How does the donation to transplantation procedure take place?

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.