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María Luisa Carcedo presents the results from activity by the Spanish National Transplant Organisation in 2018

Spain, world leader in organ donation and transplantation, celebrates 30th anniversary of Spanish National Transplant Organisation with 48 donors p.m.p.

Monday 14 January 2019

This figure raises the transplant rate to 114 p.m.p., the highest in the world.

According to the Spanish National Transplant Organisation (ONT), these figures represent six donors and 14.6 organ transplants per day.

These figures were highlighted by the Minister for Health, Consumption and Social Well-being, María Luisa Carcedo, at a press briefing held at the ministerial headquarters, at which she released the activity data from the ONT for 2018. The minister was accompanied by the Secretary-General for Health, Faustino Blanco, and the Director of the Spanish National Transplant Organisation, Beatriz Domínguez-Gil.

"The ONT is celebrating its 30th anniversary in 2019 and doing so by beating its own record once again after reaching a rate of 48 donors per million population and surpassing 5,300 organ transplants, including all-time highs in kidney and lung transplantation. Donations from non-heart-beating donors also increased by 10%, consolidating their position as the main driving force behind the increase in organ donations: 1 in 3 donors are now asystolic donors", said María Luisa Carcedo.

The minister believes "these are incredibly difficult figures to achieve given that we already come from a position of excellence with little room for improvement. However, over the course of its history, the ONT has demonstrated a high level of demand on itself and shown itself capable of increasing both the quality and quantity of the transplants performed in our country". She went on to add that, "in the last five years, the ONT has raised the organ donor rate by 37% - the largest increase in its history - from 35.1 to 48 donors p.m.p. in just five years".

After highlighting the importance of the '50x22' Strategic Plan launched by the ONT and the Regional Transplant Coordination Authorities last year, María Luisa Carcedo also underlined the contribution from transplants to the sustainability of the National Health System given the savings they represent for the public purse. She also highlighted their important contribution to social cohesion thanks to the exchange of organs between the various regions of Spain. "The Spanish transplant system is a fine example of cohesion within our healthcare system, an organisation model in which the ONT and the regions of Spain collaborate in an exemplary fashion to offer the most suitable response to the needs of our patients", she said.

Finally, María Luisa Carcedo expressed gratitude for the work done by the professionals involved and especially the generosity of Spanish society at one of the most difficult times in people's lives. "Organ donation is one of the most charitable acts that exist, a gift of life to other people", she explained.

New all-time records

Subsequently, the Director of the Spanish National Transplant Organisation, Beatriz Domínguez-Gil, explained the organ donation and transplantation activity data recorded in Spain during 2018. According to these figures, Spain set new all-time records in both the total number of donors (2,241) and the number of solid organ transplants (5,318). New all-time records were also set in kidney and lung transplantation while the number of liver transplants fell slightly, probably due to less demand thanks to new antiviral drugs to combat the hepatitis C virus.

In total, 3,310 kidney transplants, 1,230 liver transplants, 321 heart transplants, 369 lung transplants, 82 pancreas transplants and six intestine transplants were performed. The waiting list has shortened for all organs (except heart and intestine) from a total of 4,891 at 31 December 2017 to 4,804 at the same date in 2018. Of those, 88 are children. It is worth noting the significant reduction to the liver transplant waiting list (down 19%).

Non-heart-beating and ER donors

According to the ONT, the positive results from last year are due to some of the measures already adopted by the Spanish transplant system to streamline organ donation. These measures are contained in the "50X22" Plan that seeks a figure of 50 donors p.m.p. and more than 5,500 transplants in 2022. They include the promotion of asystolic donation and its transformation into a multi-organ donation process, as well as collaboration between ICUs (intensive care units) and other hospital services, especially ER units.

Asystolic donation is consolidating its position as the clearest way to increase the number of transplants, with a total of 629 donors representing an increase of 10% on the previous year. 1 in 3 donors are now non-heart-beating donors. More than 100 hospitals throughout the country (in 16 autonomous regions) are already accredited to perform this type of organ donation.

Organ donation from brain-dead donors remains stable.

In contrast, the number of live-donor kidney transplants continued to fall, with a total of 289 (compared with 332 in 2017). This is likely due to a greater chance of receiving a transplant from a deceased donor. This type of transplant accounts for 9% of the total.

Donors dying in road traffic accidents account for 3.8% of the total, the lowest percentage to date.

In terms of donor age, more than half (57%) are over 60; 31% are over 70; and 9% are over 80. The oldest age for an effective donor stands at 91, which enabled a liver transplant to be performed. Only 14% of donors are under 45.

Objections from relatives now stand at 14.8%. This percentage falls to 8.8% in the case of non-heart-beating donors.

Furthermore, the ONT states that 1,181 patients received a transplant thanks to the exchange of organs between the regions of Spain, representing 24% of the total. This figure highlights the cohesive role played by the Spanish transplant system.

Data by autonomous region

10 autonomous regions posted a figure of more than 50 donors p.m.p. Of those, seven were above 60 donors p.m.p. and two were above 80 donors p.m.p.

Cantabria leads the table with a rate of 86.2 donors p.m.p. This is followed by La Rioja (80.6), Asturias (66.7), Extremadura (64.5), the Basque Country (64.4) and Navarre (64.1).

The increase in the number of donors in absolute terms is led by Castile-Leon, followed by Andalusia and Extremadura.

In percentage terms, Castile-Leon (up 43%), Extremadura (up 38%), Asturias (up 33%), the Balearic Islands (up 20%) and Cantabria (up 16%) are the autonomous regions posting the highest increases in the number of donors

Ranking of hospitals by activity.

By hospital, the units posting the greatest activity in 2018 were as follows:

  • Highest number of donors: Hospital Universitario Virgen del Rocío
  • Highest number of brain-dead donors: Hospital Universitario Central de Asturias
  • Highest number of non-heart-beating donors: Hospital Donostia
  • Highest number of kidney transplants: Hospital Universitarios Virgen del Rocío
  • Highest number of living kidney donors: Hospital Clinic de Barcelona
  • Highest number of liver transplants: Hospital Universitario La Fe
  • Highest number of heart transplants: Hospital Universitario Gregorio Marañón (adults and children) / Hospital Universitario La Fe (adults)
  • Highest number of lung transplants: Hospital Vall d'Hebrón
  • Highest number of pancreas transplants: Hospital Clinic de Barcelona
  • Highest total number of transplants: Hospital Vall d'Hebrón

Within hospital organ donation activity, it is worth noting:

  • Hospital de Donostia de San Sebastián - of the hospitals with no transplant activity, this is the unit with the highest level of organ donation (a total of 69 donors).

Within hospital organ transplant activity, it is worth noting:

  • Hospital la Vall d'Hebron performed the most transplants in Spain this year (6% of the total)
    Other outstanding achievements in 2018
  • The ONT launched a plan to improve organ transplants in children. Under this plan, the first ABO-incompatible children's heart transplant was performed at Hospital Gregorio Marañón in Madrid. At the close of 2018, four such transplants have been performed (two at Hospital Gregorio Marañón and two at Hospital La Paz).
  • Together with Italy, Spain performed the first international crossed kidney transplant in southern Europe in a complicated logistics operation involving the Fundación Puigvert de Barcelona and the Ospedale de Pisa.
  • Spain led a new resolution against organ trafficking at the United Nations General Assembly, in which Member States are urged to train healthcare professionals and State law enforcement agencies in the prevention, detection and notification of this type of offences.

National Bone Marrow Plan

At 1 January 2019, Spain has a total of 391,609 bone marrow donors (up 9%) registered with the Spanish Register of Bone Marrow Donors (REDMO). A figure of 400,000 donors is expected during the first quarter of this year, almost two years ahead of schedule under the National Bone Marrow Plan. In this regard, the Spanish minister underlined her strong support for the plan, to which her ministerial department has allocated 1,830,000 euros this year; one million euros more than last year and an increase of 120%.

Non official translation