Increasing the number of organ transplantsBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6991.1404 (Published 27 May 1995) Cite this as: BMJ 1995;310:1404
Professionalisation of organ procurement in Spain has increased donors
- Rafael Matesanz,
- Blanca Miranda,
- Carmen Felipe
- National coordinator Attached doctor Attached doctor Organizacion Nacional de Trasplantes, 26029 Madrid, Spain
EDITOR,—The success of organ transplantation in terms of survival, quality of life, and the ratio of costs to benefits has been such that ever greater numbers of patients are being referred to transplant teams. The shortage of organs remains the main obstacle to the full development of these procedures. In 1992 we reported the initial results of several integrated actions accomplished since the creation of the Spanish National Organisation of Transplants1 and proposed that this approach could be used to alleviate the lack of organ donors.
Three years later things do not seem to have got better. The number of organ donors per million population has remained stable in the United States (around 17-19 donors per million)2 and western Europe (14.7 donors per million in 1993). Furthermore, preliminary data from several European countries for 1994 showed a dramatic decrease in the rate of organ donation, usually attributable to the impact of negative media issues on public opinion.3
The situation in Spain is just the opposite. The number of organ donors has risen continuously from 14.3 per million population in 1989 to 25 per million in 1994 (table). So far as we know, this is the highest rate reached for a medium sized country like Spain with nearly 40 million inhabitants. Some regions, such as the Canary Islands or the Basque country, now have over 40 donors per million population, while others, such as Andalucia, still have only 18.
All organs for transplantation are obtained after informed consent has been obtained from the relatives. We have developed a network of medical doctors working part time as transplant coordinators after specific training.4 The quick and clear explanation of any problem and confusion about the transplantation process (for example, brain stem death or distribution of organs) to journalists and the maintenance of a telephone line operating 24 hours, seven days a week to answer any doubt or question about organ donation and grafting have achieved a positive atmosphere for organ donation in Spain during the past years.
Efforts to improve organ donation should be focused on medical professionals, who are often faced with the responsibility of having to raise the question of donation with bereaved relatives without specific training for this difficult task. The Spanish experience emphasises the need for training and professionalisation of people who procure organs and for an organisation focusing on the promotion and facilitation of organ donation.