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A new liver, kidney or heart
In an organ transplant, a non-functioning or poorly functioning organ in someone is replaced by the same organ from someone else; a donor. Unfortunately, the waiting lists are sometimes long and such an organ does not arrive on time for everyone. About 140 people die each year waiting for a donor organ.
A transplant can take place with organs from a deceased (post-mortem) donor, or with an organ from a living donor (for kidney or liver for example).
Which organs?
Organs transplanted in the Netherlands are the kidney, the pancreas, liver, heart, lungs and small intestine. Tissues that are transplanted are the cornea (cornea), heart and vascular valves, bone and tendon tissues and skin.
Transplants are performed in transplant centers. These centers are located in academic hospitals across the country. A patient who wishes to be considered for an organ transplant is referred by his or her attending physician to a hospital where the possible transplant takes place. The doctor at that transplant hospital determines whether someone is eligible for a transplant. If this is the case, the doctor will register the patient for the waiting list at the Dutch Transplantation Foundation (NTS). You will find current figures on the number of transplants and waiting lists here.
What does the law say?
The Organ Donation Act stipulates how the NTS organ center may designate a recipient for a donor organ or tissue. The selection may only take place on the basis of established medical criteria, namely:
• similarity in blood group between the donor and the recipient
• similarity in donor and recipient tissue characteristics
• height and weight of the donor and recipient. This applies to transplants of a heart, lungs and liver
• medical urgency
• if there are two ‘equal’ patients on the waiting list, the donor organ will go to the patient who has been on the waiting list the longest.
Practical aspects such as distance, available time and options for transplantation can also play a role in the allocation of an organ. This is because vital organs outside the body have a limited shelf life.
Blood type
To prevent the donor blood from breaking down in the recipient’s body, a so-called transfusion reaction, patients almost always receive blood from donors with the same blood type. However, transplants have also been performed where the donor’s blood type differed from that of the recipient.
Rejection
The implanted donor organ or tissue is by definition perceived as foreign. If the transplanted patient does not use anti-rejection drugs, his defense mechanism will reject the donor organ or tissue. After all, every person has different tissue characteristics, ie transplant antigens. In medical science this is called the HLA system (Human Leucocyte Antigens).
This system is responsible for the rejection symptoms and is genetically determined. The worse the donor-recipient HLA match, the stronger the rejection symptoms can be after a transplant.
Family and people
Each person may have his own characteristics, but there is a greater degree of tissue similarity between relatives and between some peoples. Certain blood and tissue characteristics may occur more or less in some peoples than in other peoples. As a result, a patient who originally comes from another country can sometimes be helped earlier with an organ from a deceased donor from his country of origin.
After the transplant
After transplantation, the patient still has to come for regular check-ups in the transplant hospital. The doctor examines the patient to see if the transplant was successful. The doctor passes on part of the research data, the so-called follow-up data, to the NTS. The NTS makes an inventory and evaluates the data of all patients who have undergone a transplant. This information is used to improve the long-term outcomes of organ transplants.
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