SPAIN’S SHINING RECORD IN ORGAN DONATION & TRANSPLANT, A TWO-PART SERIES: (2) Spain Outperforms Itself

NewssliderSpainUncategorized

At nearly 6,000 per year, Spain surpasses its best transplant figures.  The
ONT Director General says, “By 2023 we have easily exceeded
our target of 5,500 transplants per year.” Spain has
done 5,861 organ transplants, to be precise.

 

A GUIDEPOST Report
Source: La Moncloa, Gobierno de España

 

Like her predecessor at the Ministry of Health, José Miñon, no sooner had the New Year begun than Monica Garcia (she took office as Minister of Health on 21 November 2023), commended the great work of Spanish health professionals which has made it possible to achieve the remarkable rate of 48.9 organ donors per million population (PMP), a historic high, and 122.1 transplants PMP, the latter surpassing the 2019 pre-COVID record, heretofore Spain’s best year for transplants.

Minister of Health Monica Garcia, left, and ONT Director General Beatriz Dominguez-Gil present transplant and donor balance sheet at the press conference in January 2024

In 2023, organ donation and transplantation activity in Spain reached levels of excellence that are difficult to surpass. Thanks to a cohesive national program spearheaded by the National Transplant Organization (Organización Nacional de Trasplantes or ONT), in which professionals from various fields of specialization take part, and generous donations, 5,861 organ transplants were performed in Spain. This represents a rate of 122.1 transplants PMP, as Minister of Health Garcia announced at a press conference in January 2024.

 

Record growth across the board

The high level of transplant activity was owing to the 2,346 people — the abovementioned 48.9 donors PMP — who donated their organs after death, bringing the rate of this type of donation up to 48.9 donors PMP. As for donations during lifetime, 433 people donated a kidney, an increase of 24% from the previous year, while two people donated part of their liver. This totals an overall 435 donors which represents a growth of 9% in transplantation and 7% in donation compared to 2022. This transplant rate is higher than the all-time high recorded in 2019.

Growth in 2023 occurred across all types of transplants, giving rise to an all-time record for the total number of transplants. A total of 3,688 kidney transplants (8% more than the previous year), 1,262 liver transplants (+9%), 479 lung transplants (+15%), 325 heart transplants (+5%), 100 pancreas transplants (+9%) and 7 intestinal transplants were carried out.

The rate of 48.9 deceased donors PMP that Spain reached in 2023 is close to the 50 donors PMP targeted by the ONT in its Strategic Plan “50X22”. This rate of activity is much higher than any achieved by other countries anywhere in the world, according to the Global Observatory on Donation and Transplantation. In 2022, the US recorded 44.5 donors PMP, France 25.8, Italy 25.0, Canada 21.4, the UK 20.6, Australia 17.4, Germany 10.4, and the EU as a whole 20.9 donors PMP.

At the press conference, Minister García thanked “the solidarity of donors and their families, the crucial work of the professionals involved in all phases of the complex process of donation and transplantation, and the coordination of the ONT and the Autonomous Communities.” Spain’s phenomenal achievement is a testament to the social and health cohesion obtaining in the country, “a perfectly coordinated network that saves thousands of lives every year, as reflected in the data we are presenting today,” García said.

 

Asystolic donation spurs growth

ONT press conference in January 2019 celebrating ONT’s 30th anniversary and spain’s becoming world leader in organ donation and transplantation

For her part, ONT Director General Beatriz Domínguez-Gil, who accompanied the Minister of Health at the press conference, underscored “the impeccable work of all the transplant coordination and transplant teams and the regional transplant coordinators who, together with the ONT, continue to look for new ways to further improve the current figures and ensure that complex transplant therapy reaches all the patients in need.” The lines set out in the Strategic Plan “50×22”, which aims to reach 50 donors PMP and 5,500 transplants per year, “already enabled us to comfortably surpass the latter figure by 2023,” Dominguez-Gil pointed out.

Behind the prodigious increase in transplant activity is the increase in asystolic donation. (Asystole, the most serious form of cardiac arrest which is usually irreversible, is the state of total cessation of electrical activity from the heart.)  With a total of 1,050 donors (15% more than in 2022), 45% of donors in Spain in 2023 were asystolic donors. Asystolic donation has given rise to multi-organ donation, thanks to the generalized implementation of a complex organ preservation procedure in Spanish hospitals based on Spain’s extracorporeal circulation devices (ECMO). Accordingly, in 2023 1,488 kidney transplants, 474 liver transplants, 195 lung transplants, 58 heart transplants and 31 pancreatic transplants were performed with organs from asystole donors, making Spain the only country in the world that transplants all types of organs from asystolic donors.

Organ transplant in Madrid during the SARS-Covid pandemic: donors with positive PCR for SARS-CoV-2 has been confirmed safe

The profile of potential organ donors in Spain has remained basically unaltered through the recent years. Donors who died as a result of traffic accidents accounted for only 4.7% of the total. The leading cause of death among donors was stroke. In terms of age, more than half the donors (56.8%) were over 60, 30% were over 70 and 5% were over 80. The oldest donor on record in 2023 was 92 years old. After organ transplantation from donors with positive PCR for SARS-CoV-2 has been confirmed safe, between December 2020 and the end of 2023 341 patients were transplanted from such donors.

Then there is the generosity of those donors who had requested assisted dying and expressed their wish to become donors: Since 2021 when the law regulating this type of donation came into force, and up to December 2023, a total of 90 people have been donors following their death, enabling the transplantation of 249 patients.

The constant increase in transplantation activity goes hand in hand with the search for new formulas to prioritize patients in clinical situations and solutions for those with anthropometric or immunological difficulties in transplantation.

Waiting list is still long

However, after all has been said and done, and despite last year’s impressive donor figures and the high level of transplantation activity in Spain, there is still a significant number of patients on the waiting list. As of 31 December 2023, the waiting list stood at 4,790 patients. This number of waiting patients is similar to that recorded in 2022 (4,746 patients).

 

———

Images
> Featured image (Guidepost collage: AI-generated woman holding heart/Praxie05-Kellie from Bad Homburg, Pixabay, cropped. Map of Spain with colors of the Spanish flag/Peggy und Marco Lachmann-Anke from Pixabay, vignetted.)
> Minister of Health and ONT Director General press conference, Pool Moncloa
> “Human organ for transplant” photo appears in La Moncloa transplant and donor news
> ONT press conference in January 2019/La Moncloa photo
> Organ transplant during the COVID pandemic/Nemo, 3 May 2020, CC BY-SA4.0, cropped, Wikimedia Commons
> File cabinet/OpenClipart-Vectors, Pixabay. Edited.