Spain is world number one in transplants for 27th year

In 2018 alone, donors rose in number by 37%, from 2,183 to 2,243, allowing surgeons in Spain to carry out a total of 5,314 transplant operations – up from 5,259 in 2017.

The National Transplant Organisation (ONT) aims to break the 5,500 barrier by the year 2022.

Spain's donation rate now sits at 48 per million inhabitants, having gone up in the past five years by more than ever before, from 35.1 per million, says Beatriz Domínguez-Gil of the ONT, which marks its 30^th anniversary in 2019.

Transplant numbers now come in at 114 per million inhabitants – the highest proportion in the world – breaking records with kidney and lung transplants.

Out of Spain's 17 autonomously-governed regions, a total of 10 have surpassed the 50-per-million milestone, seven have broken the 60-per-million barrier and two of them are at over 80 per million – Cantabria (86.2) and La Rioja (80.6).

One in three donors, or 629, became so after they were confirmed clinically dead due to irreparable cardiac arrest, or cessation of heartbeat; 10% more than in 2017.

Over 100 hospitals in Spain are authorised to carry out transplants from these donors.

The numbers of donors who became so after being declared brain-dead has remained around the same.

Last year, 289 donors were live – fewer than the 332 in 2017, but still 9% of the total.

Live donors are, clearly, more limited in the organs they can provide, although typically, segments of liver – since this can be extracted from a live patient – kidneys, as one alone is enough for survival, and stem-cell and bone-marrow transplants can be carried out using donations from persons who are still living.

Non-live donors who were victims of traffic accidents have reduced to 3.8% of the total – the lowest on record to date.

More than half of all donors, in fact nearly six in 10, were aged over 60, with 31% being over 70 and 9% over 80.

The oldest successful donor in Spain last year – who provided a liver for transplanting - was aged 91.

Only 14% are aged under 45.

Spain's transplant record is not just the result of a high non-disease-related mortality rate, but also fruit of patients agreeing in life to donate their organs after death, or their next of kin being willing for them to do so if it is too late for the patient to express these wishes.

Last year, only 14.8% of families refused to allow their deceased loved ones to become organ donors – fewer in the case of those who were in irreversible cardiac arrest at the time, where only 8.8% of next of kin refused permission.

Ground-breaking transplant techniques are seen across the western world every year – and 2018 was no exception, says the ONT, which was behind four successful heart transplants in children, as well as the first cross-border kidney transplant in southern Europe, along with Italy.

This international transplant involved highly-complex logistics, but the operation is believed to have gone well.

Spain is also a world leader in campaigning against organ-trafficking in line with the United Nations' resolution.

Beatriz Domínguez-Gil says increasing transplant operations are now becoming possible because of a 'changing donor profile' – persons who die from old age, including very elderly people who die from strokes or heart failure, can still provide vital organs to much younger patients needing transplants.

“We've now got patients walking around with livers of over 100 years old,” Sra Domínguez-Gil reveals.

“Fortunately, donors are no longer limited to those who die tragically young in car accidents, for example.”

Other strategies that have increased donor numbers include working closely with A&E departments and intensive care units, enabling the ONT to detect potential donors 'outside the usual channels', and a national scheme to encourage 'donation in asystolia', or in patients with irreversible cardiac arrest.

Cross-party plans discusses in Parliament to make every person a donor unless they or their next of kin expressly state otherwise have not as yet come to fruition, and not everyone who would be willing to become a donor after death is on the register.

It is advisable to make one's wishes clear in life, including in a last will and testament.