Tissue chain: donation and transplantation
Discover how the tissue chain is organized in the Netherlands 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 guarantee independence and trust in both procedures, and to prevent traceability between donor and recipient. However, the process from donation to transplantation is, of course, precisely coordinated. From the identification of a tissue donor to successful transplantation and aftercare: in every step of the tissue chain, the work of organizations and professionals is aligned.
Commissioned by the Ministry of Health, Welfare and Sport (VWS), the NTS manages the national coordination to optimize processes and cooperation within the tissue chain and to monitor the chain. In addition, through the Organ Center, the NTS performs statutory duties under the Organ Donation Act.
Read also: What does the NTS do?
Organizations and officials in the chain
Below is a general outline of which organizations and officials play a role in the process steps from tissue donation to transplantation.
Tissue donation
From donor identification to donor acceptance
Tissue donation starts the moment a medical professional sees that a patient is expected to pass away. 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. When a medical professional sees that a patient is expected to pass away, 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 performs 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 will now first speak 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 may also take place after death.
Registering a donor
After the patient's death, the medical professional registers the deceased as a donor with the NTS. The medical professional gathers information about the patient in advance, which the donation professional from the Organ Centre requests.
A donor screening physician from the NTS Organ Centre 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 the registration of deceased persons via the donation form.
The DC is also the contact person in the hospital for the implementation of national donation policy, together with the donation intensivist.
Furthermore, the DC analyzes the hospital's organ and tissue donation data. For instance, the DC evaluates afterwards whether the donor identification went well, and together with the organ donation coordinator, the DC ensures that knowledge about organ and tissue donation within the hospital is up to date.
Retrieval of tissues
Mortuary and funeral center
Hospital mortuary staff or staff at a funeral center make preparations for tissue retrieval if necessary.
WUON retrieval team
The donation professional from the Organ Centre instructs the tissue retrieval organization WUON to retrieve tissue(s) from a donor. The specialized teams of WUON 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. Prior to the retrieval, a final physical screening of the donor is conducted by WUON. The team draws blood, retrieves the tissue, performs an 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 as soon as a donor has been accepted by the Organ Centre.
Testing, processing, and storage
Tissue banks ETB-BISLIFE and AER
In the Netherlands, two specialized tissue banks handle the testing, processing, and storage of donor tissues
- Multi-tissue bank ETB-BISLIFE
- Eye tissue bank: Amnitrans EyeBank Rotterdam (AER)
Following the tissue retrieval, employees of a tissue bank perform a quality control 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 for patients awaiting a cornea or a heart valve. The NTS also handles the allocation of heart valves and scarce corneas (HLA-typed corneas). This is done based on allocation rules established in close cooperation with national advisory committees.
When it concerns non-scarce tissue (eye tissue without HLA typing, skin, bone, and tendon tissue), physicians request it directly from a tissue bank, and the tissue bank's allocation officer ensures its assignment. Any waiting list is managed by the bank itself.
More about the 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
(Transplantation) doctor
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 intended for Dutch patients. In addition, exchanges take place with other countries. 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 abroad.
In the Netherlands, tissue transplantations are performed in various treatment centers. After the transplantation, the centers provide patient check-ups and track the outcomes. By combining knowledge and experience, the centers work together to ensure the best possible care. This is managed through the tissue advisory committees.
In which centers in the Netherlands do which transplantations take place?
- Corneal transplantation: in UMC's, peripheral hospitals, and independent treatment centers (ZBC) authorized to do so.
- Heart valve transplantation: only in UMC's.
- 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 in repairing bone fractures, hip surgeries, and jaw implants.
The (transplantation) doctor who needs tissue for a patient (such as a corneal surgeon) registers a patient. This is done with the NTS in the case of scarce tissue and with the tissue bank in the case of non-scarce tissue. The doctor receives an offer.
The treating center receives the tissue and the doctor performs the transplantation. After the transplantation, the patient returns to the transplantation center for check-ups.
The process is therefore not yet entirely complete. 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 tissue functioning?
Regarding corneal transplantations, the medical professional provides medical data to the Dutch Organ Transplantation Registry (NOTR). With the nationally collected follow-up data contained herein, the quality of transplantation care is monitored and research is conducted at an aggregated level.
National coordination
The NTS works together with various parties to ensure good coordination regarding national tissue donation and transplantation policy and the management of the associated processes and organization.
Coordination on policy and research in the field of donation and transplantation care takes place within 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 on corneal transplantation care, among other things. The NTS collaborates with the board of this working group.