Spain exceeds transplant records

The Minister of Health, Mónica García, has applauded the great work of health professionals, which has allowed Spain to achieve the rate of 48.9 donors per million population (pmp) and 122.1 transplants pmp; The latter exceeds that recorded in 2019, the best year in transplant activity so far.

In 2023, organ donation and transplant activity in Spain reached levels of excellence that are difficult to surpass. Thanks to a cohesive national program, led by the National Transplant Organisation (ONT), in which professionals from multiple specialties participate and which is born from the generous act of donation, 5,861 organ transplants were performed in Spain last year, which It represents a rate of 122.1 transplants per million population (pmp). This is clear from the balance presented by the Minister of Health, Mónica García, who was accompanied by the general director of the ONT, Beatriz Domínguez-Gil.

This high level of activity was achieved thanks to the 2,346 people who donated their organs after death, which places the donation rate at 48.9 donors pmp, and the 435 people who donated a kidney (433) or part of their liver (2) in life. These data represent a growth of 9% in transplantation and 7% in donation compared to 2022. Furthermore, the transplant rate exceeds the historical maximum recorded in 2019 by 8%, before the COVID-19 pandemic. The average number of daily donors last year was 8 and the average number of transplants performed each day was 16.

Record activity in kidney, liver and lung transplantation

The growth in 2023 was widespread across all types of transplants. 3,688 kidney transplants were performed (8% more than the previous year), 1,262 liver (+9%), 479 lung (+15%), 325 heart (+5%), 100 pancreas (+9%) and 7 intestinal transplants (+75%). With a total of 433 procedures, living donor kidney transplant activity increased by 24% and represented 12% of the total kidney transplants performed. In addition to the historical record represented by the total number of transplants, the figures for kidney transplants (both from living donors and deceased donors), liver and lung transplants also exceed any recorded figure.

The rate of 48.9 deceased donors pmp that Spain reached last year is close to the objective of 50 donors pmp set by the ONT in its “50X22” Strategic Plan and the figure of 2,346 donors represents another historical maximum. This activity is much higher than that achieved by the rest of the countries in the world, according to data from the Global Observatory of Donation and Transplantation, managed by the ONT as a Collaborating Centre of the World Health Organisation.

In 2022, the United States registered 44.5 pmp donors, France 25.8, Italy 25.0, Canada 21.4, the United Kingdom 20.6, Australia 17.4, Germany 10.4 and the European Union as a whole 20.9 pmp donors.

Minister García thanked “the solidarity of the donors and their families, as well as the essential work of the professionals who participate in all phases of the complex donation and transplant process and the coordination of the ONT and the Autonomous Communities, an example of social and health cohesion, a perfectly articulated network that saves thousands of lives every year, as reflected in the data we present today.

Donation in asystole, main line of growth

For her part, the general director of the ONT, Beatriz Domínguez-Gil, has insisted on “the impeccable work of all the coordination and transplant teams and the regional transplant coordination bodies that, together with the ONT, continue to identify new avenues of growth to continue improving these figures and for the complex transplant therapy to reach all patients who need it. Precisely the lines established by the aforementioned strategy, which seeks to reach 50 pmp donors and reach 5,500 annual transplants, “have already allowed us to easily surpass this last figure in 2023.”

Years ago, the ONT identified a decisive initiative to maintain this path of growth: non-asystole donation. With a total of 1,050 donors (15% more than in 2022), 45% of donors in Spain in 2023 were in asystole. Furthermore, this type of donation is consolidated as multi-organ donation, thanks to the generalisation in Spanish hospitals of a complex organ preservation procedure based on extracorporeal circulation devices (ECMO), also with a Spanish signature. Thanks to this, in 2023, 1,488 kidney, 474 liver, 195 lung, 58 heart and 31 pancreatic transplants were performed with organs from donors in asystole. Added to these is another intestinal transplant in asystole carried out by the Hospital Univ. La Paz, which in 2022 already carried out two intestinal transplants with the same characteristics. All of this once again places Spain as the only country in the world that transplants all types of organs from non-asystole donors.

92 years old, the oldest donor

Regarding the profile of the potential organ donor in our country, it remains similar to that of previous years. Donors who died due to traffic incidents only represented 4.7% of the total. The main cause of death of donors was stroke. In terms of age, more than half of the donors (56.8%) were over 60 years old, 30% over 70 and 5% over 80. The oldest donor recorded in 2023 was 92 years old. Over the past year, the transplantation of organs from donors with positive PCR for SARS-CoV-2 was also normalised, after its safety was confirmed over recent years. From December 2020 to the end of last year, there have been 341 patients transplanted from donors with this condition.

To the generosity of all donors, since 2021, we have added that of those people who request assistance in dying and express their willingness to be donors: 90 people have been donors after dying in these circumstances and have made the transplant of 249 patients possible. since the law that regulates said benefit came into force until December 2023.

The constant growth of transplant activity goes hand in hand with the search for new formulas to prioritise patients in a clinical situation and solutions for those with difficulties in receiving a transplant due to their anthropometric or immunological characteristics. In this sense, 314 patients were transplanted in zero urgency and 190 children received the organ transplant they were waiting for. Likewise, 153 hyperimmunised kidney patients (for whom it is very difficult to find a compatible donor) could be transplanted, thanks to the ONT’s PATHI program.

Despite the impressive figures from last year and the high transplant activity in Spain, a significant number of patients remain on the waiting list. As of December 31, 2023, the waiting list stood at 4,790 patients. Of them, 75 were children. This number of patients on the waiting list is similar to that registered in 2022 (4,746 patients).

Data by Autonomous Communities

Ten Autonomous Communities exceeded 50 pmp donors and 3 of them exceeded 70 pmp donors last year. Cantabria once again led the ranking, with a rate of 74.1 donors pmp, followed by Navarra (71.6) and Murcia (71.0). Of the Autonomous Communities with populations greater than 5 million inhabitants, the activity recorded in the Valencian Community (52.6) and Andalusia (51.5) stands out. The Autonomous Communities that grew the most in donations were, in this order, Murcia (+49%), Madrid (+24%) and Castilla la Mancha (+22%).

The ONT estimates that 1,304 transplants were carried out thanks to the exchange of organs between Autonomous Communities, which represents 23% of the total. In turn, 7% of recipients have been transplanted in a centre outside their Community of residence. Both data demonstrate the cohesive role of the Spanish Transplant System.

Other notable achievements in 2023

Spain and Italy successfully carried out the second international crossover kidney transplant with three couples involved. In this crossing of the International Cross Kidney Transplant Program, 10 Spanish, 7 Italian and 2 Portuguese hospitals participated with 133 donor-recipient couples that had not achieved an exchange in their countries: 67 from Spain, 42 from Italy and 24 from Portugal. In addition, Spain performed 19 kidney transplants thanks to the National Cross-Kidney Transplant Program. There were three two-transplant exchanges, three three-transplant exchanges, and one four-transplant chain initiated by an altruistic donor.

The non-asystole donor heart transplant program was consolidated last year. In addition to the 110 transplants carried out from January 2020 (12 of them paediatric) to December 2023, the H. Clinic in Barcelona performed the first combined heart and kidney transplant from a donor in asystole. The hospitals involved in this program were: Complejo H. Univ. of A Coruña, H. Clinic, H. Univ. of Bellvitge, H. Univ. Dr. Negrín, H. Univ. Gregorio Marañón, H. Univ. La Fe, H. Univ. La Paz, H. Univ. Marqués de Valdecilla, H. Univ. Puerta de Hierro, H. Univ. Vall d’Hebron, H. Univ. Virgen de la Arrixaca and H. Univ. Virgen del Rocío. This type of transplant represented 18% of the total heart transplants performed in 2023.

In November of last year, the High Level Meeting ‘Towards a global consensus on transplants: availability, transparency and registration’ was held in Santander, in the context of the Spanish Presidency of the European Union. Spain, through the ONT, led the design of the roadmap for donation and transplantation of organs, tissues and cells in the world for the next decade, with the approval of the Santander Declaration.

National Bone Marrow Plan

As of December 31, 2023, our country had 484,175 bone marrow donors in the Spanish Registry of Bone Marrow Donors (REDMO), a figure that brings us closer to the goal of 500,000 registered donors, in which the ONT and the Autonomous Communities work together with the Josep Carreras Foundation, Scientific Societies and patient associations. There were 23,686 donors who joined in 2023, 8% more than those registered the previous year, thus recovering the percentage of growth prior to the pandemic and returning to the path of annual growth.

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