[Current status and evolution of organ and tissue procurement at EsSalud: functional management versus process-based management]

Organ and tissue transplantation represents the best therapeutic alternative for end-stage organ failure, yet its development relies on the availability of donors. This institutional narrative review-historical and critical in nature-analyzes the evolution of organ and tissue procurement within Peru's Social Health Insurance system (EsSalud) from the establishment of the Procurement and Transplantation Directorate in 2011 through the first half of 2026. The review outlines five stages of institutional development: initial organization, expansion of units and coordinators, operational strengthening, data-driven management, and the transition toward process-based management. This transformation is reflected in the five-link procurement chain, the expansion of the network from eleven to twenty-five Procurement Units, the implementation of the Procurement Operations Center, and the formulation of the "Donation-Friendly Hospital" strategy. Historical data on EsSalud's procurement processes from 2011 to 2026 are presented, including indicators from the first half of 2026; notably, family refusal remains the primary barrier, persisting at a rate of 85% among those with a donation declaration on their National ID (DNI). The benefits of the described interventions are expected to yield results in the coming months, and a subsequent evaluation will be necessary to assess their impact on improving organ and tissue donation in the country.