Organ procurement in Spain: impact of transplant coordination

Organ transplantation is a well-established treatment for irreversible renal, liver, cardiac, and respiratory failure. However, there is a shortage of organs that remains a serious obstacle to the full development of these therapeutic procedures. Some solutions such as presumed consent laws, the use of organs from living unrelated donors, compensation or payment for organs or xenografting have been proposed. In Spain during the last 3 years a well-designed program of transplant organization including a network of well-trained transplant coordinators has been established. In each potential donor hospital there is a transplant coordination team that is responsible for the whole process of organ procurement, from the detection of the donor to the organ grafting or tissue banking. Annual rate of cadaveric donors rose from 14.3 per million population (pmp) in 1989 to 21.7 donors pmp in 1992. Organ retrieval rate increased by 81% during the same period. Renal, liver and cardiac transplants increased by 44%, 175% and 162% respectively. We conclude that this particular approach to the problem has been successful in Spain, overcoming obstacles such as untrained or undertrained requesting staff, unidentified donors, and reluctance to approach grieving families. This kind of approach should be considered initially before resorting to more controversial approaches to the problem of the organ donor shortage.