They had only just heard that he was not going to make it, when the doctor entered the family room for the second time. “Whether we wanted to think about organ donation,” recalls Charella van Ee (32), daughter of Roel van Ee (66), who died in 2022. Her father had registered as a donor, but that was so long ago that the doctor wanted to give serious weight to the considerations of relatives.
“No, I immediately said: we’re not doing it. You’ve had enough of him.” Her partner Jordi Deckert (34): “I thought: wait a minute. We lost Roel and now we have to think about whether we should have him emptied? There was so much sadness.”
Charella van Ee: “The doctor said: ‘Think about it for a moment. You have an hour, then we want the definitive answer.’”
As more organs become available for transplant, more doctors are placing their patients on the waiting list
Roel van Ee was retired for two weeks in the fall of 2022 and was looking forward to the rest of his life. He was an athlete, exercised daily. Cycling, walking and in the swimming pool, where he was a volunteer for many years. But one rainy evening, disaster struck. On the way home after a party he must have fallen with his bicycle, causing cardiac arrest. A passerby found Roel in a ditch.
After three restless nights in the hospital, it turned out that he was brain dead and would not recover. “An hour after our initial decision, the doctor came back,” says Deckert. “Then we announced that of course we were going to do it.”
After the initial shock, they concluded that that was what their father would have wanted. When all the children were eighteen, he started talking to them about organ donations, Charella van Ee remembered. He had always said that ‘he could let them have anything’. “My father would have thought we were crazy if he had known that we had doubts at first.”
Hopital
In July 2020, the Dutch donor law was amended. Anyone aged eighteen or older who had not yet registered whether they wanted to make organs available for donation after death (that was seven million people) received a letter in the following months asking them to register that choice. Those who did not respond were sent a reminder, but ultimately ‘no choice’ equated to ‘no objection to organ donation’.
This is also the case for everyone who turns eighteen after that. Changes can still be made via the website Donor register.
The main reason for the change in the law was to reduce waiting lists for organ transplantation. The aim was also to clarify what people want, which should facilitate the discussion about organ donation in the hospital. Before the law, about two-thirds of people had not had their wishes recorded at all in the Donor Register – which had existed since 1998 – and many surviving relatives decided not to give consent.
NRC spoke to doctors and experts about the effects of the donor law, which was introduced in 2020. Has practice changed since then?
Peak
Since the introduction of the law, the number of organ donors has increased. Last year there were 308, according to the latest figures. That is an increase of more than 20 percent compared to 2019 (250), the year before the new law was introduced. The increase was steady until 2023 (292), but there was a donation peak in 2024 (360). According to the Dutch Transplant Foundation (NTS), this was remarkable; the foundation does not have a clear explanation. Probably more people who were suitable for donation simply died.
That increase is partly due to the changed law, experts say. New techniques that improve the quality of organs also influence the number of transplants. When transplant surgeon Frank Dor returned from nine years of working in London a year and a half ago, he was struck by how many more transplants were being performed at Erasmus MC. “The practice had taken off, especially better mechanical preservation of organs, which protects them when they are outside the body and allows organ function to be tested before transplantation.”
If someone were healthy, they could in principle save or improve seven human lives
Organs that were previously considered high-risk, for example from old people, are now more widely accepted thanks to these new techniques. In 2024, the oldest donor was 82 years old. The number of heart transplants doubled: from about 40 per year between 2016 and 2021 to 79 in 2024.
Moreover, the waiting list for organs has actually grown in recent years. Partly due to the aging population, partly due to the increasing supply, says Nichon Jansen, policy officer and researcher at the NTS. “Because more organs become available for transplantation, more doctors are placing their patients on the waiting list.” On December 31, 2025, 1,607 people were on the so-called active waiting list (which has the highest urgency), the largest part for a kidney transplant. In 2019 there were 1,069.
Human lives
Doctors note that consultations with relatives about possible organ donation are very different these days. “That is due to the law,” says intensivist Marlijn Kamps, who has conducted about fifty of those conversations since 2016. “More people have now thought about it because of the.”
Farid Abdo, intensivist and one of the doctors who fought for the law, has also noticed that the conversations have changed. “We used to say: we see that your father is not registered. This means that it is up to you to decide about the organs. Now we say: in the Donor Register we see ‘no objection’, with which he has given permission for donation. We want to carry out that last wish as best as possible. Have you ever discussed this at home?”
Kamps: “If someone were healthy, they could in principle save or improve seven human lives. Would that have suited the person, I ask.”
About 70 percent of unregistered cases became a ‘no’ before the introduction of the law, but now half of the people who are on the register with ‘no objection’ become a ‘no’.
Abdo often noticed that families regretted this. “If you are having a hard time emotionally and don’t know what your loved one would have wanted, you quickly say no research we know that more than a third of refusers regret it afterwards.”
Illiterate
This is how it initially went with Van Ee and her partner Deckert. “We are both medical professionals. We know how much organs are needed. But even our first reaction was: don’t do it.” That is why the couple emphasizes how important it is “that you have thought about it calmly if the emotion is not yet too high.” Together they give presentations about their experience to doctors.
The deceased’s family can still prevent organ donation. For example, if their loved one said they did not want that, or if they were illiterate and could not read the letters. “The most important thing is that we know what the patient would have wanted,” says Kamps.
Only people whose organs still function but the brains do not, or those for whom medical treatment is futile, are eligible for donation. Such a person can still look very ‘alive’, Kamps knows.
That is why, according to Kamps, it is important to explain clearly and in detail to loved ones what is going on. “If we think that a patient can no longer recover, we first have a conversation with the family. We share CT scans and brain films. We make it palpable. The most important thing is that you as a team know that you have done what you need to have done to save someone.”
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‘State corpses’
Initially, the change in law met with a lot of opposition. Wasn’t the law violated? “The proposal conflicts with Article 11 of the Constitution, which enshrines the right to inviolability of the body,” wrote NRC in a critical commentary. “The key question is whether the right to self-determination may be sacrificed for the higher goal of getting more donors and therefore saving people’s lives.” Former VVD leader Frits Bolkestein even spoke of ‘state corpses’.
The attention for the donor law even caused people to register en masse with a ‘no’, says Jansen of the NTS. “Before this, 13 percent registered ‘no’, after that 31 percent.” But that is also a win, she thinks. “Then you at least know what people want, and that decision does not fall to the relatives.”
The law ultimately passed, thanks to a last-minute twist by 50Plus MP Henk Krol and the unexpected absence of Party for the Animals MP Frank Wassenberg, who had missed the train and was not in time to vote against. The medical federation KNMG was also critical of the law. He was concerned, among other things, about the role of surviving relatives. It stated that they had to make it plausible that the donor had changed his mind if, in their opinion, he wanted something different from what was stated in the register. The KNMG feared that this would force doctors to discuss with relatives at a difficult time.
It can be concluded from the final law that the choice of the surviving relative is leading. And now, five years after its introduction, KNMG has “no signals [ontvangen] that the concerns expressed at the time,” she wrote in a response.
The law came into effect in the middle of the corona pandemic, a time when trust in institutions was under pressure. That distrust was reflected in the reactions of critics who feared that the sick would be declared dead too early, just so they could use their organs. Those kinds of “ghost stories” still have an effect, says transplant surgeon Dor. “It must have something to do with the discomfort surrounding death. Nobody likes to think about that. Having a drink about death tonight? No, thanks. But it is a shame if such stories get in the way of someone’s last wish. Because that is what we do: carry out that last wish.”
Thank you letter
Roel van Ee’s relatives ultimately draw comfort from the donation, they say. At the funeral there was a photo of the organ transport. Charella van Ee: “but still feels proud because Roel has given others a life.” Some time after the transplant, they received anonymized information about the recipients of the organs. A kidney went to a peer of Roel, his liver to a peer of his daughter and son-in-law. Deckert: “Damn it, you think: someone our age with a liver that is completely destroyed can now grow old healthily thanks to Roel.”
Recently someone came along the line of the football field to surgeon Dor. You transplanted an organ into a friend of mine, the person said, after which he said that his friend was running, running and cycling again. Dor: “That is fantastic to hear, also for a donor family – but that rarely happens. Not every doctor may find it appropriate to promote this.”
In the Catharina Hospital in Eindhoven, run by intensivist Marlijn Kamps, relatives of organ donors receive a miniature of organ donors as a thank you. The Climbthe donor monument next to the Grote Kerk in Naarden. That statue is a tribute to all organ donors and symbolizes, among other things, a transplant who ‘climbs to a new life’ thanks to a donation. A Donor Place of Honor is currently being set up at Erasmus MC. Jordi Deckert made a souvenir himself after the death of father-in-law Roel. He built two model cars, in the image of the car that transported his father-in-law’s organs. One is in the room with him and Van Ee, one is with her mother. “First we felt doubt, now pride.”
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