The Spanish organizational structure for organ donation: Update

Abstract

At the end of 1989, the Organizacion Nacional de Trasplantes (ONT) was created within the Spanish Department of Health. It has become a common meeting place for professionals involved in all types of transplantation, central and autonomous administrations, the media, and Spanish society in general. It has a formal but flexible management structure that ensures that the hospital transplant coordinators working at the grassroots level have a sense of involvement and are accountable for performance. These coordinators are responsible for the process of organ donation and procurement within hospitals. The ONT deals with organ sharing and management of waiting lists, arranges for transplant teams or organ transport, maintains the official statistics on organ donation and transplantation activity, and keeps interested groups informed. The ONT is concerned with training programs and research in the field of organ donation and transplantation. It is the unit in charge of official reports in the field of organ donation and transplantation, and it guarantees the complete equity and transparency of the system. Within this framework, the average annual rate of solid-organ donation increased from 14 donors per million population (pmp) in 1989 to 34 donors pmp in June 2000. Average donor age has increased yearly, and more than 30% of the current donors are aged older than 60 years. Most donors (58%) now die of cerebrovascular accidents, and only 21% die in car accidents (43% died in car accidents in 1992). In Spain, the current rate of family refusal of donation was 21.5%, a decrease from the 30% rate seen in the early 1990s. These changes resulted from efforts to overcome various obstacles, such as untrained or undertrained staff, unidentified donors, and reluctance to approach grieving families. This means the professionalization of organ donation, together with an organization focusing on the promotion and facilitation of these actions. Coordinators are identifying more potential for organ donation in all types of hospitals, stating that the problem is not only a lack of donors, but rather a failure to convert potential into actual donation. Overall analysis of the organ donation process and detection of the various obstacles in the different hospitals or regions provide the means to find the most appropriate solutions.