The Minister for Health, Mónica García, and the general director of the ONT, Beatriz Domínguez-Gil, during the presentation of the balance sheet
In 2023, organ donation and transplantation activity in Spain reached levels of excellence that are difficult to surpass. Thanks to a cohesive national programme, led by the National Transplant Organisation (ONT), in which professionals from multiple specialities take part, and which stems from the generous act of donation, 5,861 organ transplants were performed in Spain last year, representing a rate of 122.1 transplants PMP. This balance was announced today at a press conference with the Minister for Health, Mónica García, who was accompanied by the Director General of the ONT, Beatriz Domínguez-Gil.
This high level of transplant activity was achieved thanks to the 2,346 people who donated their organs after death, bringing the donation rate to 48.9 donors PMP, and the 435 people who donated a kidney (433) or part of their liver (2) during their lifetime. These figures represent a growth of 9% in transplantation and 7% in donation compared to 2022. Moreover, this transplant rate is 8% higher than the all-time high recorded in 2019, before the COVID-19 pandemic. The average number of donors per day last year was 8 and the average number of transplants performed each day was 16.
Record activity in kidney, liver and lung transplants
Growth in 2023 was spread across all types of transplantation. 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 performed. With a total of 433 procedures, living donor kidney transplantation activity increased by 24%, accounting for 12% of the total number of kidney transplants performed. In addition to the all-time record for the total number of transplants, the figures for kidney (both living and deceased donor), liver and lung transplants also exceed previous highest figures
The rate of 48.9 deceased donors PMP that Spain reached last year is close to the target of 50 donors PMP set by the ONT in its Strategic Plan "50X22", with the figure of 2,346 donors representing another historic high. This rate of activity is also much higher than that achieved by other countries worldwide, according to data from the Global Observatory on Donation and Transplantation, managed by the ONT as a World Health Organisation Collaborating Centre.
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.
Minister García thanked "the solidarity of donors and their families, as well as the essential 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, an example of social and health cohesion - a perfectly coordinated network that saves thousands of lives every year, as reflected in the data we are presenting today".
Asystole donation, main line of growth
Meanwhile, the Director General of the ONT, Beatriz Domínguez-Gil, highlighted "the impeccable work of all the transplant coordination and transplant teams and the regional transplant coordinators who, together with the ONT, continue to identify new ways to improve these figures and ensure that complex transplant therapy reaches all the patients who need it". In this regard, the lines set out in the aforementioned strategy, which aims to reach 50 donors PMP and 5,500 transplants per year, "already enabled us to comfortably surpass the latter figure by 2023".
Some years ago now, the ONT identified an initiative that was decisive in terms of maintaining this growth path: asystolic donation. With a total of 1,050 donors (15% more than in 2022), 45% of donors in Spain in 2023 were asystolic donors. This type of donation is also becoming consolidated as a multi-organ donation, thanks to the generalised implementation in Spanish hospitals of a complex organ preservation procedure based on extracorporeal circulation devices (ECMO), also with a Spanish signature. Thanks to this, 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. To these figures can be added another intestinal transplant in asystole was carried out by the Hospital Univ. La Paz, which had already performed two intestinal transplants with the same characteristics in 2022. This once again makes Spain the only country in the world that transplants all types of organs from asystole donors.
The oldest donor, 92 years old
The profile of potential organ donors in Spain is currently similar to that of previous 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. Organ transplantation from donors with positive PCR for SARS-CoV-2 was also standardised last year, following confirmation of its safety over recent years. Between December 2020 and the end of last year, 341 patients were transplanted from donors with this condition.
To the generosity of all donors, since 2021 can be added the generosity of those requesting assistance in dying who expressed their wish to be donors: A total of 90 people have been donors following their death under these circumstances, enabling the transplantation of 249 patients from when the law regulating this type of donation came into force up to December 2023.
The constant increase in transplant activity goes hand in hand with the search for new formulas to prioritise patients in clinical situations and find solutions for those with anthropometric or immunological difficulties in transplantation. In this regard, 314 patients were transplanted in zero emergency, and 190 children received the organ transplant they were waiting for. In addition, 153 hyperimmunised kidney patients (for whom it is very difficult to find a compatible donor) received transplants, thanks to the ONT's PATHI programme.
Despite last year's impressive figures and the high level of transplant activity in Spain, there are still a significant number of patients on the waiting list. As of 31 December 2023, the waiting list stood at 4,790 patients. Of these, 75 were children. This number of patients on the waiting list is similar to that recorded in 2022 (4,746 patients).
Data by Autonomous Community
Last year, ten Autonomous Communities exceeded 50 donors PMP, and 3 of them exceeded 70 donors PMP. Cantabria again led the ranking, with a rate of 74.1 donors PMP, followed by Navarra (71.6) and Murcia (71.0). Of the Autonomous Communities with populations of more than 5 million inhabitants, the transplant activity recorded in the Valencian Community (52.6) and Andalusia (51.5) stands out. The Autonomous Communities with the highest growth in donation were, in this order, Murcia (+49%), Madrid (+24%) and Castilla la Mancha (+22%). (Table 1).
The ONT puts the number of transplants carried out thanks to the exchange of organs between Autonomous Communities at 1,304, which represents 23% of the total. In turn, 7% of recipients were transplanted in a centre outside their Autonomous Community of residence. Both data are proof of the cohesive role of the Spanish Transplant System.
Activity by hospital
The centres with the highest activity in 2023 were:
Other highlights in 2023
- Spain and Italy successfully performed the second international crossover kidney transplant involving three couples. Ten Spanish, seven Italian and two Portuguese hospitals took part in this crossover of the International Renal Transplant Crossover Programme, with 133 donor-recipient pairs that had not achieved an exchange in their countries: 67 from Spain, 42 from Italy and 24 from Portugal. In addition, Spain performed 19 kidney transplants, thanks to the National Cross Kidney Transplant Programme. These included three exchanges of two transplants, three exchanges of three transplants and a chain of four transplants initiated by an altruistic donor.
- The asystole donor heart transplant programme was also consolidated last year. In addition to the 110 transplants carried out between January 2020 (12 of them paediatric) and December 2023, H. Clinic de Barcelona performed the first combined heart and kidney transplant from an asystole donor. The hospitals involved in this programme were: H. Univ. de A Coruña Complex, H. Clinic, H. Univ. de Bellvitge, H. Univ. Dr. Negrín, H. Univ. Gregorio Marañón, H. Univ. La Fe, H. Univ. La Paz, H. Univ. Marqués de Valdecilla, H. Univ. Puerta de Hierro, H. Univ. Vall d'Hebron, H. Univ. Virgen de la Arrixaca and H. Univ. Virgen del Rocío. This type of transplantation accounted for 18% of all heart transplants performed in 2023.
- In November last year, the high-level meeting 'Towards a global consensus on transplantation: availability, transparency and registration' was held in Santander, under the Spanish presidency of the EU. Through the ONT, Spain will lead the design of the roadmap for organ, tissue and cell donation and transplantation in the world for the next decade, with the approval of the Santander Declaration.
National Bone Marrow Plan
As of 31 December 2023, our country had 484,175 bone marrow donors on the Spanish Bone Marrow Donor Registry (REDMO), a figure that brings us closer to the objective of 500,000 registered donors, on which the ONT and the Autonomous Communities are working together with the José Carreras Foundation, Scientific Societies and patient associations. A total of 23,686 donors joined in 2023, 8% more than in the previous year, thereby recovering the pre-pandemic growth rate and returning to annual growth.
Non official translation