Every step of the organ preparation process is designed to ensure the safety, quality, and success of the transplant. Medical teams work closely together to guarantee a smooth and efficient transition of the organ from the donor to the recipient.

The typical process includes the following steps:

1. Organ Procurement
   Organ retrieval is performed under strict surgical conditions by a specialized transplant team. Organs are removed as soon as possible after brain death or circulatory death has been confirmed. During the procedure, the organs are flushed with a preservation solution to maintain their viability. The maximum preservation times before transplantation are:
   • Heart: up to 4 hours
   • Small intestine: up to 6 hours
   • Lungs: up to 10 hours
   • Liver: up to 12 hours
   • Pancreas: up to 12 hours
   • Kidneys: up to 24 hours
   These time limits represent the period during which each organ can be preserved under optimal conditions.
2. Organ Evaluation
   After retrieval, the organ is carefully assessed to ensure it is suitable for transplantation. Blood tests and other medical examinations help evaluate organ function and identify any potential risk of infection or disease. For example, kidney function is assessed before a kidney transplant.
3. Recipient Selection
   While the donor is being cared for, Eurotransplant searches its centralized database to identify the most compatible recipient based on medical and allocation criteria.
4. Storage and Transport
   Organs are transported as quickly as possible from the donor hospital to the transplant center. During transport, they are stored in sterile containers with preservation solution and ice to maintain a stable, low temperature and minimize tissue damage.
5. Recipient Preparation
   At the same time, the recipient is prepared for surgery. This includes a final medical assessment, compatibility confirmation, and preparation for the transplant procedure. Immunosuppressive medication may also be started to reduce the risk of rejection.
6. Transplantation
   As soon as the organ arrives at the transplant center, it is prepared for implantation. The transplant surgery is performed using techniques specific to each organ. Timing is critical to maximize the chances of a successful transplant.
7. Post-Transplant Follow-up
   After surgery, the recipient is closely monitored for signs of organ rejection, infection, or other complications. Lifelong medical follow-up and adherence to immunosuppressive treatment are essential to ensure the long-term success of the transplant.

The criteria for receiving an organ transplant depend on a combination of medical, psychological, and logistical factors. The main considerations include:

1. Medical Need
   The primary criterion is medical necessity. Patients with end-stage organ failure or serious diseases affecting vital organs may be considered for transplantation.
2. Medical Evaluation
   Candidates undergo a comprehensive medical assessment to determine whether they are fit enough to undergo transplant surgery and the lifelong immunosuppressive treatment that follows. This evaluation includes tests of other organ functions, screening for infections or other diseases, and an overall assessment of health.
3. Compatibility
   Recipients must be compatible with potential donors in terms of blood type and tissue characteristics. A high level of compatibility reduces the risk of organ rejection and improves transplant outcomes.
4. Organ Availability
   Patients must be registered on the national transplant waiting list. When an organ becomes available, allocation is based on several factors, including medical urgency, waiting time, donor-recipient compatibility, and logistical considerations.
5. Psychological Assessment
   Candidates are evaluated to ensure they are psychologically prepared for transplantation and understand the responsibilities, risks, and lifestyle changes associated with the procedure.
6. Commitment to Treatment
   Transplant recipients must be willing and able to follow lifelong immunosuppressive therapy and attend regular medical follow-up appointments. Adherence to treatment is essential to reduce the risk of organ rejection.
7. Organ-Specific Criteria
   Each type of transplant has its own eligibility requirements. For example, kidney transplantation may take into account the remaining level of kidney function, while heart transplantation is primarily based on the severity of heart failure.

Organ transplant waiting lists are managed at the national level, and organ allocation follows strict medical criteria to ensure that available organs are offered fairly and to the patients with the greatest need and the highest likelihood of a successful transplant.

Belgium is a member of Eurotransplant, an international organization that coordinates organ allocation and transplantation across several European countries.

Founded in 1967 by Professor J.J. Van Rood, Eurotransplant is a non-profit organization headquartered in Leiden, the Netherlands. Its mission is to ensure that donated organs are allocated fairly and efficiently, giving patients the best possible chance of receiving a compatible transplant.

The organization coordinates organ donation and transplantation in eight European countries:

• Austria
• Belgium
• Croatia
• Germany
• Hungary
• Luxembourg
• The Netherlands
• Slovenia

By sharing organs across borders, Eurotransplant increases the likelihood of finding the most suitable recipient while making the best possible use of every donated organ.

The main responsibilities of Eurotransplant include:

1. Waiting List Management
   Eurotransplant maintains a centralized waiting list for each transplantable organ, including the heart, kidneys, liver, lungs, pancreas, and intestines. Patients are registered by their transplant physicians. Organ allocation is based on medical criteria such as blood and tissue compatibility, the urgency of the transplant, the severity of the patient’s condition, waiting time, and other clinical factors.
2. Organ Allocation
   Organs are allocated using transparent medical algorithms designed to ensure fairness while maximizing the likelihood of a successful transplant. The medical, serological, and administrative information of all patients on the waiting list is centralized at Eurotransplant’s headquarters in Leiden, where the most suitable recipient is identified whenever a donor organ becomes available.
3. Research and Education
   Eurotransplant supports scientific research and contributes to the education of healthcare professionals. By collecting and sharing clinical data and research findings, the organization helps improve transplantation practices and patient outcomes.
4. International Cooperation
   Eurotransplant works closely with healthcare authorities and transplant organizations throughout Europe to promote organ donation and facilitate cross-border transplantation. This cooperation is especially valuable in rare or urgent situations, such as finding a compatible donor for a newborn or a patient with uncommon medical characteristics.
5. How Eurotransplant Operates
   Whenever a potential organ donor is identified within a Eurotransplant member country, the local transplant coordinator notifies Eurotransplant and provides the donor’s medical information. Once the most appropriate recipient has been identified, Eurotransplant informs the transplant coordinator at the receiving hospital and provides all relevant logistical information, including:
   • Organ retrieval time
   • Distance between donor and recipient
   • Transportation arrangements
   • Estimated delivery times
   After the transplant has been successfully completed, the transplant coordinator reports the procedure to Eurotransplant, and the recipient is removed from the waiting list.

Although organ allocation is coordinated internationally, Belgium gives priority to Belgian patients for certain organs, including the heart, lungs, liver, and pancreas. These organs are only offered to another Eurotransplant country when there is no suitable Belgian recipient or when another country has a patient with an exceptional level of medical urgency. Likewise, Belgium may receive organs from other member countries when Belgian patients require urgent transplantation.

This international cooperation and solidarity help ensure that donated organs are used as effectively as possible while reducing waiting-list mortality across all participating countries.

Many organs can be transplanted to treat serious illnesses or organ failure. Below is a list of the main organs that can be transplanted.

1. Kidney
   The kidney is the most frequently transplanted organ. Kidney transplants are common in people with end-stage renal failure or chronic kidney disease who require regular dialysis.
2. Liver
   The liver can also be transplanted. Liver transplants are used to treat conditions such as cirrhosis, hepatitis, and liver cancer. The liver is unique because it can be partially transplanted, making living donor liver transplantation possible.
3. Heart
   Heart transplants are performed for patients with severe heart failure or irreversible heart disease. They can save the lives of patients who no longer respond to conventional medical treatments.
4. Lung
   Lung transplants are used to treat serious lung diseases, such as pulmonary fibrosis or chronic obstructive pulmonary disease (COPD). Depending on the patient’s condition, one or both lungs may be transplanted.
5. Pancreas
   Pancreas transplants are generally performed for patients with severe type 1 diabetes, often alongside a kidney transplant. This procedure can restore insulin production and improve blood sugar control.
6. Intestines
   Intestinal transplants are less common but may be necessary for patients with severe intestinal disorders, such as Crohn’s disease or intestinal failure.
7. Multivisceral Transplantation
   Multivisceral transplantation involves transplanting several abdominal organs, such as the liver, intestines, pancreas, and others. It is typically performed in cases of complex diseases or certain cancers.
8. Cornea
   Although the cornea is considered a tissue rather than an organ, corneal transplants are among the most common transplant procedures. They are used to restore vision or treat damaged or diseased corneas.

Each type of transplant has its own specific procedures and eligibility criteria. Organs may come from deceased or living donors, depending on the type of transplant and the recipient’s condition. The success of a transplant depends on several factors, including donor-recipient compatibility, ongoing medical follow-up, and adherence to post-transplant treatment.

Elk type transplantatie vereist specifieke procedures en criteria. Organen kunnen afkomstig zijn van overleden donoren of levende donoren, afhankelijk van het type orgaan en de toestand van de ontvanger. Het succes van de transplantatie hangt af van veel factoren, waaronder compatibiliteit, medische nazorg, en de naleving van de behandelingen na de transplantatie.

The organ donation and transplantation process is carefully coordinated to ensure the safety of the donor and recipient while maximizing the chances of a successful transplant. In Belgium, the procedure generally follows these steps:

1. Donor Identification
   The process begins when a potential donor is identified in a hospital, usually after brain death or circulatory (cardiac) death has occurred in a critical care unit. The attending physician contacts the transplant coordinator, who first checks the National Register to determine whether the person registered a decision regarding organ donation. If no refusal has been recorded, the healthcare team consults the family to determine whether they are aware of the deceased person’s wishes. In every case, the donor’s expressed wishes are respected.
2. Declaration of Death
   Brain death or circulatory death must be formally confirmed before organ donation can proceed. The diagnosis is independently certified and signed by three physicians who are not members of the transplant team. This documentation is included in the patient’s medical record and retained for 10 years. Brain death is the irreversible loss of all brain function, including the ability to breathe independently and all brainstem reflexes. It may result from severe head trauma, prolonged cardiac arrest, or a major stroke. Circulatory (cardiac) death occurs when the heart permanently stops beating, preventing blood and oxygen from reaching the brain and other organs. Without circulation, brain death rapidly follows.
3. Donor Assessment
   Once consent has been confirmed, a comprehensive medical evaluation is performed to determine which organs are suitable for transplantation. This includes screening for infectious diseases, cancer, and other medical conditions that could affect recipient safety. The transplant coordinator works closely with the medical and nursing teams to review:
   • Medical and family history
   • Vital signs and physical characteristics
   • Current treatments and medications
   • Laboratory and diagnostic test results
   Based on this information, a complete donor profile is created and shared with Eurotransplant to begin the recipient matching process.
4. Recipient Selection
   Eurotransplant identifies the most suitable recipient using medical criteria such as urgency, blood group, tissue compatibility, waiting time, and other allocation factors to ensure the best possible match.
5. Organ Procurement and Transport
   Organ retrieval is carried out under strict surgical conditions to preserve organ quality. In general, thoracic organs (heart and lungs) are removed first, followed by abdominal organs (such as the liver, pancreas, kidneys, and intestines), because some organs tolerate only a short period outside the body. Throughout the procedure, the transplant coordinator:
   • Coordinates the retrieval schedule
   • Organizes the work of surgical teams
   • Communicates with transplant centres
   • Oversees organ packaging and transportation
   After organ retrieval, tissue procurement teams may collect tissues such as corneas, skin, bones, and heart valves, provided there is no registered refusal. At the end of the procedure, the retrieval surgeon prepares a detailed report describing the condition and anatomy of the donated organs for the transplant teams.
6. Transplantation
   The transplant operation is performed by specialist surgeons. Depending on the organ involved, the diseased organ may be removed and replaced with the donor organ. After surgery, recipients are transferred to intensive care, where they begin immunosuppressive treatment to reduce the risk of rejection.
7. Post-Transplant Follow-up
   Long-term follow-up is essential after transplantation. Recipients must take lifelong immunosuppressive medication and attend regular medical appointments to monitor organ function, detect signs of rejection, and manage any complications.
8. Psychological and Social Support
   Organ transplantation can have a significant emotional and social impact on both recipients and their families. Psychological counselling and social support services are often provided to help patients adjust to life after transplantation and cope with the challenges of recovery.

Every stage of the organ donation and transplantation process is designed to protect the donor, provide the best possible outcome for the recipient, and ensure that the donor’s wishes are fully respected.

In addition to the principle of presumed consent, several medical and legal criteria determine whether a person can become an organ donor. The main considerations include:

1. Health Status
   A potential donor should be in good overall health. Certain medical conditions may prevent organ donation, including active infectious diseases (such as COVID-19) or certain types of cancer. Each potential donor is assessed individually by the medical team.
2. Type of Death
   Organ donation is possible after brain death or circulatory (cardiac) death. Because organs must be retrieved quickly to remain viable, potential donors are generally cared for in a critical care environment such as an intensive care unit, emergency department, or operating theatre.
3. Age and Physical Characteristics
   There is no strict upper age limit for organ donation. The condition and function of the organs are more important than the donor’s age. Organs from older donors can often be successfully transplanted if they remain healthy. Factors such as height and weight are also considered, particularly for organs such as the heart, lungs, and liver, to ensure an appropriate match between donor and recipient.
4. Family Consultation
   After a person’s death, the national donor registry is checked to determine whether they recorded a decision regarding organ and human body material donation. If no decision has been registered, the medical team consults the family to determine whether they know the deceased person’s wishes. Although Belgian law is based on presumed consent, discussing one’s wishes with family members in advance can help avoid uncertainty during an emotional time.
5. Living Donation
   In addition to deceased donation, living individuals may donate certain organs or parts of organs, such as one kidney or part of the liver. Belgian law requires that living donors:
   • Be at least 18 years of age.
   • Give free and informed consent.
   • Receive comprehensive information about the physical, psychological, social, and family implications of donation.
   • Sign their consent in writing in the presence of an adult witness.
   • Donate for an altruistic purpose.
   A living donor may withdraw their consent at any time before the procedure. The physician responsible for the donation must ensure that all legal requirements have been met, including proof of informed consent and compliance with all eligibility criteria. Under Belgian law, living donors who donate a kidney or part of their liver are entitled to ten years of free medical follow-up.
6. Compatibility
   Compatibility between the donor and recipient is essential for a successful transplant. Matching is based on factors such as blood group, tissue compatibility, organ size when relevant, and other medical criteria to minimize the risk of rejection and maximize the likelihood of long-term transplant success.