Frequently asked questions

Question 1

May I ask for organ donation after euthanasia myself?

Accepted Answer

Yes. It is most natural when the request comes from you, but your physician may also raise it early in the process. One thing is certain: the decision about euthanasia is separate from the donation, and the donation never changes your care. Discuss your wish with your treating physician or GP as early as possible.

Question 2

Do I have to be in the Donor Register?

Accepted Answer

For organ donation after euthanasia, what counts most is your own explicit request to your physician. It is nevertheless sensible to record your choice in the Donor Register as well, so that there can be no misunderstanding. In the hospital your registration is checked and discussed with you and your relatives, so everyone works from the same understanding. You can change your registration at any time.

Question 3

Can I still change my mind?

Accepted Answer

Always. Up to just before the procedure you can decide against the donation or against the euthanasia. Your care will not change because of it.

Question 4

Which organs can be donated?

Accepted Answer

After euthanasia the kidneys, liver, lungs and pancreas are usually suitable, and the heart can be donated too. Tissue donation (for example corneas, heart valves, blood vessels, skin or bone) is often not possible in neurodegenerative disease such as ALS or Parkinson's disease. Which organs or tissues are usable in your case depends on your illness, your age and the results of the screening. The organ donation coordinator discusses with you before the procedure which organs are suitable in your case, so you know where you stand in advance.

Question 5

Can a minor donate after euthanasia as well?

Accepted Answer

In the Netherlands euthanasia can, under strict conditions, also be performed in minors; from the age of 12 with the involvement of the parents. If those conditions are met, age does not rule out organ donation. From the age of 12 a person can record a donation choice in the Donor Register themselves; for younger children the parents or guardian decide. Such a pathway is exceptional and requires extra care, with support from the paediatric team, the physician and an organ donation coordinator.

Question 6

Can I donate if I have cancer?

Accepted Answer

That depends on the type of cancer. With metastatic cancer organ donation is not possible, because there is a risk that tumour cells would be transmitted with the organ. With some forms of cancer, for example a tumour that has remained localised or was declared cured years ago, donation is sometimes possible. Certain infections can also rule donation out. The organ donation coordinator always assesses your situation individually, together with your physician.

Question 7

Is it also possible in cases of psychiatric suffering?

Accepted Answer

Yes. Organ donation after euthanasia is also possible when the euthanasia is based on psychiatric suffering. Because assessing a euthanasia request in psychiatric suffering is particularly complex, additional due-care requirements apply, laid down in the guideline on euthanasia in psychiatric suffering of the Dutch Association for Psychiatry. The treating physician and the organ donation coordinator jointly assess whether donation is responsible in that specific case.

Question 8

How many people choose donation after euthanasia?

Accepted Answer

The number of people choosing organ donation after euthanasia is small, but growing gradually. In the Netherlands there are a few dozen such donations each year. At the same time it is estimated that about 10 per cent of people who undergo euthanasia are medically suitable to donate at least one organ. That underlines that this form of donation can make a meaningful contribution. It remains a special and carefully managed pathway that never stands on its own: donation is only an option when someone explicitly asks for it. Every donation counts fully and can help several people to a matching organ.

Question 9

Which illnesses most often lead to donation after euthanasia?

Accepted Answer

Organ donation after euthanasia occurs most often in people with a neurodegenerative disease, such as ALS, Parkinson's disease or MS. In these conditions there are usually no metastases or infection, so organs such as the kidneys, liver, lungs and pancreas can be well usable. Donation is also possible for other indications, such as psychiatric suffering, provided the due-care criteria are met. Dementia can also be grounds for euthanasia; whether donation is then possible depends on the stage of the disease and is assessed case by case. Which organs are usable in your case is always assessed individually by the organ donation coordinator together with your physician.

Question 10

Do I have to die in hospital, or can it be at home?

Accepted Answer

For organ donation the euthanasia has to take place in hospital. Organs have to be retrieved within minutes after death; there is no time for that if you die at home. You can say goodbye to your relatives at home and travel to the hospital shortly before the agreed time. In hospital you usually have your own room where your relatives can be with you. Under specific circumstances there are options to be put to sleep at home, after which you are transported to hospital, where the procedure is still performed by your own physician. If you insist on dying at home, organ donation is not possible, although tissue donation (for example corneas or skin) sometimes is.

Question 11

Do I really have to undergo euthanasia, or may I choose anaesthesia instead?

Accepted Answer

The procedure always begins with a euthanasia that meets the statutory due-care criteria. You first receive a sedative, after which you are no longer aware of anything, and then the medication that causes death. There is no route in which you are only put under anaesthesia and the organs are then retrieved: that would mean the operation itself causes death, which is not permitted in the Netherlands. The donation operation only starts once a physician has formally determined your death. Researchers are meanwhile working on national guidelines for donation after euthanasia, in which possible adjustments — such as variation in the medication used — are being weighed. For now, the current practice remains leading.

Question 12

Will I feel anything of the donation operation?

Accepted Answer

No. The operation only begins once a physician has formally determined your death.

Question 13

Does it cost my family anything?

Accepted Answer

No. The donation procedure involves no costs for you or your relatives.

Question 14

Are there differences with Belgium?

Accepted Answer

Yes, mainly in regulation and in how the procedure is embedded. In Belgium organ donation after euthanasia has been practised since 2005; in the Netherlands only since 2012. In both countries the initiative and the explicit wish always lie with you: a physician may not prompt you. There are practical differences too. In the Netherlands the euthanasia is reported as a non-natural death to the forensic physician, and the donation operation can only start after release by the public prosecutor. In Belgium the euthanasia is reported to the Federal Control and Evaluation Committee and there is no such release step. Different rules also apply to minors: in the Netherlands euthanasia is possible from the age of 12 (with parental involvement under 16); in Belgium, since 2014, also for younger minors if they have decision-making capacity. The medical principles — which organs are usable, the quality of the organs and the careful working method — are comparable in both countries.

Question 15

Can my relatives stay with me?

Accepted Answer

Yes. Your relatives can be with you until the moment of death. After that there is an interruption of two to four hours for the operation; afterwards they can say goodbye again.

Question 16

Is an open coffin still possible afterwards?

Accepted Answer

Yes. After the operation the body is carefully closed and cared for. Lying in repose and a farewell with an open coffin generally remain possible.

Question 17

How long before my relatives get the body back?

Accepted Answer

The donation operation usually takes two to four hours. Afterwards the body is cared for and your relatives can say goodbye again. The funeral can nearly always go ahead on the planned day.

Question 18

What is the quality of organs donated after euthanasia?

Accepted Answer

Research shows that the quality and outcomes of organs donated after euthanasia are at least as good as those of organs from other donors. Because the donation is carefully planned and the process runs smoothly, the organs are generally healthy and well usable. Kidneys donated after euthanasia, for instance, give results comparable to kidneys donated after brain death. Even so, the organ donation coordinator assesses every situation individually, so that only organs that are safe and suitable for the recipient are retrieved.

Question 19

What is the effect on the transplant waiting list?

Accepted Answer

It is absolutely not the aim of organ donation after euthanasia to create more transplants. The starting point is always that the initiative and the wish come from the person themselves, and care is entirely focused on a dignified and careful euthanasia pathway. Donation is only an option when someone explicitly asks for it. When that happens, such a donation does yield additional organs and thereby contributes to reducing the transplant waiting list. Each donation means in practice that one or several people on the waiting list can receive a matching organ sooner, for example a kidney, liver, lungs or pancreas. It is not a substitute for other forms of donation, but a welcome addition that gives more people the prospect of a transplant. Allocation takes place as usual through Eurotransplant, based on medical criteria.

Question 20

Can I choose who receives my organs?

Accepted Answer

No. Organs are allocated through Eurotransplant, on the basis of medical criteria such as blood group, tissue match, urgency and waiting time. This way the patient who benefits most medically receives the organ. Living donation to someone you know (a kidney, for example) is something different and is separate from this procedure.

Question 21

Will I find out who receives my organs?

Accepted Answer

No, donation is anonymous. Your relatives can receive general information, for example how many people were helped by the donation.

Question 22

Who decides who will receive my organs?

Accepted Answer

Allocation is done by Eurotransplant, the independent organisation that manages the waiting list for the Netherlands, Belgium and several other countries. A computer algorithm determines, on the basis of fixed medical criteria — blood group, tissue match, urgency, waiting time and distance to the transplant centre — which patient on the waiting list is offered the organ. Your physician, the organ donation coordinator, your relatives and you yourself have no influence on this. The recipient's transplant team then assesses whether the offered organ is suitable for that specific patient.

Question 23

May I be there at the farewell?

Accepted Answer

Yes. You can be with your loved one until just before the euthanasia, usually in a private room in the intensive care unit. After death there is a waiting time of five minutes; then your loved one goes to the operating theatre and you say goodbye.

Question 24

What happens to the body after the donation?

Accepted Answer

After the donation operation the body is carefully closed and cared for. Lying in repose and a normal funeral are perfectly possible; outwardly hardly anything is visible.

Question 25

How soon can the funeral take place?

Accepted Answer

The funeral is not delayed by the donation. Because euthanasia is legally a non-natural death, the forensic physician is involved and the public prosecutor grants release; this does not cause any delay either. Simply discuss the planning with the funeral director in advance.

Question 26

Do relatives have to give consent?

Accepted Answer

No, the choice is the patient's own. In practice relatives are always involved in the conversation, because their support makes the pathway more bearable for everyone.

Question 27

Can we hear afterwards what the donation achieved?

Accepted Answer

Yes, in general terms. The organ donation coordinator can later provide anonymised information, for example how many people were helped. Names of recipients are never shared.

Question 28

Where can we as relatives turn with questions or grief?

Accepted Answer

Ask for a follow-up conversation with the treating physician or organ donation coordinator; many questions only arise later. For grief and aftercare you can turn to your GP. The page 'For relatives' contains more extensive information.

Before you start

Who can donate, and what

The procedure itself

Relatives and farewell

Results

After the donation

For relatives

Glossary

Frequently asked questions

Before you start

May I ask for organ donation after euthanasia myself?Yes — the request preferably starts with you.

Do I have to be in the Donor Register?Not required; your own request to your physician carries most weight.

Can I still change my mind?Yes, until just before the procedure, without any effect on your care.

Who can donate, and what

Which organs can be donated?Usually the kidneys, liver, lungs, pancreas and sometimes the heart.

Can a minor donate after euthanasia as well?Yes, under strict conditions; it is exceptional.

Can I donate if I have cancer?Not with metastatic cancer; in other cases sometimes.

Is it also possible in cases of psychiatric suffering?Yes, with additional due-care requirements.

How many people choose donation after euthanasia?A few dozen a year in the Netherlands; the number is growing.

Which illnesses most often lead to donation after euthanasia?Mainly neurodegenerative diseases such as ALS, Parkinson's and MS.

The procedure itself

Do I have to die in hospital, or can it be at home?Organ donation requires the hospital; saying goodbye at home is possible.

Do I really have to undergo euthanasia, or may I choose anaesthesia instead?Only euthanasia; a route with anaesthesia alone does not exist.

Will I feel anything of the donation operation?No, the operation only starts after death has been determined.

Does it cost my family anything?No, there are no costs for you or your relatives.

Are there differences with Belgium?Yes, mainly legal and logistical; medically it is comparable.

Relatives and farewell

Can my relatives stay with me?Yes, until the moment of death and again after the operation.

Is an open coffin still possible afterwards?Yes, lying in repose and an open coffin remain possible.

How long before my relatives get the body back?The operation takes two to four hours; the funeral goes ahead as planned.

Results

What is the quality of organs donated after euthanasia?At least as good as from other donors.

What is the effect on the transplant waiting list?More transplants are not the aim, but they are a welcome consequence.

After the donation

Can I choose who receives my organs?No, Eurotransplant allocates on medical criteria.

Will I find out who receives my organs?No, donation is anonymous; general information is possible.

Who decides who will receive my organs?Eurotransplant, using fixed medical criteria.

For relatives

May I be there at the farewell?Yes, until just before the euthanasia and again afterwards.

What happens to the body after the donation?The body is carefully closed and cared for.

How soon can the funeral take place?The donation does not delay the funeral.

Do relatives have to give consent?No, the choice is the patient's own.

Can we hear afterwards what the donation achieved?Yes, in general terms and anonymised.

Where can we as relatives turn with questions or grief?Ask for a follow-up conversation; your GP helps with grief and aftercare.

Glossary