Spain is leading the world in deceased organ donation. An article in the American Journal of Transplantation explains how this happened.
In 1989, the Spanish Ministry of Health created the Organización Nacional de Trasplantes (ONT), a technical agency in charge of the coordination and oversight of donation and transplantation activities in Spain. It created a model of coordination in deceased donation that made the country evolve from 15 donors per million population to more than 30 per million in less than a decade.
The Spanish model relies on designated professionals (mostly intensive care doctors) who make donations happen when a potential donor dies. These professionals are supported in their work by ONT and regional coordination offices.
The Spanish model also makes it a priority to identify donation opportunities not only in intensive care units, but also in emergency departments and hospital wards. In addition, it considers organ donation from persons over the age of 65 years. (While only 7% of organ donors are over the age of 65 years in the United States, 10% of organ donors in Spain are over the age of 80.)
Furthermore, the model has considered donation after circulatory death, in which circulation, heartbeat, and breathing have stopped (as opposed to brain death, in which all the functions of the brain have stopped), even in the setting when death follows a sudden cardiac arrest in the street.
"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," said ONT's Beatriz Domínguez-Gil. "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."
Lead author Rafael Matesanz, who is the director of ONT, highlighted that "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".