Why Does Spain Lead the World in Organ Donation?

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Why Does Spain Lead the World in Organ Donation?

The Wire


Spain a very special country indeed, it leads the world in organ donation.

Facts to be known:

Figures published for 2017 reveal that

  • 2,183 people in Spain became organ donors last year after they died.
  • 46.9 per million people in the population (pmp) – a standard way of measuring the rate of donation in a country.
  • Spain’s closest contender is Croatia, with 38.6 pmp (2016). It has maintained its position as the clear leader for the past 26 years.

How Spain is leading in organ donation?

  • Countries focus on changing the law as a key way to increase donations.
  • It’s the ‘opt-out’ (or presumed consent) system for deceased organ donation that is the reason for success.
  • Opt-out means that a patient is presumed to consent to organ donation even if they have never registered as a donor.
  • Responsible and committed Transplant coordinators who makes sure the organs reach the needy on time.
  • Transplant coordinators uses a database to share information about where and when the donation requires.
  • Mandatory family consent for organ donation of deceased
  • Intensive care staff deal with the potential for their patients to become donors as a routine part of their job
  • Coordinators have proper planning regarding transportation of organs in dangerous and normal areas. They even arrange for jet services if they come across a patient in dangerous i.e extreme harsh weather conditioned locations.

How popular is Spain model?

  • Lawmakers in England are currently deciding whether the country should change from opt-in to opt-out like Spain.
  • This is an attempt to redress a major difference between the UK and Spain: the rate of refusal of potential donors or their families in consenting to donation.
  • The rate of family refusal is still significantly higher in England than Spain, at 37 % versus 13 %.

Challenges for organ donation in Spain:

  1. A falling of mortality from causes that permit transplantation.
  2. Road traffic deaths are becoming less common due to strict belt laws
  3. Deaths among young road users have fallen more than for other age groups.

So, what Spain is doing?

  • Increasingly creative in identifying alternative sources of donor organs. For instance, it is becoming increasingly common to find donors in their 70’s, 80’s  and 90’s.The oldest deceased donor recorded in 2017 in Spain was 91, a liver donor.
  • Looking for organ donation from those who are suffering from chronic diseases or  life-threatening diseases of the nervous system.
  • kidneys from donors who were 75 years old or more had continued functioning well in their new hosts for ten years in two-thirds of cases.

Death —-> Donation:

  • There are two broad categories of death: brain death and circulatory death. But even these have their complications.
  • In most of Europe and US, Brain death is the reason for organ donation. Spain is very low in brain deaths due to increased health services
  • Another pool of patients that are increasingly becoming organ donors are those who have suffered circulatory death – when the heart and lungs have ceased to function properly. The difficulty with circulatory death is that organs must be retrieved very quickly after the patient’s heart has stopped beating.

    There are two types of donation after circulatory death.

  1. Uncontrolled donation after circulatory death (uDCD) – when a patient has died suddenly, say of a heart attack outside the hospital. It is challenging as the time available is just 20 min
  2. Controlled circumstances donation – for example, when a patient’s life support is turned off. Spain has had most success with increasing the number of these controlled donations after circulatory death (cDCD)

Lessons learnt from Spain:

  1. Croatia contacted the ONT several years ago to ask for advice and subsequently “completely reproduced” the Spanish system.
  2. Netherlands recently passed an opt-out law that automatically makes all adults potential organ donors after death unless they explicitly register their desire not to be
  3. Wales changed its own law to presumed consent in 2015 – but a big increase in donation has not followed.
  4. In 2010, Israel launched a scheme that when allocating transplant organs in situations of equal medical need, gives priority to living donors, family members of deceased donors and those who have long been on the donor register.

Global challenge to organ donation:

Muslims, for example, may cite religious scholars who have prohibited organ donation – though some believe it is compatible with the faith. And reluctance to donate organs after death for religious reasons has been documented in some black and Asian communities in Britain.

Lessons for India:

  1. Organ donation not be a commercial affair
  2. Committed staff to support the patients
  3. Organised data base for identifying the donars immediately
  4. Responsible and committed Transplant coordinators who makes sure the organs reach the needy on time.
  5. From doctors to the ground level staff ethical training is needed
  6. End of corruption is the major reform needed.
  7. Superstitions about organ donation to be faded by creating awareness
  8. Organ donation not to linked with religion
  9. India should not be confined to brain dead donations instead we need to extend ourselves with live donations.


Opt out system like in Spain may not be possible in India as most of the people raise Right to choice issue and sees the opt out system as a threat rather than looking for the noble cause. So a proper law should be legislated.


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