The challenge
Organs for transplant were scarce, mainly because many potential donors who died in hospital were never identified or approached.
The case
In 1989 Spain created the National Transplant Organization (ONT) and a national network of specially trained hospital doctors, the transplant coordinators, in charge of the whole donation process, with a proactive programme to detect potential donors. Hospitals carry out systematic audits of deaths to find missed donors and are reimbursed for donation activity. Deceased organ donors grew from 550 in 1989 to 1,334 in 1999, a 142% increase, and total solid organs transplanted from 1,302 to 3,330. Spain has had the world's highest deceased donation rate for a whole country for decades; in 2025 it reached 51.9 donors per million people, with 6,335 transplants.
Why it worked
Spain shows the bottleneck isn't a lack of potential donors but turning them into actual donors, which takes trained staff and systematic hospital processes. The ONT's leaders say the model can be adapted elsewhere if the basic conditions are in place.
Sources
- Matesanz, R., & Miranda, B. (2002). A decade of continuous improvement in cadaveric organ donation: the Spanish model. Journal of Nephrology, 15(1), 22–28.
- Organización Nacional de Trasplantes. Official website (2025 activity figures, in Spanish).
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