Spain is the world leader for organ and tissue donations, and Malaga in particular plays a leading role in that, says the director of the National Transplant Organisation (ONT), Beatriz Domínguez-Gil, who has just given a talk at a conference in Malaga on the keys to the success of the Spanish transplant model. The event was organised by IBIMA, the Instituto de Investigación Biomédica de Málaga. Last year, 5,314 organ transplants were carried out in Spain.

-The donation rate in Spain has grown by 37 per cent between 2013 and 2018. Why was that?

-Innovation is the key. We were already extraordinarily active in terms of donations and transplants, but they had levelled out although the waiting lists and number of people needing transplants were increasing. So we drew up a national strategy, aiming for a target of 40 donors per one million of the population by 2020. We are now working on reaching 50 per million in 2022.

-What are your strategies?

-One which is very important is collaboration with the emergency services, because they now play an essential role in the donation process. Nearly 25 per cent of donors in Spain are identified in the emergency departments. The second pillar in our strategy has been a progressive change in the profile of potential organ donors. There are older people, in their sixties, seventies or eighties, who die from natural causes. Their organs are being transplanted with very good results. The third line is donation in asystole, which is from people who have died from cardiorespiratory failure. The numbers of transplants from donors have risen from 24 at the beginning of this century to more than 1,000 last year. One of every three donors now is in asystole.

-It must be a matter of pride that Spain is the world leader in organ donations.

-Yes, we are the absolute leader in donations and transplants. For 27 consecutive years Spain has headed the international list, and no other country in the world has matched our record. Last year we had 2,241 donors, which was 48 per million of the population. The USA had 32.8, the EU as a whole 22.2 and even such an important country as Germany only reached 11.6. We have nearly five times as many as Germany.

-I imagine it has helped that we have a universal health system and organ donations are free?

-The National Health Service is an essential element in our success, because it means anybody, with no discrimination whatsoever, can have a transplant. The solidarity among the Spanish population is also important. What makes Spain unique, however, is the organisational model it has developed. That is what makes us different to other countries. Only one to two per cent of people who die in a hospital are in a condition to be donors. If the system is not prepared to identify these situations and convert them into an actual donation, no matter how enthusiastic people in general may be about donating, that donation will not take place. The Spanish model is conceived with that in mind.

-What is unusual about the Spanish transplant model?

-It is based on transplant coordinators in the hospitals. They are professionals who act in accordance with specific protocols and undergo continual training. All that is orchestrated by the ONT and regional transplant coordinators.

-What is the situation in Andalucía in terms of donations and transplants?

-Andalucía as a region reached a figure of 52.5 donors per million of population last year, so it is ahead of our target of 50 for Spain as a whole by 2020. That has been thanks to conscientious and examplary work over many years. It is a region with exceptional donation figures and is not only a leader in Spain but also at world level.

-And where does Malaga come within the excellent figures for Andalucía?

-Malaga is the absolute leader for donations. Some years ago, the ONT carried out a study to identify the best hospitals for donations so we could learn from them. Malaga's Regional Hospital is a benchmark because of its excellent results. The transplant sector in Malaga has developed some fantastic programmes for organ and tissue donations.

-What strategies are you considering in order to keep Spain as the world leader?

-Apart from collaboration with the emergency services, our lines of work are to increase donation in asystole, where there is still a margin for improvement, and donations from older people. We are also working on other proposals. One is to be more flexible about the criteria for accepting organs for transplants, but always in accordance with safety regulations. So we have started to transplant organs from people infected by hepatitis C into recipients who are not infected, given that the new direct action anti-viral treatments enable us to do so with security. Another star project which is under way is cooperation with the private health sector.

-What type of collaboration will there be with private hospitals?

-Our objective is for private centres to progressively incorporate donation of organs and tissues, but not to carry out transplants. People need to be given the option to donate, if they are suitable, whether they die in a national health hospital or a private one.