Aser Garcia Rada: Exporting the Spanish and European organ donation system

Aser Garcia RadaMost Europeans support organ donation, but there is still a need for more organ donors, according to several experts at a recent international meeting on donation and transplantation, organized in Madrid by the European Commission and the Spanish Minister of Health, Social Services, and Equality. By the end of 2011, 61 500 patients were on the waiting lists for receiving an organ in the EU. Although there has been a constant increase in donations and transplants—from 2855 kidney and liver transplants in 2009, to 4100 in 2011—and although the EU has the highest number of organ donations in the world, it is estimated that 5500 citizens died while waiting for an organ donation in 2011.

There are wide variations among the EU member states. Spain has been leading over the last two decades with a current rate of 35.3 donations from deceased patients per million of population (pmp). With 26.3 donations pmp, the Netherlands leads living kidney donations. On the other hand, the rate of donations from deceased patients in Bulgaria is 0.5 pmp, and the living kidney donation rate in Lithuania is 0.9 pmp.

Currently “one of the mayor reasons for not donating organs is distrust in the system,” said Axel Rahmel, medical director at Stichting Eurotransplant. Since 2002, three EU directives  have been released to improve the quality and safety of organ and blood donations, which are key for the population’s trust in organ donation. Some general campaigns, such as the European Day for Organ Donation and Transplantation established by the Council of Europe may raise awareness. However, other elements are crucial.

José Ignacio Sánchez Miret, transplant coordinator of the Spanish autonomous community of Aragon, said general awareness campaigns are not enough. The focus needs to be on health professionals, improving the coordination network, optimizing the care of families of the deceased, and having a good relation with the media. The ONT—the Spanish National Transplants Organization—has a best practice guide for organ donation and transplants which is freely available in several languages on its website.

Sánchez Miret used the example of most Scandinavian countries, where the will to donate is high—around 80%—but where donations only account for around 15 pmp. On the other hand, although Spaniards will to donate has remained at 57% from 1993 to 2007, donations have increased from 500 to 1600 per year over those years, and families choosing not to let their relative’s organs be used has decreased from 40% to 15%.

Rafael Matesanz, director of the ONT recalled how the media is, “one of the cornerstones of his organization.” When he took over during the early 1990s he dedicated 30% of his time to the media. Actually most Spanish health journalists would acknowledge that the ideal communication department to deal with is the ONT’s one, which is available for journalists, health administrations, or health professionals 24 hours a day. Matesanz is easy to get in touch with as well. His personal phone number is available to any journalist interested. The ONT actively promotes positive news related to organ transplants, or makes sure that journalists have a reliable source to confront negative information, as donations drop when negative issues occur. The ONT also organizes an annual meeting where transplant coordinators and journalists share experiences.

Transplant coordinators receive communication courses to deal with families and with the media. This is especially important when controversial issues such as brain death or organ trafficking must be discussed. As Matesanz recalled, these measures are highly cost-effective, not only regarding donations—the annual savings in hemodialysis post kidney transplantation is close to £17,000 per year per patient.

Although efforts can still be improved, on the whole Europe remains a privileged region and the WHO is trying to export the Spanish and European experience worldwide. In 2012, 112 000 transplants were performed worldwide, only 10% of those that are needed, which is estimated to be around 1 million according to the ONT and the WHO. Of the ones performed, around 10% were linked with organ trafficing according to the WHO medical officer for transplantation procedures, José Ramón Núñez.

The WHO is especially focusing on Asia and Latin America, where organ trafficking and health tourism are leading issues. According to Núñez, some goals are being achieved. He said that after a recent meeting in Peru the country has made legal changes to request two years of residency before someone can access the transplantation waiting list, in order to prevent health tourism.

China has also changed its legislation in order to have the WHO as adviser. From now on the controversial donations from prisoners condemned to the death penalty (the numbers remain obscure) will only be accepted after both the person and his or her relatives accept the donation. Two pilot centers have been opened in Beijing and are practising with European standards, said Núñez. Though Chinese people don’t believe in brain death for cultural reasons, last year 11% of donations in those centers came from brain death patients. As Núñez explained, if Chinese numbers rose to those in Spain, a huge region of the planet will be covered.

Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.