Organ donation rates in Spain for British residents are higher than in UK

BMJ 2011; 343 doi: (Published 01 August 2011) Cite this as: BMJ 2011;343:d4948
  1. María de Lago
  1. 1Madrid

Spain’s transplantation service seems to have more success than the UK’s own services at getting British people to donate the organs of a dead relative.

The Spanish National Transplant Organisation’s data for 2005-7 show that in 51 (91%) of 56 cases where a British person died in Spain and became a potential organ donor the relatives agreed to donation, whereas data for the UK show that relatives agree to donate in only six in 10 cases. In the first years of the decade the proportion consenting to organ donation after a death in Spain was similar (92%).

In 2008-10 the number rose to 64, although the proportion of relatives who refused is not available for this period. The director of the Spanish National Transplant Organisation, Rafael Matesanz, acknowledged that the numbers are not large enough for a statistical comparison to be made. But he suggested that the finding of a higher consent rate in cases of death in Spain than in the UK “is a curious detail that I have discussed with my colleagues in the United Kingdom.”

One of the explanations for the higher rate of agreement to donation in Spain may be the approach taken by Spanish transplant coordinators and medical staff. Another may be the typical profile of British residents in Spain, many of whom are retired people living on the Mediterranean coast or on one of the Spanish islands and who, when they die, are more likely to be brain stem dead. Their relatives “may be grateful for the treatment received here and be more prone to donate,” Dr Matesanz suggested.

A person’s prior intention to donate doesn’t seem to be a factor. “Scandinavians are at the top of the ranking when asked in surveys about their willingness to donate their organs,” said Dr Matesanz. “However, they have a low rate of donation. Spain is in the middle of the table in such surveys and has the highest rate of organ donation. The results depend on how the family is approached.”

The transplant centre in Alicante, on Spain’s southeast coast, has a refusal rate of about 5%.

Dr Matesanz says that training is very important. Over the past 20 years more than 11 000 doctors and nurses have attended courses on different aspects of organ donation. Ongoing training is provided to intensive care staff and, more recently, to emergency specialists, as well as to organ transplant coordinators.

“Almost all coordinators speak English, but we also have professionals who speak German or Scandinavian languages and cultural mediators who meet families from North Africa,” said Dr Matesanz.

“Having a well trained person in each intensive care unit who can coordinate donations in a professional way is essential,” he said. Spain has 300 doctors acting as transplant coordinators across its 177 hospitals.

Dr Matesanz, who was consulted by the Organ Donation Taskforce established by the UK government in 2006 to suggest measures to increase numbers of organ donations, considers that the taskforce’s resulting action plan adopted many aspects of the Spanish system. “In the past few years organ donations in UK have increased, not because the refusal rate has dropped but because potential donors are better detected.”

In a bid to make it easier for potential UK donors to sign up to the organ donor register, applicants for a driving licence will have to respond to prompter questions asking whether or not they wish to become an organ donor before they can complete their online application to the Driver Vehicle Licensing Agency.

The “prompted choice scheme,” which expands on an existing scheme, is intended to double the percentage of driving licence applicants choosing to sign up to the register from this month onwards.


Cite this as: BMJ 2011;343:d4948

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