Spain leads way in transplants
Pioneering system enabled doctors to perform an incredible 4 818 organ transplants last year.
Hours after Juan Benito Druet learned that he would receive a healthy kidney, the 63-year-old boilermaker underwent the life changing surgery at Madrid’s La Paz hospital – thanks to a pioneering system that has made Spain the world leader in organ transplants for the past 25 years.
Doctors performed 4 818 transplants last year, including 2 994 kidney transplants, according to the health ministry’s National Transplant Organisation (ONT).
That means there were 43.4 organ donors per million inhabitants last year, a world record, up from 40.2 donors in 2015.
By comparison, in the United States there were just 28.2 donors per million inhabitants in 2015, 28.1 in France and 10.9 in Germany, according to the Council of Europe.
“It is even better than if we had won the jackpot in the lottery,” said Druet’s wife Jeronima, 60, as she sits close to him along with the couple’s two adult children before the surgery.
Now she dreams of going on a cruise with her husband, something impossible as long as he needed to be hooked to a 15kg kidney dialysis machine every night to filter his blood.
‘Transplant lives’
The transplant operation lasts four and half hours.
Surgeons make a 15-centimetre incision in Druet’s abdomen to transplant a healthy kidney extracted the night before from a woman who died.
After a transplant, patients “start to regain weight, their health improves. It is as if we transplant lives”, says the founder of the ONT, Rafael Matesanz.
Matesanz oversaw the implementation of a centralised and well-oiled organ donation and transplant system which has been replicated in Portugal and Croatia and inspired others across Europe.
Each hospital has a transplant coordinator, usually a doctor or nurse who specialises in intensive care, charged with identifying patients at risk of a heart attack or brain death.
In both situations kidneys, livers, lungs, pancreas and sometimes even the heart can still work and can be transplanted.
Organ donations are quickly reported to the ONT which searches for the best match from its organ waiting list.
If the patient is far away, a cooler with the organ is sent by plane inside the cockpit with the pilot.
The operation is free under Spain’s public health system, anonymous and available only to residents of the country to avoid organ trafficking.
Worldwide only about 10% of all the patients who need a transplant receive a donated organ, she adds.
“That means that 90% will die while they are on a waiting list,” she explains.
In Spain only 4-6% of patients died in 2016 while they were on a waiting list for a vital organ – a liver, heart or lung.
Ramon Garcia Castillo, 85, a former TV technician, spent 13 months on dialysis before he received a kidney transplant in 2010.
He would previously trek to a hospital three times a week to be hooked up to a machine for threeand-a-half hours, a routine that kept him alive.
The kidney transplant “gave me my life back”, says Castillo, who now just needs to take pills to ensure his body does not reject the donated kidney.
‘Empathy and respect’
The other secret to the success of the Spanish system is training and communication, explains Matesanz.
Since it was set up in 1989, the ONT has trained over 18 000 transplant coordinators who break the news of a person’s death and then gently convince their loved ones to agree to donate their organs.
Spanish law presumes consent for organs to be removed on their death unless they had previously made clear that they were against donation.
But loved ones are systematically consulted.
“You have to have a lot of empathy, sensitivity, respect,” says Belen Estebanez, the transplant coordinator at Madrid’s La Paz hospital.
“It comforts many families to know that the organs of their loved ones will live on inside someone else, that people will be thankful for the rest of their lives.” –