Spain is world leader in organ donation and transplantation for 25 straight years, smashing its own record and reaching 43.4 donors per million population

Spain has been the world leader in organ donation and transplantation for 25 straight years. It smashed its own record in 2016 by reaching 43.4 donors per million population, with a total of 2,018 donors enabling 4,818 organs to be transplanted.

This is an all-time record for the Spanish National Transplant Organisation (Spanish acronym: ONT), both in terms of organ donation and transplants. Furthermore, for the second consecutive year, Spain surpassed the figure of 100 transplants per million population. This figure is especially significant and demonstrates the high transplant index that exists in the country. In fact, Spanish citizens are the most likely in the world to have access to a transplant should they need one.

The Minister for Health, Social Services and Equality, Dolors Montserrat, personally received the results of activity by the ONT in 2016 during her visit on Wednesday morning to the headquarters of the Spanish National Transplant Organisation, where she greeted all its professionals and congratulated them on "the excellent work they do". The ONT is an essential body within the Spanish transplant system. Among many other things, it is responsible for coordinating all the logistics necessary for the organ donation and transplantation process to be implemented anywhere in the country as swiftly as possible and successfully. The nursing and medical team coordination professionals work 24 hours a day, 365 days a year.

The data provided by the ONT on last year show all-time records for both the total number of donors (2,018) and the total number of solid organ transplants (4,818). Spain also posted higher figures in terms of kidney and lung transplantation than at any other time in the history of the ONT.

In total, 2,994 kidney transplants, 1,159 liver transplants, 281 heart transplants, 307 lung transplants, 73 pancreas transplants and four intestine transplants were performed. The waiting list has shortened for almost all organs from a total of 5,673 in 2015 to 5,477 patients (down 196, of which 22 are children).

Non-heart-beating and ER donors

According to the ONT, the positive results from last year are due to the measures adopted by the Spanish transplant system to streamline organ donation that were contained in the 2015 Strategy. These include the promotion of asystolic donation and increased collaboration between ICU units and other hospital services, especially ER units and all critical care units in general.

Asystolic donation is consolidating its position as the clearest way to increase the number of transplants, with a total of 494 donors representing an increase of 57%. This type of donation now accounts for 24% of all deceased donors, in other words, one in four donors provides asystolic donation. At the present time, a total of 68 Spanish hospitals have active programmes in this type of donation.

Together with asystolic donation, the involvement of ER doctors is another of the keys to explaining this latest achievement allowing the number of donors to be increased. In fact, the donors found in emergency rooms now account for 24% of the total at hospitals included in the study.

In contrast, the number of live-donor kidney transplants fell for the second year, with a total of 341 (compared with 388 in 2015). This is likely due to the much greater chance of receiving a transplant from a deceased donor.

Donors from road traffic accidents account for 4.4% of the total, a similar percentage to that posted in previous years.

Furthermore, the gradual aging of donors is becoming more evident: over half (54.6%) are over 60; close on a third are over 70; and almost 10% are over 80. An all-time record was set by a liver donor aged 94.

The number of objections from relatives remains similar to those posted in previous years, at 15.6% (provisional data).

The ONT puts the exchange of organs between autonomous regions of Spain at 23.1%, slightly higher than last year (22%).

Data by autonomous region

By autonomous region, Cantabria tops the table with a rate of 65.5 donors per million population, followed by the Basque Country (65.1), Navarre (60.9), Murcia (52.1) and La Rioja (51.6).

All autonomous regions surpassed a rate of 35 donors p.m.p. Furthermore, three of them surpassed a rate of 60 donors per million population, five surpassed 50 p.m.p. and 14 of them surpassed a rate of 40 donors p.m.p., which was the target set for 2020.

In percentage terms and in order, Catalonia, the Basque Country, Andalusia, Aragon and Murcia are the autonomous regions posting the highest increases in the number of donors.

In absolute terms and again in order, the number of donors also rose significantly in Andalusia, Catalonia, the Basque Country, the Canary Islands and Murcia.

List of hospitals by activity

By hospital, the units posting the greatest activity in 2016 were as follows:

• Highest number of donors H. Virgen de la Arrixaca (Murcia)

• Highest number of non-heart-beating donors H. Clínico San Carlos (Madrid)

• Highest number of kidney transplants H. Regional de Málaga

• Highest number of living kidney donors H. Clínic i Provincial de Barcelona

• Highest number of liver transplants H. La Fe de Valencia

• Highest number of living liver transplants H. La Paz Infantil

• Highest number of heart transplants H. La Fe de Valencia and the
C. H. Univ. de A Coruña (CHUAC)

• Highest number of lung transplants H. Vall d'Hebrón de Barcelona

• Highest number of pancreas transplants H. Clínic i Provincial de Barcelona

• Highest total number of transplants H. La Fe de Valencia

Second stage of the National Bone Marrow Plan

Spain also posted a new record in the number of new bone marrow donors in 2016, which rose to 74,397, practically twice the figure posted in the previous year (37,619). The speed at which new donors registered in the system sped up last year, with an average 200 new donors per day.

At 1 January 2017, a total of 281,969 bone marrow donors were registered in Spain. This compares with a figure of 207,572 registered at the same time in the previous year.

Last year, both the ONT and the regional governments approved a second stage of the National Bone Marrow Plan in order to reach 400,000 donors by the end of 2020, at an average of 40,000 new donors in each of the next five years.
This target was comfortably surpassed this year.

By autonomous region, it is worth noting the extraordinary degree of compliance with the targets set by the second stage of the National Bone Marrow Plan in Andalusia, Aragon, Asturias, Murcia and Galicia (see table attached).