Balance of activity of the National Transplant Organisation (ONT)

Darias: The National Transplant Programme is a shared success of authorities, professionals and society

News - 2023.1.19

The Minister for Health, Carolina Darias, highlighted the shared success that the National Transplant Programme represents for the health authorities, health professionals and Spanish society; a programme, she remarked, that unites excellence, effort, drive and generosity.

The minister's appraisal came during the presentation of the balance sheet of the activity of the National Transplant Organisation (ONT) in 2022, at a press conference where she was joined by Beatriz Domínguez-Gil, director general of the body attached to the Ministry of Health.

Last year, detailed Darias, a total of 5,383 organ transplants were performed in our country, representing a 13% increase in the number of transplants and a 15% increase in the number of donations compared to 2021.

In 2022, a total of 3,402 kidney transplants (15% more than the previous year), 1,159 liver transplants (+8%), 415 lung transplants (+15%), 311 heart transplants (+3%), 92 pancreas transplants (+12%) and 4 intestinal transplants were performed. Notably too, with a total of 350 procedures, living donor kidney transplantation activity accounted for 10% of all kidney transplants.

These figures are thanks to the 2,196 people who donated their organs after death, putting the donation rate at 46.3 deceased donors per million population (p.m.p.). To these must be added the 355 people who donated a kidney (350) or part of their liver (5) during their lifetime.

Minister Darias thanked all the professionals involved in each of the phases of the donation and transplant process, as well as the coordination of the ONT. She also thanked he autonomous communities and cities, and the work of the state law enforcement forces and agencies, the Armed Forces, airlines, airport workers, ambulance drivers and all those involved in the logistics required to carry out this type of operation.

She also highlighted the extensive network of collaborations established by the ONT together with all the scientific societies that represent the healthcare professionals involved in the donation and transplantation process.

She also underlined the generosity of Spanish society, highlighting the high percentage of acceptance of donation by families (84%) at the time of the loss of a loved one.

Spain, world leader in donation

The Minister for Health also highlighted the level of excellence that the National Transplant Programme has achieved worldwide. To this effect, the 2022 transplant figures for Spain mean a rate of 113 per million population (p.m.p.) and an average of 7 donors and 15 transplants per day.

Spain's rate of 46.3 deceased donors p.m.p. 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 this regard, in 2021, Germany recorded 11.1 donors p.m.p., Australia 16.3, Canada 19.3, the US 41.6, France 24.7, Italy 24.1, the UK 19.8, Sweden 19.3 and the EU as a whole, 19.5.

Pioneers in asystole donation worldwide

As Darias pointed out, the growth recorded has been aided by the constant search for new ways to increase activity and ensure that transplant therapy reaches all patients who need it.

To this effect, last year the strategic lines of the ONT's '50X22 Plan' were able to be resumed, aiming to reach 50 donors p.m.p. and to surpass the figure of 5,500 transplants per year.

Notable in this regard is the 38% growth in asystole donation compared to 2021, a decisive initiative for the expansion of transplantation. With a total of 913 donors, 42% of donors in 2022 were asystolic donors.

As Carolina Darias pointed out, Spain is the only country in the world that transplants all types of organs from donors in asystole, a procedure that has gone from being exclusively renal to becoming multi-organ, thanks to the generalisation of the preservation procedure based on extracorporeal circulation devices (ECMO).

In this regard, in 2022, 1,299 kidney transplants, 375 liver transplants, 152 lung transplants, 37 heart transplants and 20 pancreatic transplants were performed with organs from asystole donors. Furthermore, the first intestinal transplant in asystole was performed by the Hospital Universitario La Paz in Madrid which, after the good results obtained, carried out a second intestinal transplant with the same characteristics.

Adaptation to the profile of the potential organ donor in Spain is another pillar of the '50x22 Plan'.

Donor deaths due to traffic accidents remain very low at just 4.3%. The leading cause of death among donors is stroke. In terms of age, more than half of the donors (57.3%) are over 60, 28% are over 70 and 5% are over 80. The oldest donor on record in 2022 was 90 years old.

Another necessary adaptation has been the coexistence with COVID-19, including the transplantation of organs from donors with positive PCR for SARS-CoV-2, following individualised assessment and appropriate selection of recipients. As of 31 December 2022, 180 patients had received transplants from 84 donors with this condition.

To the generosity of all donors in 2021 can be added the generosity of those requesting assistance in dying: 49 people became donors after dying this way, enabling 135 patients to receive transplants.

Solutions for emergency or difficult-to-transplant patients

Over the years, formulas have been sought to prioritise patients in very serious clinical situations, and to find solutions for those with specific difficulties to receive transplants due to their characteristics. In this regard, in 2022, transplants for 253 patients in emergency zero and 188 children stand out. 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 which, with this figure, has reached its highest ever number.

Despite last year's growth 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 2022, the waiting list stood at 4,746 patients. Of these, 66 were children.

This number of patients on the waiting list is similar to that recorded in 2021 (4,762 patients).

Renal cross-transplantation

Spain also carried out 24 kidney transplants thanks to the Cross Kidney Transplant Programme. Eight chains were completed, two of them of five transplants initiated by altruistic donors. The programme involves 26 hospitals in 13 autonomous communities and 22 histocompatibility laboratories, coordinated by the ONT.

The asystole donor heart transplant programme is also being consolidated in Spain. A total of 52 transplants have been performed since January 2020 (9 paediatric transplants).

National Marrow Plan

As of 1 January 2023, Spain has 474,455 bone marrow donors on the Spanish Bone Marrow Donor Registry (REDMO). Of these, 21,903 are donors who joined in 2022.

The ONT and the autonomous communities, together with the José Carreras Foundation, scientific societies and patient associations, are working to reach 500,000 registered donors.

Non official translation