Many more registrations after changes in donor law

NOS News•today, 6:00 PM•Amended today, 6:28 PM

Since the donor law was changed four years ago, the number of people who have ‘actively’ indicated whether they want to donate organs has increased by more than 50 percent. This is stated in an evaluation of the first years of the law, which was commissioned by the Ministry of Health.

Outgoing Minister Dijkstra for Medical Care has sent the results to the House of Representatives. As a D66 MP, she herself was the initiator of the change in the law. The new donor law came into effect on July 1, 2020. The core of the change in the law was that people who do not respond to the question of whether they want to become an organ donor are still registered as donors.

The researchers (from the Berenschot agency, together with Ipsos I&O) say that the number of people who have actively registered their wishes has increased from 6.9 million in 2020 to 10.7 million in 2023. According to the evaluation, the law has therefore helped increase clarity about someone’s desire to be a donor.

Of the 10.7 million registered, 4.8 million people consent to donation and 4.4 million do not. The other actively registered people leave the decision to someone else, for example a surviving relative. Moreover, the number of people who do not consent to donation has increased faster than the number who do.

The number of donors and organ and tissue transplants performed has increased slightly since the law came into effect, but according to the researchers it is difficult to say whether this is due to the law. They point out, among other things, the relatively small absolute numbers and the consequences of the corona crisis.

The researchers therefore advise the minister to initiate a new evaluation. Dijkstra does indeed plan to do so, although she is more interested in doing this in five years and not in three years, as the researchers propose.

About 3.3 million people have not communicated a choice to the register. This means that they have a ‘no objection’ registration and that their organs are in principle eligible for donation. But if the relatives are sure and can explain to the doctor that someone really did not want to become a donor, those objections will be honored.

According to the evaluation, approximately half of this group actually has no choice or does not consider it necessary to choose. The other half give reasons such as that they find it difficult to make a choice, that they have not (yet) thought about it or that they want to leave it to the relatives.

The evaluation states that the ‘no objection’ registration leads to uncertainty, that in practice not everyone understands what that registration means and that healthcare professionals find a conversation with relatives in these types of cases difficult.

The researchers think that a change in the law can resolve this ambiguity. Dijkstra has no interest in that for the time being. According to her, the law is clear about the legal consequences of not making a choice. On that point too, she awaits the next evaluation. She would like to pay more attention to it in information campaigns.

The minister is pleased that the number of people who have actively considered whether or not they want to be a donor has increased considerably: “And whether it is no or yes, it is important that surviving relatives know what the person who may be eligible as a donor wanted.” She hopes that even more people will indicate their preference in the register.

The Dutch Association for Intensive Care (NVIC) is also satisfied with the increase in registrations. ICU doctors conduct discussions with relatives of possible donors. “More people than ever have made their wishes known and relatives more often know what their loved ones’ wishes are regarding donation,” chairman Iwan van der Horst writes in a response.

More awareness about the various registrations is important, says the NVIC, but the association considers changes to the law to be undesirable. “The law entails major changes for the population and the doctors involved. It will take time to build up experience.”