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Spain reaffirmed its global leadership in organ donation during 2019 and now accounts for 20% of EU donors and 6% worldwide

Monday 7 September 2020

Albeit slowly, global transplant activity continued its upward trend last year. At least that is the impression given by the latest figures from the World Transplant Registry, which has been managed by the Spanish National Transplant Organisation (Spanish acronym: ONT) for 14 years as a partner centre of the World Health Organization (WHO) and which puts the total number of worldwide transplants in 2019 at 146,840. This figure represents a 6% increase on the previous year.

Of that total, 95,479 were kidney transplants (36% live-donor), 34,074 were liver transplants (19% live-donor), 8,311 were heart transplants, 6,475 were lung transplants, 2,338 were pancreas transplants and 163 were intestinal transplants. Kidney and lung transplants have increased the most. These transplants were made possible by 39,357 deceased donors (a 5% increase on the previous year), 41,049 living kidney donors (34,549) and living liver donors (6,500).

One of the most significant reasons for this growth was the support given by many countries to donations from non-heart-beating donors or asystolic donation in recent years. According to data from the World Transplant Registry, 24 countries around the world now have an asystolic donation programme. When compared with 2018, this type of organ donation grew by 12% worldwide and by 15% in the European Union (EU). Asystolic donation grew by 18% in Spain, one of the highest increases. In fact, asystolic donation in Spain now accounts for 37% of the EU total.

These data are contained in the official publication by the CoE Committee on Organ Transplantation ('Newsletter Transplant 2019'), which will be available on the ONT website in the next few days. They are also available from the Global Observatory on Donation and Transplantation that the ONT manages in partnership with the WHO. The World Transplant Registry developed by the ONT is the only source of official information in the world on organ donation and transplantation.

Spain, global leader in organ donation for 28 years

In 2019, Spain maintained the global leadership position it has had for the last 28 years straight, with a rate of 49.6 donors per million population (p.m.p.). The World Transplant Registry works with the population figures gathered by the United Nations Fund. This explains the slight difference between the rate recorded by the ONT at the end of 2019 (49) and the figure reported by the World Transplant Registry (49.6 p.m.p.).

The World Registry data also reflect Spain's significant contribution to organ donation: Spain accounted for 20% of all organ donations in the EU last year and 6% of worldwide donations, despite the fact that Spain only accounts for 9.1% of the total European population and 0.6% of the global population.

In terms of transplant activity in 2019, Spain posted a rate of 117.4 transplants p.m.p. This is second only to the United States, which posted a figure of 123.4 transplants p.m.p., due to its significant live-donor transplant activity. By some considerable margin, Spain occupies the top spot in the international ranking of transplants from deceased donors with a rate of 107.9 transplants p.m.p., far higher than the figure of 100.9 p.m.p. in the United States.

Activity in the European Union

The significant activity recorded in Spain last year has widened the gap between Spain and the rest of the EU, where both organ donation and organ transplantation activity remained stable.

With 11,492 donors and a rate of 22.5 deceased donors p.m.p., a total of 34,285 transplants were performed in the EU last year, which corresponds to a rate of 67.2 transplants p.m.p. The trend in EU activity over the years can be seen below:

The following EU countries posted the highest organ donation and transplantation rates:

As regards the waiting list, data from the World Registry put the number of patients in the EU waiting for a transplant at 60,000 at 31 December 2019. According to the same data, 10 patients died every day in the EU while waiting for a transplant. An identical figure was posted in 2018.

Activity in other countries

The organ donor rate in the United States rose to 36.1 donors p.m.p., with a total of 11,870 deceased donors. These figures represent an increase of 10.7% on the previous year. To a great extent, this increase was boosted by the dramatic epidemic of deaths caused by parenteral drug use in the country.

Australia, which has received consultancy in this regard from Spain and reproduced all aspects of the Spanish Model, has also posted an improvement in its organ donor rate over recent years - an increase to 21.8 donors p.m.p. in 2019. The same has occurred in Canada, with 22.2 donors p.m.p. and a steady improvement partially attributed to the figure of "Donation Physician" - intensive care doctors with responsibility for organ donation. This is another contribution from the Spanish Model.

Other large countries that report activity to the World Transplant Registry include China (with 5,818 donors in 2019 or 4.1 p.m.p.) and India (with 715 donors or 0.5 p.m.p.). In turn, Russia posted a slightly higher rate of 5.1 donors p.m.p.

Latin America, with which Spain has been working in this field for 15 years via the Iberoamerican Network/Council on Organ Donation and Transplantation (RCIDT) on both management consultancy and training for transplant coordination professionals, increased organ donation by 9% in 2019 to 10.3 donors p.m.p. and a total of 18,183 transplants performed. Growth was especially noteworthy in Argentina (from 15.7 p.m.p. in 2018 to 19.6 p.m.p. last year), Chile (from 6.5 p.m.p. to 10.3 p.m.p.) and Brazil (from 16.7 p.m.p. to 17.7 p.m.p.).

Organ donation in Latin America, which is currently led by Uruguay (with 21.4 donors p.m.p.), has practically doubled since cooperation began with Spain in 2005 and represents the largest growth anywhere in the world for a region as a whole.

The international organ transplantation data once again confirm Spain's global leadership in this field, where a rate of 49.6 donors p.m.p. was recorded last year. A total of 2,302 organ donors registered in Spain last year, enabling 5,449 organ transplants to be performed. In total, 3,423 kidney transplants, 1,227 liver transplants, 300 heart transplants, 419 lung transplants, 76 pancreas transplants and four intestinal transplants were performed.

Asystolic donation and collaboration from ICU and ER professionals with transplant coordinators have become key factors in the improvements seen. In turn, Spain has extensive experience in organ donation from elderly donors with positive results, which is an area for potential improvement in other countries. In Spain, more than half of all donors are over 60 years old, a figure that is far higher than the percentage recorded in most countries in the same peer group.

Post-COVID Plan

The upward trend posted in Spain in the field of organ donation and transplantation in recent years has levelled off in 2020 due to the health crisis caused by COVID-19. In spite of that, a total of 1,649 organ transplants were performed from 760 donors between 13 March (when the State of Emergency was announced) and 3 September. This recovery in activity despite the epidemiological situation was made possible by the establishment of clear protocols for the evaluation and selection of potential donors and recipients, and the creation of COVID-19-free circuits in line with the guidelines set in the Post-COVID-19 Plan promoted by the ONT and the Regional Transplant Coordination Offices.

The ONT stresses that Spain's organ donation and transplantation success and its enormous impact on health would not be possible without the incredible work of the healthcare professionals who take part in this activity, the cooperation from various groups and institutions, and the enormous generosity of the donors and their families.

Non official translation