Ethical and Social Issues of the Spanish Model on Organ Donation and Transplantation

Abstract

A recent call to pursuit self‐sufficiency in transplantation based on the World Health Organization (WHO) Guiding Principles is confronted with an extreme disparity in transplantation rates between countries, mainly due to differences in deceased donation activities. Spain occupies a privileged worldwide position, with deceased donation rates maintained at 33–35 donors per million population (pmp) and transplantation rates close to 90 procedures pmp. Respectful with current international ethical standards on organ donation and transplantation, the Spanish Model is described in detail, with an ethical and social analysis of some of its key components: the appointment of intensive care doctors as professionals in direct charge of the realisation of the deceased donation process (donor transplant coordinators) and the way public support and trust in the donation system is gained.

Key Concepts:

  • Organ shortage remains the main challenge for the full development of transplantation therapies. It is the root cause of unacceptable practices, such as organ trafficking and transplant tourism.

  • WHO has recently called governments to be accountable in the pursuit for self‐sufficiency in transplantation, by decreasing the burden of diseases treatable through transplantation and increasing organ availability, while respecting current international ethical standards in the field.

  • The Spanish Model on organ donation and transplantation has become a reference in the response to that call, with deceased donation rates of 33–35 donors pmp, and a privilege position in terms of its transplantation activity.

  • The Spanish Model consists of a set of organisational measures that facilitate the identification of potential donors and their effective conversion into actual donors, implemented on an appropriate legal, health‐care, political and technical background.

  • Intensive care physicians play a key role in the deceased donation process. Their appointment as donor transplant coordinators, a key aspect of the Spanish approach, is respectful with the principles of autonomy, beneficence, nonmaleficence and justice.

  • Public support and trust in the donation system in Spain is not the result of direct promotional campaigns, but of a continuous and active collaboration with the mass media.

  • Professional training and education is critical for the effective realisation of the deceased donation process in general terms and for consent to organ donation in particular.

Keywords: organ transplantation; brain death; intensive care; presumed consent; ethics; quality; mass media

Figure 1.

Evolution of deceased donation in activities in Spain, in absolute number of deceased donors and rate per million population. Years 1989–2011. © Matesanz R, Escudero D and Domíngues‐Gil B.

Figure 2.

Evolution of transplantation activities in Spain, in terms of number of solid organ transplant procedures per million population. Years 1989–2011. © Matesanz R, Escudero D and Domíngues‐Gil B.

Figure 3.

Evolution of number of families approached and refusals to deceased organ donation in Spain. Years 1989–2011. © Matesanz R, Escudero D and Domíngues‐Gil B.

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Further Reading

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Report of the Madrid Consultation (2011) Part 2: Reports from the working groups. Transplantation 91(11S): S67–S114.

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How to Cite close
Domínguez‐Gil, Beatriz, Escudero, Dolores, and Matesanz, Rafael(Dec 2012) Ethical and Social Issues of the Spanish Model on Organ Donation and Transplantation. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0024198]