Spain has experienced an increase in the donor rate of 33% between 2014 and 2018, consolidating its global leadership in this field, which has been maintained for the past 27 years, according to data provided this morning by the Minister of Health. Health, María Luisa Carcedo, who recalled that the National Transplant Organization (ONT) In 2019, it has been in existence for 30 years.
In total, the donor rate has reached 48 people per million inhabitants. "It is a system of excellence in which the capacity for improvement is already very limited," said Carcedo. The director of the ONT, Beatriz Dominguez-Gil has abounded in the idea, and has given as an example that if the data are taken by communities, all would be at the head of the world ranking. In fact, according to this balance, which has a lower rate, Castilla-La Mancha (29.2 donors per million) would be behind only the other 16 autonomous communities, and a short distance from the US (31.7) and France (29.7), the following from the list. The EU average is 22.3.
With these 2,241 donations, 5,316 solid organ transplants have been performed (kidney, heart, lung, pancreas, liver and intestine), which represents a rate of 114 per million, also a world record, which indicates that not only many donors are captured , but you get the maximum benefit (almost three transplants per donor).
To improve this situation that both have described as "of excellence", one of the ministry's ideas is to cooperate with private healthcare to help attract donors. The ONT is preparing an agreement with ASPE, the Spanish Private Health Alliance, so that patients in their centers can also donate, Dominguez-Gil said. Carlos Rus, the general secretary of the employer's association, affirms that it would be a disinterested collaboration that could consist of notifying the ONT and transferring the donor to a public center for the extraction of organs, that the extraction is done by a health team public in private facilities or that the team is mixed with professionals from the center and experts from outside. Currently only three privately owned hospitals (University of Navarra, Jiménez Díaz Foundation in Madrid and the Puigvert Foundation in Barcelona) can perform transplants.
The objective is that the waiting list does not rise, since the continuous incorporation of patients and the fact that transplants are offered to people who previously did not opt for them makes it difficult to reduce much. At the end of 2018 the list had almost 5,000 people, practically the same as the previous year. In the liver it has gone down a lot (15% in a year) due to the effect of the hepatitis C treatments, which, by curing the disease, reduce the need for transplants for carcinoma or cirrhosis.
The figures by autonomies show that there are 10 with rates higher than 60 (by order: Cantabria, La Rioja, Asturias, Extremadura, Basque Country, Navarre and Castilla y León) and three with more than 50 (Balearic Islands, Murcia and Andalusia). With more than 40 are the Canary Islands, the Valencian Community, Catalonia and Galicia, and close the list of Madrid, Aragon and the aforementioned Castilla-La Mancha.
This consolidated leadership has several explanations, according to the explanations given by Carcedo and Domínguez-Gil.
The very existence of the ONT. The agency, under the Ministry of Health, was created 30 years ago. It coordinates and regulates donations and the system of transplants both between communities and abroad, with a unique waiting list in which the only criterion is the need and compatibility of the organ. It is universally accessible (if a patient is treated in private healthcare, he is transferred to the public if he needs a transplant).
A "brave legislation". In Spain, as Carcedo recalled, all people who die are potential donors unless they have stated otherwise before or their relatives show objections later.
Altruism and gratuity. Neither the donor charges nor the recipient pays for the organ, so that all, rich and poor, have equal access. The rate of family refusals is also in record Spain: it is below 15% (in the United Kingdom, for example, it is 40%).
The professionals. The system is based on a network of transplant coordinators who are in charge of locating potential donors in public health hospitals, especially in the Emergency and ICU. The professionals who participate in these processes they have the corresponding gratification for the work done. Despite this, the cost of a transplant is very low in Spain, Domínguez-Gil has said, largely because the salaries of professionals are. The work of the professionals is so clear that often the ONT leaders themselves attribute the differences between communities or hospitals or the interannual variations in the rate of donors within a center to the name of the coordinator. Domínguez-Gil has put another example of the role of health workers: while in the United Kingdom the family refusal triples the Spanish rate, among tourists or residents of that nationality those who refuse to donate are as few as among nationals, which indicates that the The protocol with which they are approached to obtain their permission is essential.
Medical advances. The increase in donations in the last five years follows a period of stagnation of more than 15 years at rates of around 34 per million. And this trend has been reversed because a modality has been promoted, the donation in asystole (when a cardiorespiratory arrest occurs, unlike the one that takes place when there is a brain death and there is more time to prepare the process because the heart keeps beating and organs maintain blood flow) which is already responsible for 28% of donations, when until 2011 they were very scarce (less than 7% of the total).
The age of the donors. Related to the technical and scientific advances, more organs of older people are being used. Although they are not ideals, the fall in the number of deaths in traffic accidents (usually younger) has forced to refine the processes. In total, 57% of donors last year were 60 or older. In 2000, people who offered organs accounted for 31.5% of the total. For example, in 2016 a liver was transplanted from a donor of 94 years, and a year earlier a kidney from a person of 90. The age record in the other organs is 86 years for lung, 79 for heart and 55 for pancreas .