The donor

Any person domiciled in Belgium for 6 months is presumed to consent to procurement after their death, unless expressly stipulated (orally, in writing, registered with the municipal administration).
People who have not been listed on the Population Register, or on the Aliens' Register for 6 months must express their prior agreement to procurement.

 The donor's death

According to article 11, procurement can only be carried out on a person (the donor) whose death has been confirmed by three independent doctors from the procurement and transplantation team and the doctor who is treating the recipient. The diagnosis of brain death is a diagnosis for which each of the three doctors personally assumes responsibility independently. Any form of influence or pressure constitutes serious ethical misconduct. Brain death is established according to most recent medical data. The diagnosis of brain death is mentioned in a signed and dated statement. The latter must be kept for a period of at least 10 years.

According to article 4 & 1, the transfer of organs and tissues cannot be consented for lucrative purposes, regardless of the parties between whom this has been agreed. Also, the donor and his close family has no claim on the recipient. The donors targeted by the legislation may be living donors or deceased donors.

In the case of the donor's sudden death, the cause of which is not suspicious (e.g.: car crash), the doctor in charge of procurement writes a report to the public prosecutor with all the information which may be required in the event that the public prosecutor orders a judicial investigation or an autopsy at a later date.
If, however, the death is suspicious, procurement only takes place if the public prosecutor has been informed and is not opposed to it. The latter may ask a doctor to be present during procurement.
Before procurement, the doctor should ensure that the donor has not expressed any opposition in any way whatsoever. Therefore, the doctor has no other choice than to inform the family of the planned procurement so that they can communicate the existence of any opposition expressed by the deceased while still alive.

Since 2007, the doctor is no longer obliged to take the family's opposition into account. This adaptation of the law strengthens the opting-out system.

 Two types of procurement

In the case of a post-mortem donation, the donor may have died from cerebral or cardiac causes. The majority of donors are brain dead.

  • Heart-beating donors (HBD)                                                                                        

    This corresponds to donors in a state of brain death. In this case, all the organs and tissue may be procured (heart, lungs, liver, kidneys, pancreas, intestines, etc.).

    Brain death corresponds to the irreversible destruction of the brain. The diagnosis of brain death is established by a set of clinical signs and, when the situation requires it, by the implementation of additional examinations. If the brain is dead, other organs may still work if kept artificially alive for a few hours.

    Brain death may be caused by an oedema resulting in the complete loss of intra-cerebral blood circulation. Several conditions may cause this state:

       -   a stroke,

       -   high blood pressure that is not properly treated,

       -   a head trauma (fall, road accident, etc.),

       -   cerebral anoxia, etc.

  • Non-heart-beating donors (NHBD)                                                                                        

    These donors are the result of cardiopulmonary arrest, unsuccessful resuscitation.

    Owing to the lack of blood circulation, procurement mainly concerns the kidneys, liver, pancreas, lungs and tissue.

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