International Health Care Systems

Why are organ donation rates so high in Spain?

As you can guess from the title of this post, Spain leads the world in rates of organ donation. More recent figures back this up.

Figures published for 2017 reveal that 2,183 people in Spain became organ donors last year after they died. That’s 46.9 per million people in the population (pmp) – a standard way of measuring the rate of donation in a country.
Spain’s closest contender is Croatia, with 38.6 pmp (2016). It has maintained its position as the clear leader for the past 26 years.

The Independent

Why is this the case?

PBS Newshour

There are a number of reasons. The most well known is that Spain relies on the “opt-out” system.

When attempting to explain Spain’s success, it’s the “opt-out” (or presumed consent) system for deceased organ donation that is perhaps cited more often than anything else. Opt-out means that a patient is presumed to consent to organ donation even if they have never registered as a donor…
Despite Spain having a nominal presumed consent system, in practice coordinators do all they can to find out whether a patient is happy to donate before they die, and also whether their relatives or loved ones are comfortable with this.

The Independent

While the opt-out system was created in 1979, things really took off only after Spain implemented the administrative systems necessary to take advantage of this rule. Specifically, i6mn 1989, Spain’s Ministry of Health created the Organización Nacional de Trasplantes (ONT). This agency was put in charge the coordination and oversight of donation and transplantation activities across Spain. ONT was succressful; donations rose from 15 per million to 30 per million in under 10 years.

Another factor is that Spain prioritizes organ transplants from the elderly.

While only seven percent of organ donors are over the age of 65 years in the United States, ten percent of organ donors in Spain are over the age of 80.


While there are many other factors to consider, organ donation is certainly an area where the US could learn something from the Spanish.

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