American Transplant Congress

American Transplant Congress


Dominguez-Gil, B. Session #234. Presented at: American Transplant Congress; May 30 - June 1, 2020 (virtual meeting).

Disclosures: Dominguez-Gil reports no relevant financial disclosures.
June 05, 2020
2 min read

Presumed consent helpful for increasing transplants in Spain, but challenges remain


Dominguez-Gil, B. Session #234. Presented at: American Transplant Congress; May 30 - June 1, 2020 (virtual meeting).

Disclosures: Dominguez-Gil reports no relevant financial disclosures.
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Spain has had a significant increase in organ transplants since adopting a presumed consent policy 40 years ago, but policy changes have been required to sustain deceased donor levels, according to a speaker.

The Organizacion Nacional de Transplantes (ONT) manages the program, where growth in donations has been significant - from 14.3 per million population in 1980 to 49 deceased donors per million population in 2019. That reflects 550 donors in 1980 in the program’s first year increasing to 2,302 donors in 2019, according to ONT data.

doctor holding a kidney
Source: Adobe Stock

“In Spain, everyone is an organ donor after their death unless they have expressed the opposite during their lifetime,” Beatriz Dominguez-Gil, MD, PhD, director of the Spanish National Transplant Organization in Madrid, said in a presentation at the American Transplant Congress, which was held as a virtual event.

Under the program, residents can “opt out” of donating altogether or can specify only certain organs they want to donate. Otherwise, it is assumed that all residents agree to donate their organs upon death.

Dominguez-Gil presented ONT data that showed fewer people are opting out of donation. In 2019, 14% opted out and elected not to become donors, a drop from 28% in 1992. ONT always gives family members the option to make the final decision if an individual opted in to donate, she said. “In the end, the family always has the final veto,” she said. “If the family opposes it, we will not proceed with the organ recovery.”

Dominguez-Gil said one of the challenges facing the program is the inconsistency in the number of deceased donors by region – ranging from 34 donors per million population to 90 donors per million population – even with the same level of training provided to medical professionals to educate patients about the value and importance of donation.

“We have trained over 20,000 medical professionals through ONT courses since 1991,” Dominguez-Gil said. That includes general courses on donor coordination, courses targeted to emergency department personnel, neurologists in stroke medical units and medical residents working in the ICU. Courses are also offered to non-health care professionals, and include deceased, as well as living donation.

A presumed consent policy for obtain organ donors can have positive messages, but also faces some challenges, Dominguez-Gil said.

“Having a presumed consent policy can be seen as something positive because it launches a message to the population that donating is the normal option,” she said.

However, the public may also perceive that the state becomes the owner of the organs “and somehow it would be a system to oblige us to ignore the surrogate of relatives” to donate an organ, she said.

In the last 6 years, ONT has seen a 40% increase in donors, Dominguez-Gil said, after adopting a new “50-22” directive. The goal has been to reach 50 donors per million population by 2022. “The difficulty was is the change in the potential organ donors themselves,” she said, which included the manner of death and the aging of the country’s population that made for lower eligibility. “We really needed to think in a different way and do things in a different manner.”

That included accepted older age donors up to 70 years old – sometimes even into their 80s, she said.