Spain, with over 6,400 transplants, exceeds forecasts for 2024

The Minister for Health, Mónica García, at the presentation of the report on the activities of the National Transport Organization

The generosity of Spanish society and the excellence of healthcare professionals have ensured that organ donation and transplantation activity in Spain will exceed all the 2024 targets set by the National Transplant Organisation (ONT). Last year, 6,464 organ transplants were performed, representing a rate of 132.8 per million population (p.m.p.), the highest transplant activity ever recorded in our country. The number of transplant procedures increased by 10% compared to 2023. This is a milestone for Spanish healthcare, as can be seen from the balance of activity presented at a press conference by the Minister for Health, Mónica García, accompanied by the Director General of the ONT, Beatriz Domínguez-Gil.

By organ type, lung transplants experienced the greatest growth, which, with 623 procedures performed last year, increased by 30%. There were 4,047 kidney transplants (10% more than the previous year), 1,344 liver transplants (+6%), 347 heart transplants (+7%), 98 pancreas transplants and 5 intestinal transplants. In addition to the all-time record total number of transplants, kidney, liver and lung transplant activity also surpassed any figure ever recorded in Spain.

This transplant activity was possible thanks to the 2,562 people who donated their organs after death, a rate of 52.6 per million population, a record figure in Spain and the highest in any country in the world. This represents a growth of 9% compared to the previous year. In turn, 404 live donors donated a kidney (397) or part of their liver (7). The average number of donors per day last year was 8 and the average number of transplants performed each day was 17. In terms of tissue donation, of the people who donated their organs after death in 2024, 1,675 were also tissue donors (65% of the total). The donation of corneas, bones and tendons was the most numerous.

Target of 50 donors per million population exceeded

The rate of 52.6 deceased donors per million population that Spain reached last year far exceeds the target of 50 donors p.m.p. set by the ONT in its Strategic Plan "50X22". This level of activity is difficult for other countries in the world to achieve, according to data from the Global Observatory on Donation and Transplantation, which the ONT manages as a Collaborating Centre of the World Health Organization. In 2023, the United States recorded 48.1 donors p.m.p., Italy 29.4, France 27.6, Sweden 25.2, United Kingdom 22.4, Canada 21.4, Australia 19.4, Germany 11.6, and the European Union as a whole 22.9 donors p.m.p.

All these achievements were highlighted by Minister García, who insisted on the difficulty of achieving these levels of excellence every year. "It may be nothing new to say that Spain is a leader in organ donation and transplants, but we must not forget the tireless work of the health professionals involved in this process to achieve these record figures, as well as the solidarity of donors and their families," she said.

Along the same lines, the Director General of the ONT, Beatriz Domínguez-Gil, wanted to emphasise "the high complexity of each donation and transplant operation, whose development is possible thanks to the impeccable collaboration of the coordination and transplant teams, as well as the regional coordinators and a wide network of health and non-health professionals." The director of the ONT also announced that a new strategy is already being designed "so that organ transplant therapy reaches all patients who need it, in the shortest possible time and with the greatest guarantees of success." This constant search for new ways to expand donation is what allows Spain to continue to grow every year.

More than half of donors are asystole donors

In 2024, the importance of asystole donation in the growth experienced has again been demonstrated. With a total of 1,316 asystole donors (25% more than in 2023), this type of donation already represents more than half of all donors in Spain. Asystole donation is carried out in 25 other countries in the world, although Spain not only has the highest activity of this type, but remains the only country that successfully transplants all types of organs from these donors. With the generalisation in Spanish hospitals of a complex organ preservation procedure based on extracorporeal circulation devices (ECMO), also with a Spanish signature, 1,866 kidney transplants, 579 liver transplants, 272 lung transplants, 101 heart transplants, 24 pancreatic transplants and one face transplant from asystole donors were performed in 2024. Because of its special difficulty (only eight countries in the world perform it), it is important to highlight that cardiac transplantation in asystole already contributes to 29% of the total number of cardiac transplants in Spain.

The profile of the potential organ donor in our country remains similar to that of previous years. Donors who died as a result of traffic accidents accounted for only 5% of the total. The main cause of death of donors was stroke (52%). In terms of age, nearly 60% of donors were over 60, 31% over 70 and 5% over 80. The oldest donor on record in 2024 was 88 years old.

In addition to these donors, from 2021 onwards, the generosity of people who apply for assistance in dying and, in addition, express their wish to become donors: A total of 154 people have been donors following their death under these circumstances, enabling the transplantation of 442 patients from when the law regulating this type of donation came into force up to December 2024.

Patients with more difficulties in receiving a transplant due to their anthropometric, clinical or immunological characteristics continue to be a priority for the ONT and the transplant and coordination network, which are constantly searching for formulas that allow them access to the transplant they need. As a result of this work, 308 patients were transplanted in zero emergency and 197 children received the organ transplant they were waiting for in 2024. In addition, 140 hyperimmunised kidney patients (for whom it is very difficult to find a compatible donor) received transplants, thanks to the ONT's PATHI programme.

Although the high level of donation and transplant activity makes it possible to reach many patients, there are still a significant number of patients on the waiting list. At 31 December 2024, the waiting list stood at 5,096 patients. Of these, 73 were children. The number of patients on the waiting list is slightly higher than at the end of 2023 (4,794 patients).

Data by Autonomous Community

Twelve Autonomous Communities exceeded 50 donors per million population and four of them surpassed 60 donors per million population last year. Cantabria again led the ranking, with a rate of 94.9 donors p.m.p., followed by Navarre (76.1), Murcia (69.4) and Extremadura (63.8). Of the Autonomous Communities with populations of more than 5 million inhabitants, the activity recorded in Andalusia (57.5) and the Valencian Community (57.4) stands out. The Autonomous Communities with the highest growth in donation were Cantabria (+30%), Castilla y León (+26%) and Galicia (+26%). (Table 1).

The ONT puts the number of transplants carried out thanks to the exchange of organs between Autonomous Communities at 1,428, which represents 23% of the total. In turn, 7% of recipients were transplanted in a centre outside their Autonomous Community of residence. Both data are proof of the cohesive role of the Spanish Transplant System.

Activity by hospital

The centres with the highest activity in 2024 were:

Other highlights in 2024

Last year, 16 live kidney transplants were performed in the context of the Cross Kidney Transplant Programme managed by the ONT. These transplants were performed in the form of four cycles of two transplants, one cycle of three transplants and a chain of four transplants initiated by an altruistic donor. In addition, one patient from Spain received a transplant in an international cycle of three transplants carried out with Portugal.

In December, the Lower House of Parliament approved the Law to improve the protection of living organ and tissue donors. The Law recognises sick leave due to donation as special situations of temporary disability due to common contingencies and grants paid leave for the time necessary for the study of the donor, the surgical intervention and the recovery after the graft has been obtained. This is an initiative that has been promoted for years by patient associations and the ONT.

In May, the EU Parliament and Council adopted the Regulation on Substances of Human Origin (SoHO), a major achievement of the Spanish presidency of the Council of the European Union, which achieved the consensus of the countries and the political agreement necessary for a fundamental regulation for the protection of SoHO recipients and donors.

In May last year, the 77th World Health Assembly adopted the resolution "Increasing availability, ethical access and oversight of human cell, tissue and organ transplantation", promoted by Spain. This initiative once again positions Spain as an international leader in the field of transplantation, on this occasion due to its role in designing the roadmap for this programme at a global level for the coming years. The resolution is based on elements reflected in the "Santander Declaration", the result of the Global Transplant Summit organised by the ONT in Santander in November 2023, on the occasion of the Spanish presidency of the Council of the European Union.

The prestigious journal The Lancet recognised the Spanish Donation Model as a world benchmark on the cover and in its editorial of the September issue. Trust in the system and proper management of the donation process with the leadership of the ONT and the Autonomous Communities results in a "society that responds with solidarity." The Lancet explains that Spain's success is based on three pillars: legislation, organisational model and clinical leadership.

National Bone Marrow Plan

In 2024, the target of 500,000 people registered in the Spanish Bone Marrow Donor Registry (REDMO) set by the National Plan was exceeded. Moreover, by 31 December last year, this figure had risen to 505,505 bone marrow donors. In total, 30,010 donors joined in 2024.

^{Table. Organ donation activity of deceased persons in Spain by Autonomous Communities}

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