How does an organ transplant come about?

A Monday afternoon in March. Organ donation coordinator Rianne van Zoggel of Radboudumc in Nijmegen has already completed a seven-hour shift when the phone rings at 5 p.m. It is the Dutch Transplantation Foundation. A patient in the west of the Netherlands has been declared brain dead and is registered as a donor. Van Zoggel calls the IC doctor of the hospital in question to discuss the donor’s medical history. “I want to know if the patient had high blood pressure or diabetes, what medications he was taking and whether he had cancer.”

After the call, the ICU doctor arranges a blood and urine test, an abdominal ultrasound, a picture of the lungs and a lung examination to check whether the patient has something in the sufferers that makes one of the organs medically unfit. At Van Zoggel, the driver is now at the door to take her to the hospital in question.

Donorprofiel

8:00 PM in the evening. Van Zoggel arrives at the hospital and goes straight to the donor’s partner and his daughter. They have a nice conversation and the family is fully behind the organ donation. “I think it’s very important to hear what the family wants, even if someone is registered as a donor. If a donation procedure gets in the way of their grieving process, I don’t think we should do it.” Ultimately, the IC doctor makes the decision based on the conversation with the next of kin.

After the conversation, the organ donation coordinator finds a computer and starts working on a donor profile. In it she puts the results of the examinations requested by the IC doctor, together with information about, for example, height, weight and medical details. To do this, she goes through the medical history, checks with the donor whether she sees any particularities on the body that are not in the file and calls the doctor. “This is a lot of work, but you have to be sure that you have not missed anything and that you are submitting a diseased organ for a transplant, for example.”

The lungs, liver, kidneys, heart valves and pancreas appear suitable for donation. The heart cannot be used because of the donor’s age. It is midnight when she finishes and sends the donor profile to Eurotransplant. This European organization immediately starts looking for suitable recipients in eight countries: the Netherlands, Austria, Slovenia, Luxembourg, Croatia, Germany, Hungary and Belgium.

Match wanted

Eurotransplant calls. The organization passes on a match list with potential recipients. Van Zoggel calls the relevant hospitals to see whether the available organs would suit their patients, but also whether there is time and space for a transplant. She keeps calling until she has found a place for all organs. When she’s done, it’s 2:30 AM.

She calls on the Independent Removal Team (ZUT) from the region: a team of doctors and surgical assistants with its own OR organ donation coordinator. They remove the liver, kidneys, heart valves and pancreas from the donor’s body.

Because the donor also donates his lungs, Van Zoggel calls the surgery team of the receiving hospital. Lung and heart operations are highly specialized; that is why surgery teams for those organs come to the donor hospitals. “In this case, two teams came to the OR. Then it is quite busy in the operating room.”

Organs on transport

Now that the organs have been assigned a destination, Van Zoggel’s work is almost over. All she has to do is arrange the White Cross transport cars to take the liver and kidneys to the various teaching hospitals where the recipients are located. The heart valves go to the tissue bank in Beverwijk where they are stored until a suitable donor is found. They can be kept there for five years.

At 03.00 she is picked up by the driver and brought home. On the drive home, she makes a transfer for her colleague who takes over the procedure from her the next morning. At 4.30 am she goes to bed. She is tired but satisfied.

A few hours later, her colleague arranges for the donor operation to start at 10:00, as discussed with the family. Van Zoggel’s colleague takes their deceased husband and father to the OR with the family. Then the family goes home.

Once removed, it is important that the donor organs reach their new owner as soon as possible.

Still rejected

From that moment on, time starts ticking. The lungs must be in the recipient’s body within six hours of surgery. The liver within twelve hours. There is a little more time for the kidneys. For this, the operation of the recipient must take place within 24 hours. The pancreas will be used for scientific research.

By the time the organs are out it’s 2pm. The kidneys are connected to a perfusion machine that flushes the organs with fluid to keep them healthy. All organs appear to be suitable. Except one heart valve. It is still rejected. Van Zoggel is awake again and calls the donor’s family to tell them that everything went well.

Meanwhile, the other caregivers are working hard. They quickly put the liver and kidneys in the transport vehicles, on their way to the recipients. The couriers deliver the organs to the porters and from then on the receiving hospitals take over. The surgery team that came for the lungs takes them to their own hospital with sirens on the lungs. The OR teams in all hospitals are ready to operate on the patients and give them the new organs. More than a day after the first phone call, the recipients wake up with their new organ.

Support and comfort

Seven weeks after her service in the west of the country, Van Zoggel calls the donor’s family and asks if they want to know how the recipients are doing. They want that. She tells Van Zoggel that the lungs were transplanted in a woman aged 50-55. The liver was transplanted in a man aged 60-65. One kidney went to a man aged 25-30 and the other to a man aged 60-65. All transplants went well. She is not allowed to say more about it, but the family is happy to receive this information, it gives them support and comfort.

In 2019, 428 kidneys were transplanted, 168 livers, 123 lungs and 38 hearts. It almost never happens that an organ eventually does not get a place. Eurotransplant and the organ donation coordinator keep calling until they find a hospital that wants the organ. It only happened during the corona pandemic that there was nowhere an OR and IC place available.

Children can also donate. Van Zoggel: “The only difference is that before we start talking to the family, we check whether there are any patients on the Eurotransplant waiting list. If they don’t show up, we don’t have to ask the family anything.”


Source: Kennislink by www.nemokennislink.nl.

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