account managers for the DCs, ODCs, and CDIs and DIs.
Professional association DONOR and ODC-NL
These professional associations for donation coordinators (DONOR) and organ donation coordinators (ODC-NL) aim to professionalize the roles.
National coordination on transplantation policy
In the field of transplantation, the NTS works closely with the Dutch Transplantation Society (NTV) and the organ advisory committees.
NTV
As a scientific association, the NTV develops national transplantation policy and stimulates transplantation research to promote the quality of transplantation care.
The NTV also provides continuing education, clinical review symposia, and ethical symposia, which also address the relationship with organ donation.
Organ Advisory Committees
In national organ advisory committees, medical professionals from university medical centers ensure that the quality of transplant care remains high and that new insights are applied in practice.
Agreements are also coordinated regarding national donation criteria and allocation rules. These committees are a collaboration between the NTV and NTS.
Each committee focuses on themes such as:
- Medical-content issues
- Waiting list management and allocation rules
- Participation in international consultations with Eurotransplant
- Protocols and quality standards
- Monitoring of data and research results (read also: collaborating on data)
- Stimulating and monitoring scientific research
Which committees are there?
LONT: National Consultation on Kidney Transplantation
The LONT advises the NTS and the NTV on policy issues surrounding kidney and pancreas transplantation. For kidney transplantation, this concerns both transplantation of kidneys from deceased donors and transplantation of kidneys from living donors.
The committee ensures good coordination of ongoing projects and deals with the (re)definition of standards, uniform protocols, quality policy, and the setup and progress of scientific research.
LOL: National Consultation on Liver Transplantation
The National Consultation on Liver Transplantation (LOL) deals with substantive issues surrounding liver transplantations and donation of livers.
It involves promoting the quality and safety of liver transplantations in the Netherlands, and the LOL advises, among others, the NTV, NTS, Eurotransplant (ET), and Dutch government agencies.
LOTTO: National Consultation on Thoracic Organ Transplantation
The National Consultation on Thoracic Organs (LOTTO) deals with substantive questions regarding heart and lung retrieval from deceased donors and the transplantation of these organs.
LORUT: National Consultation on Regional Retrieval Teams
The National Consultation on Retrieval Teams (LORUT) deals with substantive questions regarding organ retrieval from deceased donors.
It focuses on promoting the quality of organ retrievals in the Netherlands and advising, among others, NTV, NTS, the ZUT contract partners, Eurotransplant (ET), and Dutch government agencies.
LADTI: National Advisory Committee for Donation and Transplantation Innovation
The National Advisory Committee for Donation and Transplantation Innovation (LADTI) focuses on technological developments and cross-organ innovations in the field of transplantation.
LADTI primarily advises on the alignment of these developments among the various Organ Advisory Committees across the entire donation and transplantation chain.