NEW DELHI: Spain is known for having the world's highest organ donation rate at nearly 36 per million population. That is, organs from 36 deceased persons are harvested for every one million population on an average. These organs are key to saving other lives. India, on the other hand, has one of the lowest organ donation rates at only 0.26 per million population.
What is Spain doing that has pushed up its organ donation rate? A new study published in the American Journal of Transplantation reveals some of the important reasons for Spanish success.
In 1989, the Spanish Ministry of Health created the Organizacion Nacional de Trasplantes (ONT), a technical agency in charge of the coordination and oversight of donation and transplantation activities in Spain. It created a model of coordination in deceased donation that doubled the organ donation rate in a decade.
The so-called Spanish model relies on the designation of appropriate professionals (mostly intensive care doctors) to make donation happen when a patient dies in conditions that allow organ donation. These professionals are supported in their work by ONT and regional coordination offices.
The Spanish model also makes it a priority to identify donation opportunities not only in intensive care units, but also in emergency departments and hospital wards. In addition, it considers organ donation from persons over the age of 65 years. Furthermore, the model has considered donation after circulatory death, in which circulation, heartbeat, and breathing have stopped (as opposed to brain death, in which all the functions of the brain have stopped), even in the setting when death follows a sudden cardiac arrest in the street.
"The most important success is that the system has made organ donation be routinely considered when a patient dies, regardless of the circumstances of death," said ONT's Beatriz Dominguez-Gil, MD, PhD, co-author of the article highlighting the Spanish Model's impact.
"Professionals attending to these patients in our country consider that, in caring for patients at the end of their lives, it is their duty to systematically explore their wishes with regards to donating organs upon their death."
Lead author Rafael Matesanz, MD, PhD, who is the director of ONT, highlighted that "good organization in the process of deceased donation and continuous adaptations of the system to changes are always the basis of successful results in organ donation". He noted that the elements and strategies of the Spanish model might be applicable to other countries, with some adaptations depending on the way organ donation is organized, the type of healthcare system in place, and other factors.
India has an estimated 500,000 patients in need of transplants every year. Most of them will sadly not get a suitable donor and hence they will die. Their last days, waiting for a donor, are usually spent in suffering. A new strategy learning from the Spanish experience can perhaps help.
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