"Altruism is gasoline for donations to flow"

Rafael Matesanz is no longer the director of the National Transplant Organization (ONT). Now he is only Rafa, grandfather and advisor of companies that want to transfer his success. For 28 years he has directed this leading agency in our country and now there are many companies that want to "copy it". That is why he has decided to write a book, "Management with a soul" (Sphere of the Books), in which, with examples, he gives the keys to transfer what is known as the "Spanish model" to any plot, economic or social.

- Is the success of the ONT due to the altruism of the Spaniards?

- It is the gasoline that makes the donation flow, but you need a technique to make it flow and that is what we have developed. The key to many countries not working is that they believe that donation is something spontaneous, that it comes from people and is not so.

- Doesn't it have something cultural?

-Absolutely. In the 80s we were far behind most countries. We had fewer donors than Germany and now we have five times more. What is evident is that what has happened in Spain in these last three decades has changed the mentality of all Spaniards.

- What was the response of the relatives in those years?

- It was quite violent, we had not developed the technique. We learned from those who had asked for organs before, it was quite amateur. You were violent reactions because it was very difficult to explain that a person whose heart is beating is dead.

- What became the percentage of refusals?

- No one knows because there were no statistics, but it is probably 40-50 percent. One of the things we learned is that, in my hospital, the refusal rate depended on who was on duty. While some of us were good, others fatal. Some collected one hundred percent negatives. To ask for kidneys, which was what we demanded then, it was key that he was on duty.

–How did you design the model that has succeeded?

- By intuition. It would be petulant to say that I studied many books because it was not so. I saw the things that worked and applied them.

- Without bureaucracy everything works much better?

-Yes. For doctors, getting out of it is essential because we dislike paperwork. It was a bottom-up process. It is what has allowed us to introduce all the news, such as the donation with a stopped heart.

-If a minister of Podemos finally takes the Health portfolio, could he get a hand in the organization?

- It is not so easy. It is true that there have been ministers who have let us do more than others. We had to act as a retaining wall with many. Messing with the system is complicated, but with the one who runs the ONT it is not so difficult.

- Disassemble a system that works ...

- Sounds really bad until it's done. I go out to minister every year and a half. Since we entered 89 until now, I think they have been 18. Add and continue. I have been dismissed from some regional coordinator and there has been a significant decrease in donation, but the ministers do not care. If you have many problems, for one thing that is going well ... With us you just have to take the picture presenting good data. It's weird that we have an important mess.

- What is the worst crisis you had to face?

- The one of the registry of marrow donors that tried to bring a German company. It was terrible. They came to threaten me personally in the European Commission. He told me what I could fall for. They asked for my head.

–Of the new techniques that may come, can anyone put the system at risk?

- No, there is much left for us to see organs created in pigs. I think that what is progressing faster is the research on the repair of organs and not so much creating other bioartificials, although Juan Carlos Izpisúa is making great progress. But there are not only technical problems, but also ethical ones. Even if organs were created, the donation problem would become economical because it would be very expensive and its manufacturing would have to comply with the current standard.


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