The “Spanish Model” – an Initiative Aimed at Increasing Organ Donation Rates in Australia

Abstract

n 15 September 1995 a national meeting of interested parties and stakeholders was held at the Adelaide Convention Centre to hear Dr Rafael Martinez, Director of the National Transplant Organisation (ONT), explain what steps had been implemented Spain to lift organ donation rates to amongst the highest the world. This meeting was sponsored by the South Australian Health Minister, Dr Michael Armitage, who recently chaired the South Australian Parliamentary Select Committee on Organ Donation and Transplantation. A broad range of delegates and speakers were present, with representation from intensive care, nephrology and transplant coordination, as well as ethicists, critical care and renal nurses, media analysts and transplant surgeons. Over 100 delegates attended this meeting. The background to the meeting was the South Australian Government Select committee findings which, whilst acknowledging the higher success rate organ procurement that state than any other, suggested that Australian donor rates are amongst the lowest the world. Whilst the Australian rate languishes at 10.6 donors per million population, countries like Spain and Austria have achieved procurement rates of over 25 donors per million. Organ donation and subsequent transplantation has obvious benefits terms of quality and quantity of life, with an added bonus of substantial economic gains. For instance, Australia it costs between $1 4,000 and $40,000 per year to maintain a patient renal failure on a home based dialysis system. A renal transplant the year of organ implantation costs $25,000, thereafter patient costs per year drop to $5,000. So not only do patients and there relatives reap benefits, but the community as a whole gains f nancially as well. Additional pressures now face organ donation rates. They include, new viruses emerging which reduce the potential donor pool, more effective road accident and vehicle safety measures reducing road accidents and fatalities and an increasing recipient pool. The current organ shortage sees approximately 3000 Australians awaiting transplantation. In the USA 7-9 people per day die on transplant waiting lists. With these strong moral and financial incentives a strategy to improve organ procurement was identified as essential. Dr Martinez and the other distinguished speakers were charged with the responsibility to examine and explain the Spanish Model of organ procurement, particularly as to its adaptability to the Australian system and demands. The Spanish Model retains the opting in option which many have argued is essential Australia if the donation program is to retain its morally successful profile our society. The opting system, whereby an individual is considered to agree to organ donation unless clearly stating otherwise, has not been shown to result consistent increases organ procurement rates and is considered by most to be unacceptable this country. The essential features of the Spanish Model are:* a universal system across the country a professional approach to all aspects of donation a central authorised agency an active media management strategy excellent data collection and distribution. Not surprisingly this system requires a commitment to funding, not the least of which is directed at the number of transplant co-ordinators. In Australia we have approximately 0.6 co-ordinators per million of population, Spain there are 3 per million. About half of all co-ordinators Spain are medical officers located all the major teaching and provincial hospitals who undertake this job on a part time basis. Their major role is to secure organ procurement after which full time co-ordinators then manage the subsequent physical donation and transplantation. Burn out rates amongst co-ordinators is high, after 4 years most leave. This however is not discouraged, fact some cases longer staying coordinators are removed as they apparently lose enthusiasm to secure donors with rates from their institutions subsequently falling. Another area of attention is training and preparation of co-ordinators. All co-ordinators Spain undergo a