Spanish System of Organ Transplantation

1
Spanish System of Organ Transplantation

• Marcos Vera-Hernández
• (not an expert on the subject)
• University College London
• A presentation to the ACERH 2009 Policy Forum,
• Perth, 20 February 2009

2

• Three things that distinguish Spain in the World
• Football
• Tapas
• One of the highest rate of organ donation
• 34.3 donors per million inhabitants
• European average is 18
• US is 25.1

3

• Type of consent
• Law 1979
• Presumed consent
• Organs can be removed for transplantation as long
  as the individual or family opposes to it
• In practice, relatives are always asked
• This cannot be the explanation for the high rate
  of donations
• Donation rates increase very rapidly after a
  agency called Organizacion Nacional de
  Transplantes is created in 1989

4

• For a donation to happen
• Encephalic death must be signed by three doctors,
  a neurologist must be one of them
• Deceased must be in an Intensive Care Unit where
  organs are kept in good condition until the
  relatives decide

5

• What is most emphasized
• Donors are lost because either
• Staff are not motivated and are not actively
  trying to detect possible donors
• Staff do not know how to detect possible donors

6

• Pillars of the Spanish system
• Hospital transplant coordinator
• Training to health care personnel
• Direct reimbursement to hospitals for expenses
  (ie. personnel) related to organ transplantation
• Sizeable public campaigns in the media, patients
  associations, schools
• Subsidies for projects dedicated to rise
  awareness
• National system

7

• Hospital transplant coordinator
• One in each hospital with Intensive Care Unit
• Prestigious position, and gets paid a bit more
• Doctor, (in most cases works in the Intensive
  Care Unit)
• Works part time as coordinator, and part time as
  doctor
• Supported by nurses
• Highly trained
• Detection of possible donors
• Interview with relatives of the deceased (It
  seems to be key, 80 success rate)

8

• Hospital transplant coordinator
• Motivates hospital staff in the detection of
  possible donors
• Works continuously, hand in hand, with doctors
  from the Intensive Care Unit on the detection of
  possible donors
• hence, the importance that the coordinator is a
  doctor
• More difficult in countries with a tighter supply
  of doctors
• Some turnover to avoid being burn out by the
  psychological pressure (It seems important)
• Cannot be one of the three doctors that sign the
  death

9

• Training of hospital staff
• Organized by the hospital coordinator
• Mostly to personnel in AE and Intensive Care
  Unit
• Topics
• Detection of possible donors
• Legal issues
• Interview with the family (though it is usually
  carried out by the coordinator himself)

10

• Criteria for transplantation
• Urgency, severity and time in the waiting list
• Two levels of Urgency
• Normal
• Urgent Death is likely in the following days
• Urgent have priority
• If no one urgent, then severity and time in the
  waiting list

11

• Summary
• Absence of incentive for donors
• Well trained staff that pay continuous attention
  to the detection of possible donors and are
  coordinated by a doctor working part-time
• Good financing of the activity
• Social marketing