Why Did it Take so Long to Start a Non-Heart-Beating Donor Program in Belgium ?

The first cadaver kidney transplant, performed in June 1963 in Belgium, was from a heart beating donor
(HBD). It was the first ever in the world.
Since that period, almost all cadaver organs were procured from brain death donors. When the Belgian law on organ
donation and transplantation was published on February 1987, with its opting-out principle, no emphasis was placed on
procuring organs after cardiac death. Based on the Maastricht experience, in the early nineties, the transplant community
interpellated the National Belgian Council of Physicians to facilitate organ procurement in Non-Heart-Beating
Donors (NHBD) following the law. But, the transplant community had to wait for the impulse of the first International
Congress on NHBD in 1995,where the 4 categories of Maastricht NHBD were defined. It also published 12 Statements
and Recommendations which were eventually approved by the European Council. Then all local Ethical Committees
received queries for approving local NHBD programs. Almost all centres requested viability testing assessment of the
NHBD organ prior to implantation, and proposed the introduction of machine perfusion technology. Finally, all centres
joined their efforts and made a collaborative agreement with Organ Recovery Systems for a 24/7 machine perfusion
service from a central laboratory. During a three year period (2003-2005), 46 NHBD kidneys were recovered. Among
these kidneys, 32 were perfused in the Organ Recovery Systems central laboratory. The Delayed Graft Function (DGF)
rate for these perfused kidneys was 25%. Only one graft was lost in this subgroup. Livers, pancreases (for islet preparation)
and lungs (for experimental ex-vivo evaluation) were also recovered from these non-heart-beating donors.