Tissue chain: donation and transplantation
Discover how the tissue chain in the Netherlands is organized and which professionals work together from donor identification to transplantation.
Coordination of processes: role of NTS
In the Netherlands, donation and transplantation are strictly separated to ensure independence and trust in both procedures and to prevent traceability between donor and recipient. The process from donation to transplantation is, of course, closely coordinated. From identifying a tissue donor to successful transplantation and aftercare: the work of organizations and professionals is aligned at every step of the tissue chain.
On behalf of the Ministry of Health, Welfare and Sport (VWS), the NTS manages the processes and collaboration in the tissue chain nationwide to ensure they run optimally and to monitor the chain. In addition, the NTS carries out statutory tasks via the Organ Center based on the Organ Donation Act.
Read also: What does the NTS do?
Organizations and officials in the chain
The following is a broad outline of which organizations and officials play a role in the process steps from tissue donation to transplantation.
Tissue donation
From donor identification to acceptance of the donor
Tissue donation starts the moment a medical professional sees that a patient is expected to die. Tissue donation can take place up to 24 hours after death, and a potential donor can be registered from both the hospital and the home situation.
Consulting the Donor Register
The NTS has an Organ Center that is available 24/7 for medical professionals to check a patient's status in the Donor Register. If a medical professional sees that a patient is expected to die, the medical professional calls the NTS Organ Center to consult the Donor Register.
The donation professional at the Organ Center consults the Donor Register to check the patient's choice regarding organ and tissue donation. If the patient has given consent for donation, the Organ Center makes an initial assessment of whether donation is possible.
Video: Donation professional at work
Tim van der Wiel is a donation professional at the NTS Organ Center. He talks about his work: 'Accepting a donor is the goal of a workday.'
Donation conversation
The medical professional first speaks with the family about the expectation that the patient will pass away and about their choice in the Donor Register, the so-called donation conversation. In the case of tissue donation, this conversation can also take place after death.
Registering a donor
After the patient has passed away, the medical professional registers the deceased as a donor with the NTS. The medical professional collects data about the patient in advance, as requested by the donation professional from the Organ Center.
A donor screening physician from the NTS Organ Center performs the medical screening of the donor and assesses whether a deceased person is accepted for donation and whether the donated tissue can be released for transplantation.
Laboratory testing
Early in the donation process, blood is drawn from the donor and sent to a designated virology laboratory. For specific tissue, blood is also drawn for HLA typing.
What is the role of a donation coordinator (DC)?
The donation coordinator (DC) works in a hospital and has a supportive and administrative role in entering data into NTS applications, such as registering the deceased via the donation form.
The DC is also the point of contact in the hospital for the implementation of the national donation policy, together with the donation intensivist.
Furthermore, the DC analyzes the hospital's organ and tissue donation data. For example, the DC assesses afterwards whether the donor identification process went well. And together with the organ donation coordinator, the DC ensures that knowledge about organ and tissue donation in the hospital is up to standard.
Tissue retrieval
Mortuary and funeral home
Mortuary staff at a hospital or staff at a funeral home make preparations for tissue retrieval if necessary.
Retrieval team WUON
The donation professional from the Organ Center instructs the tissue retrieval organization WUON to retrieve tissue from a donor. WUON's specialist teams are available 24 hours a day to retrieve tissues, whether it concerns bone and tendon tissue, heart valves, skin, or eye tissue.
The retrieval takes place in hospitals and mortuaries throughout the Netherlands. The team uses only its own materials for this. Before the retrieval, a final physical screening of the donor is performed by WUON. The team collects blood, retrieves the tissue, performs initial processing, and ensures the tissue is transported to a tissue bank.
Video: Working at WUON
Charlotte van Koesveld is an employee at WUON. She talks about her coordinating role, which begins once a donor has been accepted at the Organ Center.
Testing, processing, and storage
Tissue banks ETB-BISLIFE and AER
In the Netherlands, two specialized tissue banks are responsible for the testing, processing, and storage of donor tissues
- Multi-tissue bank ETB-BISLIFE
- Eye tissue bank: Amnitrans EyeBank Rotterdam (AER)
After the tissue has been retrieved, employees of a tissue bank perform a quality check on the retrieved tissue and prepare it for transplantation.
Read more:
Release and allocation of tissues
NTS allocation officer and tissue bank, NTS donor screening physician
The NTS donor screening physician indicates whether the tissue is suitable for transplantation.
The NTS manages the waiting list of patients waiting for a cornea or a heart valve. The NTS also carries out the allocation of heart valves and corneas that are scarce (HLA-typed corneas). This is done based on allocation rules established in close cooperation with national advisory committees.
If it concerns non-scarce tissue (eye tissue without HLA-typing, skin, bone, and tendon tissue), doctors request it directly from a tissue bank, and the tissue bank's allocation officer handles the assignment. Any waiting list is managed by the bank itself.
More about allocation of donor tissues
Video: Working at a tissue bank
In the video, Antoon van den Bogaerdt (ETB-BISLIFE) and Jacqueline van der Wees (AER) talk about working at a tissue bank.
Transplantation and follow-up
(Transplant) physician
Once donor tissue has been released for transplantation, the final step comes into view: the transplantation. This is the step we do it all for. Dutch tissue is primarily for the Dutch patient. In addition, exchange with other countries takes place. For example, in the event of a shortage in the Netherlands, tissue can be imported from abroad. In the event of a surplus, tissue can be supplied to other countries.
In the Netherlands, tissue transplantations are performed in various treatment centers. After the transplantation, the centers provide check-ups for the patients and track the outcomes. By pooling knowledge and experience, the centers work together to ensure the best possible care. This is coordinated through the tissue advisory committees.
In which centers in the Netherlands do which transplantations take place?
- Corneal transplantation: in UMCs, peripheral hospitals, and independent treatment centers (ZBCs) that are authorized to do so.
- Heart valve transplantation: only in UMCs.
- Skin transplantation: in centers that treat (burn) wounds and perform reconstructions.
- Bone and tendon tissue: in all hospitals where patients need bone tissue, for example, for repairing bone fractures, hip surgeries, and jaw implants.
The (transplant) physician who needs tissue for a patient (such as a corneal surgeon) registers a patient. This is done with the NTS if it concerns scarce tissue, and with the tissue bank if it concerns non-scarce tissue. The physician receives an offer.
The treatment center receives the tissue and the physician performs the transplantation. After the transplantation, the patient returns to the transplant center for check-ups.
The process is not yet fully completed at that point. After the transplantation, the recipient is closely monitored in a follow-up phase.
The involved physician monitors the transplanted patient:
- How is the patient doing in the long term?
- How is the donor tissue functioning?
Regarding corneal transplantations, the medical professional provides medical data to the Dutch Organ Transplant Registry (NOTR). With the follow-up data collected nationally in this registry, the quality of transplant care is monitored and research is conducted at an aggregated level.
National coordination
The NTS collaborates with various parties to ensure proper coordination regarding national tissue donation and transplantation policy, and to manage the associated processes and organization.
Coordination regarding policy and research in the field of donation and transplantation care takes place in the Cornea Committee, which is supported by a secretary from the NTS, and the Heart Valve Advisory Committee. In addition, corneal surgeons within the Cornea Working Group of the Netherlands Ophthalmological Society make agreements regarding, among other things, corneal transplantation care. The NTS works together with the board of this working group.