Spain is the undisputed world leader in organ transplants

Of these, 3,269 were kidney, 1,247 were liver, 363 were lungs, 304 were hearts, ,70 were pancreas and eight were intestines.

It means that Spain saw 46.9 individual donors per million people (pmp) in 2017, an increase from 43.9 pmp in 2016 and 39.7  pmp in 2015, "much higher" than the EU average (19.6) and the US average (26.6) according to stats published by Spain’s Health Ministry.

Spain has maintained its gold standard in organ donation despite deep austerity cuts which saw public spending on health slashed during the economic crisis years.

According to a paper published last year in the American Journal of Transplantation, Spain is a model from which other countries have a lot to learn.

The creation in 1989 of the ONT by the Health Ministry meant that one body has been responsible for overseeing and coordinating donation and transplant policies across the regions and more than doubled the number of organ donations within a decade of its creation.

The Spanish model also relies on the designation of appropriate professionals (mostly intensive care doctors) to ensure donations are quick to happen when a patient dies in conditions that allow organ donation.

A nurse prepares a patient for a renal transplantation at La Paz hospital in Madrid.  Photo: Pierre-Philippe Marcou / AFP

Professionals supported in their work by ONT and regional coordination offices are also trained to identify donation opportunities outside of intensive care units, in emergency departments and hospital wards.

While some nations cap the age at which donors qualify, Spain considers organ donation from those over the age of 65 years – and in fact ten percent of organ donors in Spain are over 80 years-old.

Furthermore, Spain considers donation after circulatory death, in which circulation, heartbeat, and breathing have stopped (as opposed to brain death, in which all the functions of the brain have stopped), even in the setting when death follows a sudden cardiac arrest in the street.

Dolors Montserrat, Spain’s minister of health, announcing the figures said it was the 26th consecutive year that Spain had been top of global rankings for transplants.

"These are the very best results in the history of the ONT, both in organ donation and in transplants,” she said.

“In the last three years the donation rate per million population has increased by 30 percent, something extraordinary when starting from a situation of excellence and if you taking into account how difficult it is to be a successful donor in the current epidemiological circumstances."

Explaining the success of the Spain’s organ donation programme, Rafael Matesanz, MD, PhD,  the founder of the ONT, highlighted that "good organization in the process of deceased donation and continuous adaptations of the system to changes are always the basis of successful results in organ donation".

Most importantly Spain operates an "opt-out" system in which all citizens are automatically registered for organ donation unless they choose to state otherwise.

The measure  was adopted in France in 2017 and is currently being considered in the UK where 8 out of 10 people approve of donating their organs although most never register.

“The most important success is that the system has made organ donation be routinely considered when a patient dies, regardless of the circumstances of death," said ONT's Beatriz Domínguez-Gil, MD, PhD, co-author of the article highlighting the Spanish Model's impact.

The European Union has highlighted the lack of organs for transplant and the increasing number of patients on waiting lists worldwide.

In Spain the number of those on the waiting list was reduced to 4,896 in 2017 from 5,480 although the number of children waiting for organs increased to 74, from 48 a year earlier.