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Expanding the organ donor pool: The Spanish Model

2001; Elsevier BV; Volume: 59; Issue: 4 Linguagem: Inglês

10.1046/j.1523-1755.2001.0590041594.x

1523-1755

R. Matesanz, B Miranda,

Renal and Vascular Pathologies

To the Editor: We read with interest the discussions of Dr. Hou regarding the best ways to improve organ donations1Hou S. Expanding the donor pool: Ethical and medical considerations.Kidney Int. 2000; 58: 1820-1836Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar. As usually happens in this field, most strategies are cited to imply that they did not achieve significant improvements. Rather surprising, the Spanish experience is not even considered, despite the fact that Spain is the only large country (40 million citizens) in the world with a sustained and progressive increase of cadaveric organ donation rates during the last decade. Since the National Transplant Organization was established in 1989, together with a national network of in-hospital, specifically trained, part-time, dedicated, and strongly motivated physicians in charge of organ procurement2Matesanz R. Miranda B. Felipe C. Organ procurement in Spain: The impact of transplant coordination.Clin Transplant. 1994; 8: 281-286PubMed Google Scholar, Spain has increased its organ donations from 14 to 33.6 organ donors per million people in 1999, a 142% increase3Matesanz R. Miranda B. Felipe C. Naya T. Continuous improvement in organ donation.Transplantation. 1996; 61: 1119-1121Crossref PubMed Scopus (39) Google Scholar. This organ donor rate is by far the highest in the world (the United States has 21.8 per million people, Canada has 13.8, and the mean of the other European countries is 14.3), which has also resulted in the highest transplant rates of cadaveric kidney, liver, heart, and lungs4Transplant Newsletter. 2000; 5: 18-19Google Scholar. There was no change in legislation during this period and, as in most European countries, permission from the family is always obtained before donation. The number of renal transplants rose from 1039 in 1989 to 2023 ten years later, 99% cadaveric (50.6 per million people versus 29.9 in the United States), a significant and sustained increase that, at least in our opinion, deserves a reference in reviews from authors of possible methods to expand the donor pool. The “Spanish Model” results from the efforts of many to overcome obstacles such as untrained or under trained staff, unidentified donors, and the reluctance to approach grieving family members.