Directed deceased donation in the Netherlands? An exploration

L. Dijkhuizen

Wednesday 4 march 2020

15:00 - 15:10h at Leo Franssen zaal

Parallel session: Parallel sessie V – Donatie en Verpleegkundige abstracts

Background: In the Netherlands, donors – or surviving relatives – have no control over the allocation of organs donated after death. The Dutch Organ Donation Act (WOD) states that the allocation of organs is the exclusive competence of a licensed Organ Center (see art. 24 WOD). In the Netherlands this license has been granted to the Dutch Transplantation Foundation (NTS).

In the case of a living donation, it’s different. Art. 3:1 WOD states that the living donor grants permission for the removal of his organ for implantation in a specific person.

So, different rules apply to post-mortem and pre-mortem organ donations. Both situations have different assessment frameworks, with their own central values: ‘donor autonomy’ before death, ‘equitable distribution of organs’ after death.

Methods: In theory, the two options are clear. But reality is not limited to these two situations. Once in a while the NTS receives phone calls from potential donors who express their wish to donate after death to a specific person. Some of the requests concerned potential donors in an euthanasia process. Another case concerned a living donor, that passed away short before the transplant date. It also happened that relatives of an unregistered deceased potential donor, when asked for permission, indicated that one of them was on the waiting list, in need of an organ and. Up till now, it is believed that the Dutch Organ Donation Act leaves no room for directed deceased donation. Patients who wish to donate post-mortem to a specific person are told that there is no possibility to do so.

Until now, a request for directed deceased donation has not been granted in the Netherlands, with reference to legal arguments. It would not be allowed under the current Organ Donation Act, and it would not be consistent with our current, objective allocation system (based on the notion of a fair distribution of medical assistance and organs).

Results: Abroad, examples of directed deceased donation can be found. In the United Kingdom, the Requested allocation of a deceased donor organ directive entered into force in 2010. This “framework document provides policy advice about the circumstances in which a request for an allocation of a deceased donor organ to a close relative or friend could be considered in exceptional circumstances and when the needs of other patients should take precedence over that request for the allocation.”#_ftn1 Conclusions: Considering the forementioned requests, the question should be answered whether the Dutch legal framework allows directed deceased donation in the Netherlands. If not, should it be changed? In that case, what legal measures are needed?