[The heart transplantation in Spain. Organization and results]

Heart transplantation has achieved a great development in Spain. With 8 heart transplantation procedures per million of inhabitants per year, we are the second ranking country, after the U.S.A., in this therapeutic activity. A relative adequacy between the number of available donors and the number of receptors included on the waiting list help to reduce the delays and the mortality rates in expecting patients, compare to other countries, which demonstrated the efficiency of the system. From 1984 to 1998, 2,756 heart transplantations were performed in Spain, in 16 authorized hospitals. In 56 cases (2%) the procedures were re-transplantation. Cardiomyopathy with ischemic origin was the most frequent pathology in determining the intervention, affecting to the 37% of the receptors, followed by idiopathic dilated cardiomyopathy with a 35%. Compared to other countries, a high proportion of cardiopathies (11%) of rheumatic origin stands out.20% of the heart transplantations were performed in a maximum emergency situation of the receptors. Assigning donors priority on a national scale. In a 2, 9% of the cases, extra procedures of circulatory assistance devises were used. The actuarial survival of the whole series is 74% at the end of the first year; 62% after five years and 46% after ten years. The mean survival of the grafts was 9.5 years. These data do not differ substantially from those of the Registry of the International Society of Heart and Lung Transplantation. The most important causes of early mortality were the graft primary failure, the infections and the rejection. Among the causes of late morbidity, cancer, with a prevalence of 6,1%, and vascular disease of the graft, present in 8,4% of the receptors, stand out. These results support the so-called Spanish Model for Solid Organ Transplantation, which, according to the health authorities of the European Union, should be implemented in all the member countries. The keys to the success of the Spanish Model are based on three factors, in order of importance: a) to have a public professionalized institution for the detection of donors, the allocation of the grafts, and the coordination of the extraction and transportation force. The Transplant National Organization is the name of this complex force in our country; b) the high rates of road and labour mortality in Spain, and c) to provide incentives for the professionals in charge of the whole process.