Spain has been the world leader in organ donation for almost 30 years. In 2023, the country even reached a new peak in terms of deceased donors, with a rate of 49.4 per million inhabitants, closely followed by the United States. For many years, Spain has made organ donation one of its priorities and has established itself as a world benchmark.
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It is a cause that makes people proud Spaniards. For more than three decades, Spain has established itself as the undisputed leader in organ donation. In 2023, the country reached a historic record with 5,861 transplants performed, an average of more than 16 transplants per day, according to data from the Spanish Ministry of Health. The country thus has 49.4 deceased donors per million inhabitants, more than double the European Union average. For comparison, France has an average rate of 27.6 deceased donors per million inhabitants. Within the European Union, Spain alone represents a quarter of donors. “ Data once again demonstrates the resounding success of the Spanish transplant system », welcomed the Spanish Minister of Health Monica Garcia when these figures were published in August 2024.
All these results owe nothing to chance. Each year, thanks to effective awareness raising among the general public, the lists of potential donors continue to grow while waiting times for transplants decrease. It must be said that organ donation is now a very well-known subject among Spaniards, who are regularly informed and raised awareness through campaigns. This gesture is now perceived by a large part of the population as an act of solidarity and generosity and has been popularized numerous times in popular culture, notably via the story of the footballer Eric Abidal or by the poignant stories of several films by Pedro Almodóvar. In less than ten years, the number of organ donations in Spain has doubled, illustrating the impact of this national commitment.
A well-established organization
If Spain has dominated the world ranking of organ donations for many years, this success can be explained in part by a reform of its transplantation system from the end of the 1980s, notably via the creation of the National Organization of Transplants (ONT), attached to the Ministry of Health. This key player plays a fundamental role in the management of organ donations by coordinating the entire process, from donor detection to organ implantation. Using a real-time computerized distribution system, the ONT ensures that organs are distributed to the most compatible people and to the most urgent cases, while respecting strict medical criteria.
This system, constantly updated, makes it possible to optimize each step of the process and better meet the needs of patients waiting for a transplant. This centralized organization has made it possible to considerably reduce waiting times for recipients. “ What makes the difference is the organization of the system. This network, this centralization, is the key » of the Spanish success, explains to AFP Marie-Charlotte Bouësseau, specialist in ethical issues for the WHO in Geneva.
While the number of potential donors is declining globally, Spain is an exception. The country saw a 7% increase in donations in 2023 and over a decade, notably by committing to donations in asystole. A pioneer in this field, Spain adapted its legislation in 2009 to include these donations, which concern donors in irreversible cardiac arrest after the end of intensive care treatment. This initiative has made it possible to expand donation possibilities: in 2023, almost half of transplants in Spain came from donations in asystole, illustrating the importance of this practice in the Spanish model.
Hospital coordinators, a key figure
Since 1979, Spanish legislation has been based on the principle of presumed consent to organ donation, unless explicit opposition is expressed during the person’s lifetime. In practice, in the event of a death, the opinion of the families is always requested. The latter plays a crucial role in the process. For this, the country is the first to have created a role of hospital coordinator, generally an intensive care doctor, at the heart of its donation system.
Indeed, for a donation to be effective, several conditions must be met: the donor must be in a state of head or respiratory death, ideally under mechanical ventilation and in a hospital environment. However, these cases only represent 1 to 2% of deaths. In each hospital, a coordinator is therefore present in order to spot and identify these situations as best as possible.
Since its creation, the ONT has trained nearly 20,000 coordinators, present in different hospitals across the country. These professionals, “ experts in critical situation management » play a dual role. They tell families the bad news in the event of death and convince them to accept the principle of donation, a process often considered delicate. “ The coordinator is perfectly trained to quickly detect potential donors, approach a bereaved family and organize all stages of the process so that the organs are collected in the best conditions. “, explains Beatriz Dominguez-Gil, director of the National Organization of Transplants (ONT). Thanks to this system, Spain has one of the highest approval rates in the world: less than 15% of families refuse organ donation from a loved one, compared to 35% in France.
If the Spanish model is recognized for its effectiveness, it continues to inspire many countries seeking to optimize their transplantation systems. The World Health Organization (WHO) also recommends this model as a global reference for increasing donation rates. While 16 people die every day around the world waiting for a transplant, the National Transplant Organization (ONT) tirelessly emphasizes its motto: “Let’s all work together to save lives”. The Organization also emphasizes that a potential donor can save up to 14 lives, thus recalling the crucial importance of these initiatives.
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