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More than six million Dutch people will receive a letter about the new Donor Register in the coming months, with the request to pass on their choice today. What do you need to know and do?
1. What does the letter say?
The letter calls for Today indicate the choice in the Donor Register. So do it right away, is the call. What do you want to happen to your tissues and organs after you die? You have 4 choices. 1. Yes, I want to become a donor, 2. I designate a person who decides after my death, 3. No, I do not want to become a donor and 4. My partner or family decides after my death.
Nothing will change for those who have already made a choice before or against donation after death.
2. I’m not done yet. What happens if I don’t make a choice?
If you do not make a choice after this letter, you will receive another reminder letter. If you do not respond to this, you will receive a letter later this year informing you that you have ‘no objection’ to donation and that you are registered as such. This means that you automatically make all organs and tissues available for transplantation after death. If that is your wish anyway, you can leave it that way, but the Donor Register argues that it should be recorded in the Donor Register. The reason is that a registration provides more clarity about your wishes to relatives. Don’t want to be a donor after death? Or do you want to leave the choice to your partner, family or a self-chosen person? Then make sure to make your choice.
3. What do I need to record my choice?
Log in to the Donor Register with your DigiD and indicate your preferences. You can also tick which organs and tissues may and may not be used. You can always change this choice. No Internet? A paper form is available from the Town Hall and the Donor Info Line: T 0900-821 21 66 (usual call charges).
4. Which organs are removed and which tissues?
Organ donation involves the heart, pancreas, liver, lungs, kidneys and small intestine. Donating tissues involves the skin, heart valves and large body artery, bone tissue and cornea. You can tick what you want to donate, see also question 3.
5. Will thousands of donor organs be added as a result of the new law?
New. The probability that organs will be taken and donated after someone dies, is and remains very small. Organs can only be transplanted when the donor is on a breathing machine. This ensures that the organs are supplied with the necessary oxygen and nutrition. A person can only be an organ donor if he or she is on a ventilator in a hospital at the time of death. This is the case, for example, in the event of a serious stroke or brain haemorrhage, and sometimes also after a traffic accident. This doesn’t happen often. Tissues (such as skin or heart valves) can go without oxygen for a long time. As a result, ventilation is not necessary for tissue donation. Tissue donation is possible after someone dies at home, in a hospital or institution.
6. Suppose someone has a brain haemorrhage, the condition is critical. His or her choice is not recorded in the Donor Register and the family does not want a donation. What then?
Relatives can withhold donation if they know that the loved one would not have wanted it. They must then demonstrate that organ and/or tissue donation does not correspond to the wishes of the person concerned. If the family cannot make this plausible, donation will follow. It is therefore important that your partner and family know what your choice is, and that you enter your choice in the Donor Register.
7. Can someone be a donor after euthanasia?
Yes, that’s possible. The GP must then make certain preparations and must therefore be informed well in advance. Euthanasia is usually done at home. If someone wants to be an organ donor, the euthanasia has to take place in the hospital, so that the organs can be removed in the operating room within a short time after death. In the case of tissue donation, euthanasia at home is possible.
8. Will my mother with dementia soon be an automatic donor?
Someone who is mentally incapacitated, for example due to advanced dementia, cannot decide on organ donation. Are you automatically not a donor if you become demented? Not that either. People who are mentally incapacitated have a legal representative. They can pass on their choice to the Donor Register. If no one has registered anything in the Donor Register upon death, the mother is automatically registered there with ‘no objection to donation’. If after death it appears that the mother was mentally incompetent when receiving the letters from the Donor Register, the next of kin will be asked after the death what the wish was.
9. Can you be too old to become an organ donor?
There is no maximum age for some organs, but the heart of a 74-year-old, for example, is no longer suitable for donation. Eye tissues can be donated up to age 85.
10. What if you have been seriously ill, are on medication or have smoked all your life?
A doctor determines whether someone is suitable as a donor. If the deceased has cancer, organ donation is usually not possible. But it is possible with certain types of cancer, just like with a well-treated cancer in the past. Active infections with tuberculosis, HIV or herpes zoster can make you unsuitable for tissue donation. The criteria for organ donation are more flexible than for tissue donation. Doctors have to, because of the scarcity of organs and the risk of death of people on the waiting list
11. I want my loved ones to be there when I die. Can I still be an organ donor?
Family can say goodbye. However, there is limited time for farewell in the case of organ donation in hospital, because the removal must take place soon after death. This has to do with the quality of the organs. There is a special hospital employee who accompanies the family. If someone has died and is an organ donor, the body is still on a ventilator. So the heart is still beating, but the brain is dead. After the farewell, the body is taken to the operating room. Once the organs and tissues have been removed, the body is handed over to the next of kin. The deceased can then be laid out in the usual manner. The donation will not affect the funeral.
12. I’m afraid I’m not really dead yet when my organs are extracted. Is that fear justified?
No, says the Transplantation Foundation. You only become a donor of organs and tissues if several doctors have declared you brain dead. A person is not brain dead until extensive research has made it clear that he or she no longer responds to stimuli, and that the brain no longer shows electrical activity and blood flow. In other words, the donor can no longer feel pain and is no longer conscious. Doctors have to follow special protocols to find out if someone is actually brain dead. Numerous checks have been built in here, such as the absence of a reaction to pain. With brain death there is no chance that someone will regain consciousness.
13. I would like to decide for myself to whom I donate after my death. Is that possible?
New. This is regulated by law. One reason for this is that everyone in the Netherlands should be able to receive the same healthcare. An organ is sent to the patient on the waiting list who needs it most urgently and for whom the organ is the best fit.
More information about donating can be found at www.donorregister.nl and on www.transplantationstichting.nl.
This article appeared in edited form earlier in Plus Magazine June 2020. Want to subscribe to the magazine? You can do that in an instant!
Sources):
- Plus Magazine