A decade of continuous improvement in cadaveric organ donation: the Spanish model.

BACKGROUND: There is an ever-increasing demand for cadaveric solid organs for transplantation all over the world. Partial strategies in many countries have resulted in small or transient increases in organ donation or even no improvement at all. In the early nineties, Spain started an original integrated approach designed to improve cadaveric organ donation.
METHODS: In 1989 an official agency, the National Transplant Organization (ONT), and a national network of specially trained, dedicated and strongly motivated hospital physicians in charge of the whole process of organ donation, was created. The network now covers 139 hospitals.
RESULTS: Cadaveric organ donors grew from 550 in 1989 to 1334 in 1999, a 142% increase, Cadaveric kidney transplants from 1021 to 2005 (96% increase), and total solid organs transplanted from 1302 to 3330 in ten years (156%). The rates of cadaveric organ donation per million inhabitants (33.6), kidney and liver transplantation (50.6 and 24.2) are the highest in the world.
CONCLUSIONS: Spain is the only example in the world of continuous improvement in cadaveric organ donation registered in a large country over a ten-year period. Organ shortage is not due to a lack of potential donors, but rather to a failure to turn many potential into actual donors. A proactive donor detection program performed by well trained transplant coordinators, the introduction of systematic death audits in hospitals and the combination of a positive social atmosphere with adequate economic reimbursement for the hospitals have accounted for this success. This model can be partially or totally translated to other countries if basic conditions are satisfied.