The coming into effect of the new donor law next Wednesday means that anyone who does not register after September automatically gives permission for organ donation. Nevertheless, the chance that a donor is actually used for organ or tissue transplantation remains small: 1 in 200. How about that?
The main reason that organ donation is so rare is that an organ donor almost always has to die in hospital intensive care. In addition, the organs must also be suitable for transplantation.
Azam Nurmohamed works at the Amsterdam UMC as an internist-nephrologist, a doctor who specializes in kidney diseases and focuses on kidney transplants.
“Most importantly, organs that are taken out are viable,” he says. “When someone dies, body cells decay. There is no more blood circulation, so that organs are no longer perfused. Especially when the body is at room temperature, decay goes very quickly. After three quarters to an hour, organs are usually no longer usable” .
Delay choice because of coronavirus
- The new donor law means that every adult, who does not record her or his choice in the donor register, gives automatic permission for organ donation. Because of the corona crisis, the Dutch have had until September to pass on their choice.
Donor almost always dies on ic
In practice, the bottom line is that organ donors almost always die in an intensive care unit and not even in a normal ward of a hospital. Only on the ICU are patients so strictly monitored and continuously monitored that doctors can remove organs in time.
And even then, many deceased IC patients are not suitable for donation. In principle, patients with cancer or an active infection cannot be used, explains Nurmohamed. “You could then transplant malignant cells or the infection, that should never be the intention.”
Age also plays a role. “As you get older, you start to notice flaws. Not only in your muscle strength and condition, but also the organ function can deteriorate. Old organs usually do less well than young organs.”
According to him, an age limit cannot be linked to this, partly because it differs per body. “We rarely use kidneys from deceased donors aged 75 or older,” he says.
Small group of suitable donors remains
What you are left with suitable donors is a “very small group”, mainly IC patients, who often die after a major accident or a heart attack, cerebral haemorrhage or stroke and are dependent on a respirator and medication. This keeps the heart pumping and blood flowing.
Doctors start thinking about organ donation when an IC patient can no longer recover and there is no point in further treatment.
A doctor may then check whether the patient is in the donor register. If this is not the case, she will discuss whether he can take place with the family or organ donation.
A surgeon, together with an extraction team, performs the operation. The donor’s body then returns to the next of kin. (Photo: Getty Images)
Facts and numbers
- Almost half (49 percent) of all Dutch people over the age of eighteen were registered in the donor register on 2 January.
- Of these more than 6.9 million people, 55 percent were donors. 34 percent did not consent to donation, and 11 percent left that choice to a surviving relative or designated person.
- More women (53 percent) than men (43 percent) had registered in the donor register at the beginning of this year. Women also give permission for organ donation more often than men.
- Almost three-quarters of eighteen and nineteen-year-olds were not yet registered in January.
- 72 percent of people with a non-western migration background were not in the donor register. More so than for people with a western migration background (64 percent) and with a Dutch background (45 percent).
- Source: Central Bureau of Statistics (CBS), June 2020.
In theory, donor can save eight lives
If there is permission for donation, doctors must determine the death. This is the case if the heart is no longer beating or if the patient is brain dead. Strict rules apply to that decision and there are always several doctors involved.
Once death has been established with certainty, suitable recipients are sought. Donor surgery takes about four to six hours to start. In the meantime, suitable recipients are sought and doctors ensure that the donor’s body remains at the proper temperature for donation.
On average, three organs are used, according to figures from the Dutch Transplantation Foundation (NTS). In principle, a person can save eight lives (heart, liver, pancreas, small intestine, two lungs and two kidneys), but this is rare in practice.
According to Nurmohamed, there is almost always a recipient for a good quality organ. Eurotransplant, a transplant network between eight European countries, including the Netherlands, links donors to recipients.
150 patients on waiting list die each year
Last year, 1,271 Dutch people were on the waiting list for an organ, according to annual figures from the NTS. The vast majority of patients (831) waited for a kidney, followed by a lung (172), liver (135), heart (116) or pancreas (46).
On the other hand, organ donors save 800 patients every year. However, it is not the case that most of the waiting list is then helped. After all, new people are constantly being added to the list. About 150 people die each year while on the waiting list.
This waiting list works differently for every body. For kidneys, for example, it does not work as a queue where someone starts at the back and everyone shifts a spot with each transplant. Kidney patients who have been on dialysis for a long time or who have the best DNA match are more likely to be offered a kidney.
‘New donor law creates awareness’
The new donor law will not increase the group of potential suitable donors. The likelihood that a deceased donor will actually donate organs may change, says Nurmohamed. The most important thing, he says, is that the law will “raise public awareness”.
“Because everyone’s choice will soon be determined, relatives and doctors will be less burdened with the difficult decision whether or not a deceased can donate,” said the kidney specialist.