Organ chain: donation and transplantation
Discover how the organ chain in the Netherlands is organized and which professionals work together from donor identification to transplantation.
In the Netherlands, donation and transplantation are strictly separated to ensure the independence of and trust in both procedures, and to prevent traceability between donor and recipient.
Coordination of processes: role of the NTS
The process from donation to transplantation is, of course, precisely coordinated. From identifying an organ donor in the hospital to successful transplantation and aftercare: the work of organizations and professionals is aligned at every step of the organ chain.
On behalf of the Ministry of Health, Welfare and Sport (VWS), the NTS provides national oversight to ensure that this coordination of processes and cooperation within the organ chain runs optimally and to monitor the chain.
In addition, the NTS carries out statutory tasks via the Organ Center based on the Organ Donation Act. The NTS also has various executive tasks, such as managing waiting lists and procuring logistics for the transport of retrieval teams and organs (from donor hospital to transplant centers).
Organizations and officials in the chain
Below is a broad outline of which organizations and officials play a role in the process steps from organ donation to transplantation.
Organ donation procedure
The organ donation procedure starts the moment doctors in acute care (emergency department or intensive care) decide that treatment will be stopped because continuing to treat a patient is no longer medically meaningful.
The patient is expected to pass away, and the doctor calls the NTS Organ Center to ask how this patient is registered in the Donor Register. This is followed by a process that may end in the registration of the donor with Eurotransplant.
Donor identification, consultation, and screening
Doctors in acute care and the NTS Organ Center donation professional
The NTS has an Organ Center that is available 24/7 for physicians to check a patient's status in the Donor Register. The Organ Center's donation professional consults the Donor Register to verify the patient's choice regarding organ and tissue donation.
If the patient is registered in the Donor Register with consent or has left the decision to their next of kin, the donation professional puts the physician in contact with the organ donation coordinator (ODC). The physician also receives advice on the next steps to take.
The physician talks to the family about the expectation that the patient will pass away.
More about consulting the Donor Register
Guidance for the organ donation procedure
Organ donation coordinator (ODC)
Organ donation coordinators (ODCs) are specialized in guiding the organ donation procedure. They work from university hospitals and are available 24/7 in all donor hospitals.
The ODC is called in once it is clear after contact with the Organ Center that a patient has not ruled out donation in the Donor Register. The ODC provides the physician with support regarding:
- Determining the medical suitability of the donor
- Investigating any legal aspects
- Logistical aspects
- Preparation for the donation conversation
The ODC initiates examinations to map out the medical suitability of each organ. The ODC also starts activities for donor management. This is necessary to maintain or even improve the function of the organs as much as possible. The ODC also arranges 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 handles tissue typing and the virology laboratory performs the agreed-upon virology tests. This is necessary to examine the suitability of organs for specific recipients in order to reduce the risk of organ rejection after transplantation.
In addition, a CT scan is performed on (potential) organ donors in the Netherlands to have a better assessment of the condition of an organ and the anatomy of organs and blood vessels.
Donation conversation
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 attending physician will inform the potential donor's next of kin about the registration in the Donor Register during a donation discussion. This only happens 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. If desired, the ODC can assist the physician in preparing for the donation discussion with the next of kin and during the discussion itself.
More about the donation discussion
Video: what does a donation intensivist do?
Donation intensivist Farid Abdo talks about his work and guiding the family: 'You contribute to finding meaning for the family, because the donor organs can save the lives of other people.'
Determining death and donor treatment
Intensivist
The patient's death is determined through careful examinations.
Subsequently, the intensivist, possibly with support from the organ donation coordinator, starts donor treatment, intended to maintain or even improve 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 donor and starting logistics
Organ donation coordinator
Once all examinations are completed and the patient proves to be 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 care are vital to finding 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 toEurotransplant (ET), a partnership of eight European countries. Thanks to this close European cooperation, we increase the chances of a good match for recipients – even across national borders.
Allocation guidelines
The rules for organ allocation are set out 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 an insight into her work.
Organ retrieval and transport
The process of organ retrieval (donor surgery) and the transport of the various organs and the surgical team is a race against time. This begins 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 differ per organ.
Abdominal Organs: Independent Retrieval Team (IRT)
For the retrieval of abdominal organs (kidneys, liver, and pancreas) from the donor, a specialized team is deployed: the Independent Retrieval Team (ZUT). A retrieval team consists of two surgeons, one of whom is a specialized retrieval surgeon. In addition, the team includes an anesthesiologist, an anesthesia assistant, two surgical assistants, and an organ donation coordinator. If necessary, an organ perfusionist also participates.
The Netherlands is divided into three retrieval regions, each with its own ZUT team. Once called up, they travel in a specially equipped ZUT bus to the hospital where the donor is located. This bus is equipped with all the materials needed for the retrieval surgery.
The donor hospital only needs to provide an operating room. This makes the process efficient and relieves the donor hospital's surgical staff. After the retrieval surgery, the organs are prepared for transport and taken to the recipient's transplant center. This is a significant logistical task, 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 travels from the recipient's hospital 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: retrieval by team from UMCG
The retrieval of a small intestine for transplantation is very rare. This is performed by a surgical team from the University Medical Center Groningen (UMCG) that travels to the donor hospital. This team retrieves the small intestine themselves and then travels to the transplant center to perform the transplantation.
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 isn't on duty. No one complains; 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 transplant 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 have their own striping, or stripes that mark the vehicle as an emergency service.
By air
In the case of international exchange of organs, it may be necessary to transport organs by plane. Kidneys usually go on a scheduled flight. For other organs, this is done by charter flight. Our partner Exxaero is responsible for this.
Role of 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 an organ donor is registered, 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 supplied with oxygen after retrieval (organ perfusion). This allows the organ to be kept in good condition for longer and improves its quality. It is also possible to test organs to see if they are suitable for transplantation.
The OPTC has been around since 2023. You can read about the experiences in an interview (October 2023).
Transplantation
Once a donor organ has been retrieved, the final step comes into view: the 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 fully completed at that point. After the transplantation, the recipient is closely monitored in 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?
The physician provides medical data on this for the Dutch Organ Transplant Registry (NOTR). With the follow-up data collected nationally in this registry, the quality of transplant care is monitored at an aggregated level and scientific research is conducted.
Transplant centers in the Netherlands
In the Netherlands, transplants are performed at the transplant 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 specialties but works closely with the other centers in the country. By pooling knowledge and experience, the centers work together to provide the best possible care. This is coordinated through the organ advisory committees (OACs).
In which transplant centers do which transplants take place?
- 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 operation with a team and is responsible for the patient's aftercare and check-ups.
Organ Perfusionist – Transplant Coordinator (OPTC)
In the transplant process, the OPTC monitors the quality of the organ and assists with the transplant process.
National coordination regarding the donation process
National, regional, and hospital level
Whether it concerns national donation policy or managing processes and organization, the NTS works together with various parties for proper coordination regarding organ donation.
In this context, coordinating roles have also been established within and between hospitals to ensure the donation process runs as efficiently as possible. All of this is done 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 on matters of organ donation and serves as a 'donation advisory committee' for the NTS.
The committee deals with medically substantive issues, such as the determination of brain death, donation after euthanasia, and guidelines for medical procedures for organ donation.
UMCNL
The UMCNL represents the 7 university medical centers.
For the organ chain, the UMCNL is responsible for properly organizing and ensuring the quality of all activities and for filling crucial positions.
The UMCNL has appointed an operations manager who coordinates the work of organ donation coordinators, including scheduling and training.
University medical centers (UMCs)
The NTS enters into a service agreement with the university medical centers (UMCs). This regulates, among other things, that the UMCs enter into 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 guide donation care. The UMCs also ensure regional coordination regarding 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 the donation policy and for the operational management of the donation organization. The SV works in the university medical center. The supervisor provides medical-substantive guidance to the organ donation coordinators.
(Coordinating) Donation Intensivist ((C)DI)
A donation intensivist (DI) is appointed in every core hospital. They act as a point of contact for doctors in the acute care pathway when they are 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 each donation region, a Coordinating Donation Intensivist (CDI) is also active. 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-based 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)
The donation coordinator (DC) is the point of contact within the core hospital 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. In collaboration with the organ donation coordinator, the DC ensures the continuity of the knowledge level regarding organ and tissue donation in the core hospital.
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 the regional donation policy is applied in the hospital and what improvements in policy are possible. The hospital committee also promotes organ and tissue donation in the hospital and reports to the UMC in the region.
Regional Consultation on Organ and Tissue Donation (Rodow)
In this consultation, donation policy, including quality standards, is coordinated regionally, cooperation between hospitals is aligned, and national changes are implemented. This consultation is supported by the NTS account managers for the DCs, ODCs, 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 these 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 society, 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 centers ensure that the quality of transplant care remains high and that new insights are applied in practice.
Coordination also takes place 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-substantive issues
- Waiting list management and allocation rules
- Participation in international consultations with Eurotransplant
- Protocols and quality standards
- Monitoring of data and research results (also read: collaborating on data)
- Stimulating and monitoring scientific research
Which committees are there?
LONT: National Kidney Transplantation Consultation
The LONT advises the NTS and the NTV on policy-related 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 proper coordination of ongoing projects and is involved in (re)defining standards, uniform protocols, quality policy, and the setup and progress of scientific research.
LOL: National Consultation on Liver Transplantation
The National Liver Transplantation Consultation (LOL) deals with substantive questions surrounding liver transplantations and liver donation.
It concerns the promotion of 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 providing advice to, among others, NTV, NTS, ZUT contract partners, Eurotransplant (ET), and Dutch government agencies.
LADTI: National Advisory Committee on Donation and Transplantation Innovation
The National Advisory Committee on Donation and Transplantation Innovation (LADTI) focuses on technological developments and cross-organ innovations in the field of transplantation.
LADTI specifically advises on the coordination of these developments between the various Organ Advisory Committees throughout the entire donation and transplantation chain.