Organ donation in Spain.

Abstract

attached to the Spanish Department of Health. From Background the very beginning, it was presumed that the shortage of organs is the principal limitation to organ transplant Spain is a European Community country with 39.66 and that the problem was probably not the absence of million inhabitants divided into 17 autonomous suitable donors but a failure to convert potential into regions. The National Health System (NHS) is comreal donors. prised of all the facilities and public services devoted Donation/transplantation is a complex process to health. The Health Counsellors from each autonominvolving different steps, which cannot be left to evolve ous region form the Interterritorial Council for the in isolation (Figure 1). The ONT emphasized the need NHS. This body is presided over by the Minister of for one person or a group of a few persons to be Health and Consumer Affairs and is in charge of the responsible for the organ and tissue procurement at coordination of health policies. Today, public health each hospital. The national transplant coordinating assistance is available for 99% of the population. The network was then conceived, at three different levels: Spanish transplant story, however, started in 1965 national, regional and local or hospital. The developwhen the first renal grafts were performed in Barcelona ment of the network has been described elsewhere. The and Madrid. ONT has developed a formal but flexible management The transplant legislation approved by Parliament structure, which ensures that the transplant coordinain 1979 is technically similar to the corresponding laws tors who work at the ‘grass roots’ have a sense of in other western countries. Brain death is defined as involvement and accountability for performance. Most ‘the total and irreversible loss of brain function’ and coordinators are qualified doctors, mainly intensive must be certified by three doctors (one of whom is a care specialists or nephrologists who are dedicated neurosurgeon or neurologist) unrelated to the transpart-time to transplant-coordinating tasks. In 1989, plant teams. Signs of brain death must be explored there were scarcely 25 transplant coordinating teams clinically and documented by a silent EEG for 30 min, in Spain, but now 139 teams are active, one in each and these tests must be repeated twice at an interval hospital with the potential for organ donations. The of no less than 6 h. The diagnosis is valid unless the profile of the Spanish transplant coordinator is sumpatient is hypothermic or exposed to drugs with known marized in Table 1. The coordinators report directly brain-depressive action. Organs may be retrieved only to the hospital medical director and not to the chief after obtaining informed consent from the donor’s