Abstract
Spain is continually striving for self-sufficiency in transplantation. Despite a changing environment in which the incidence of brain death is progressively declining, the health-care system has been able to ensure that an impressive number of transplantations are performed. However, this is not a true reflection of the current state of heart transplantation since the number of procedures carried out does not fully satisfy the transplantation needs of the Spanish population. Despite obvious difficulties, there is room for improvement: both the availability of donor hearts and the proportion used clinically could be increased. This would require a multidisciplinary approach involving a number of strategies that look critically at heart transplantation from the point of view of organ donation and allocation and from the perspective of the transplantation team. Utilizing hearts from donors after circulatory death and ex situ perfusion devices for donor hearts could help alleviate the unmet demand for heart transplantation in the future.
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