The Minister of Health, Mónica García, acknowledges the great work of health professionals, which has enabled the rate of 48.9 donors per million population (p.m.p.) and 122.1 transplants p.m.p. to be reached; the latter surpasses that recorded in 2019, the best year in transplant activity so far.
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Best activity figures and approaches 6,000 transplants a year
Organ donation and transplantation activity in Spain reached, in 2023, levels of excellence that are difficult to surpass. Thanks to a cohesive national programme, led by the National Transplant Organisation (ONT), in which professionals from multiple specialties participate and which stems from the generous act of donation, 5,861 organ transplants were performed in Spain last year, representing a rate of 122.1 transplants per million population (p.m.p.). This is according to the results presented today at a press conference by the Minister of Health, Mónica García, who was accompanied by the Director General of the ONT, Beatriz Domínguez-Gil.
This high level of activity was achieved thanks to the 2,346 people who donated their organs after death, bringing the donation rate to 48.9 donors p.m.p., and the 435 people who donated a kidney (433) or part of their liver (2) during their lifetime. These figures represent a 9% growth in transplantation and 7% growth in donation compared to 2022. Moreover, the transplant rate is 8% higher than the all-time high recorded in 2019, before the COVID-19 pandemic. The average number of donors per day last year was 8 and the average number of transplants performed each day was 16.
Record activity in kidney, liver and lung transplants
Growth in 2023 was across the board in all types of transplantation. There were 3,688 kidney transplants (8% more than the previous year), 1,262 liver transplants (+9%), 479 lung transplants (+15%), 325 heart transplants (+5%), 100 pancreas transplants (+9%) and 7 intestinal transplants (+75%). With a total of 433 procedures, living donor kidney transplant activity increased by 24% and accounted for 12% of all kidney transplants performed. In addition to the all-time record total number of transplants, the figures for kidney transplantation (both living and deceased donor), liver and lung transplantation also exceeded any recorded figure.
The rate of 48.9 deceased donors p.m.p. reached by Spain last year is close to the target of 50 donors p.m.p. set by the ONT in its Strategic Plan “50X22” and the figure of 2,346 donors represents another historic high. This activity is much higher than that achieved by other countries in the world, according to data from the Global Observatory on Donation and Transplantation, which is managed by the ONT as a Collaborating Centre of the World Health Organisation.
In 2022, the United States recorded 44.5 donors p.m.p, France 25.8, Italy 25.0, Canada 21.4, United Kingdom 20.6, Australia 17.4, Germany 10.4 and the European Union as a whole 20.9 donors p.m.p.
Minister García thanked “the solidarity of donors and their families, as well as the essential work of the professionals involved in all phases of the complex process of donation and transplantation and the coordination of the ONT and the Autonomous Communities, an example of social and health cohesion – a perfectly coordinated network that saves thousands of lives every year, as reflected in the data we are presenting today”.
Donation in asystole, the main area of growth
For her part, the Director General of the ONT, Beatriz Domínguez-Gil, insisted on “the impeccable work of all the transplant coordination and transplant teams and the regional transplant coordinators who, together with the ONT, continue to identify new ways to continue to improve these figures and ensure that the complex therapy of transplantation reaches all patients who need it”. Precisely the lines set out in the aforementioned strategy, which aims to reach 50 donors p.m.p. and 5,500 transplants per year, “have already enabled us to comfortably surpass the latter figure by 2023”.
Years ago, the ONT identified a decisive initiative to maintain this growth path: asystolic donation. With a total of 1,050 donors (15% more than in 2022), 45% of donors in Spain in 2023 were asystolic donors. In addition, this type of donation is consolidated as a multi-organ donation, thanks to the generalisation in Spanish hospitals of a complex organ preservation procedure based on extracorporeal circulation devices (ECMO), also with a Spanish signature. Thanks to this, in 2023, 1,488 kidney transplants, 474 liver transplants, 195 lung transplants, 58 heart transplants and 31 pancreatic transplants were carried out with organs from asystole donors. In addition to these, another intestinal transplant in asystole was performed by the Hospital Univ. La Paz, in 2022 already performed two intestinal transplants with the same characteristics. This once again makes Spain the only country in the world that transplants all types of organs from donors in asystole.
92 years old, the longest-living donor
The profile of potential organ donors in Spain remains similar to that of previous years. Donors who died as a result of traffic accidents accounted for only 4.7% of the total. The main cause of death of donors was stroke. In terms of age, more than half of the donors (56.8%) were over 60 years of age, 30% over 70 and 5% over 80. The oldest donor recorded in 2023 was 92 years old. Over the past year, organ transplantation from donors with positive PCR for SARS-CoV-2 was also normalised, following confirmation of its safety over the past few years. From December 2020 to the end of last year, 341 patients were transplanted from donors with this condition.
In addition to the generosity of all donors, since 2021 the generosity of those who request the aid in dying benefit and express their willingness to be donors has been added: 90 people have been donors after dying in these circumstances and have enabled the transplantation of 249 patients since the law regulating this benefit came into force until December 2023.
The constant growth of transplant activity goes hand in hand with the search for new formulas to prioritise patients in clinical situations and solutions for those with anthropometric or immunological difficulties in transplanting. In this sense, 314 patients were transplanted in zero emergency and 190 children received the organ transplant they were waiting for. In addition, 153 hyperimmunised kidney patients (for whom it is very difficult to find a compatible donor) were transplanted, thanks to the ONT’s PATHI programme.
Despite last year’s impressive figures and the high level of transplant activity in Spain, a significant number of patients remain on the waiting list. As of 31 December 2023, the waiting list stood at 4,790 patients. Of these, 75 were children. This number of patients on the waiting list is similar to that recorded in 2022 (4,746 patients).
Data by Autonomous Community
Ten Autonomous Communities exceeded 50 donors p.m.p. and 3 of them exceeded 70 donors p.m.p. last year. Cantabria once again led the ranking, with a rate of 74.1 donors p.m.p., followed by Navarre (71.6) and Murcia (71.0). Of the Autonomous Communities with populations of more than 5 million inhabitants, the activity recorded in the Community of Valencia (52.6) and Andalusia (51.5) stands out. The Autonomous Communities with the greatest growth in donation were, in that order, Murcia (+49%), Madrid (+24%) and Castilla la Mancha (+22%) (Table 1).
The ONT puts the number of transplants carried out thanks to organ exchanges between Autonomous Communities at 1,304, which represents 23% of the total. In turn, 7% of recipients have been transplanted in a centre outside their Community of residence. Both figures demonstrate the cohesive role of the Spanish Transplant System.
Activity by hospital
The centres that recorded the highest activity in 2023 were:
Other highlights in 2023
Spain and Italy successfully performed the second international cross-over kidney transplant with three pairs involved. This crossover of the International Renal Transplant Crossover Programme involved 10 Spanish, 7 Italian and 2 Portuguese hospitals with 133 donor-recipient pairs that had not achieved an exchange in their countries: 67 from Spain, 42 from Italy and 24 from Portugal. In addition, Spain performed 19 kidney transplants thanks to the National Cross Kidney Transplant Programme. There were three exchanges of two transplants, three exchanges of three transplants and one chain of four transplants initiated by an altruistic donor.
The asystole donor heart transplant programme was consolidated last year. In addition to the 110 transplants carried out from January 2020 (12 of them paediatric) until December 2023, H. Clinic de Barcelona performed the first combined heart and kidney transplant from an asystole donor. The hospitals involved in this programme were: Complejo H. Univ. de A Coruña, H. Clinic, H. Univ. de Bellvitge, H. Univ. Dr. Negrín, H. Univ. Gregorio Marañón, H. Univ. Univ. La Fe, H. Univ. La Paz, H. Univ. Marqués de Valdecilla, H. Univ. Puerta de Hierro, H. Univ. Vall d’Hebron, H. Univ. Virgen de la Arrixaca and H. Univ. Virgen del Rocío. This type of transplant accounted for 18% of the total number of heart transplants performed in 2023.
In November last year, the High-Level Meeting ‘Towards a global consensus on transplantation: availability, transparency and registration’ was held in Santander, in the context of the Spanish Presidency of the European Union. Spain, through the ONT, led the design of the roadmap for organ, tissue and cell donation and transplantation in the world for the next decade, with the approval of the Santander Declaration.
National Bone Marrow Plan
As of 31 December 2023, our country had 484,175 bone marrow donors in the Spanish Bone Marrow Donor Register (REDMO), a figure that brings us closer to the objective of 500,000 registered donors, on which the ONT and the Autonomous Communities are working, together with the José Carreras Foundation, Scientific Societies and patient associations. There were 23,686 donors in 2023, 8% more than those registered the previous year, thus recovering the percentage of growth prior to the pandemic and returning to the path of annual growth.