This article is more than 5 years old. Information may no longer be current.

Spanish organ donation rate highest in the world, demonstrating strategies for success

The Organización Nacional de Trasplantes created a model of coordination that enabled Spain to achieve the world’s highest rate of deceased organ donation at 40 donors per million population, according to an article published in the American Journal of Transplantation.

“Transplantation is the best and, frequently, the only lifesaving treatment for end-stage organ failure,” Rafael Matesanz, MD, PhD, director of Organización Nacional de Trasplantes (ONT) in Madrid, Spain, and colleagues wrote. “In 2014, 119,873 solid organ transplants were performed worldwide … Although impressive, the annual number of organ transplants represents less than 10% of the global needs. Organ shortage leads to deaths and poor quality of life for those on the waiting list.”

In less than a decade, Spain increased from 15 donors per million population to 40 donors per million population through the ONT model. The Spanish model relies on health care professionals, namely intensive care physicians, to emphasize the importance of organ donation when a patient dies under circumstances that allow for organ donation. The model prioritizes identifying donation opportunities in EDs and hospital wards, in addition to intensive care units. Circulatory death — when circulation, heartbeat and breathing stop, as opposed to brain death — is also a circumstance in which donation is considered under this model. 

“The most important success is that the system has made organ donation be routinely considered when a patient dies, regardless of the circumstances of death,” Beatriz Domínguez-Gil, MD, PhD, of ONT, said in a news release. “Professionals attending to these patients in our country consider that, in caring for patients at the end of their lives, it is their duty to systematically explore their wishes with regards to donating organs upon their death.”

Matesanz emphasized that other countries may need to make some adaptations to the Spanish model depending on how organ donation is organized and the type of health care system in place.

One strategy that has increased the pool of potential donors has been to identify patients with devastating brain injuries in whom further care has been deemed futile and posing the option of elective, non-therapeutic intensive care to facilitate organ donation. Organ donation is one consideration in the transition from active treatment to palliative or end-of-life care, and the responsible physician discusses organ donation with relatives as part of standard practice.

The ONT has also sought to increase the number of donors by closer examination of “nonstandard risk donors.” It has established a medical consultation team available for a second opinion on the medical suitability of a potential donor 24 hours a day. The ONT also places greater emphasis on considering organ donation in patients older than 65 years of age, and as a result, 10% of organ donors in Spain are 80 years of age or older; for comparison, in the United States, only 7% of organ donors are 65 years of age or older.

“Good organization in the process of deceased donation and continuous adaptations of the system to changes are always the basis of successful results in organ donation,” Matesanz said. – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.