Organ procurement and renal transplants in Spain: the impact of transplant coordination. Spanish National Transplant Organization (ONT).

The growing shortage of cadaveric organ donors remains the major obstacle to achieve satisfactory rates of transplantation. In Spain an integrated transplant organization programme, mainly focusing on organ procurement, has been established, based on a network of well-trained transplant coordinators. In every hospital that was a potential candidate for donor procurement, a transplant coordinating team was founded, including medical doctors and nurses (42% of whom belonged to renal units). The team was put in charge of all steps of transplant procurement, from locating potential donors to the organ grafting or tissue banking. The teams were integrated into a National Organization of Transplants (ONT), i.e. a coordinating structure without executive function. The annual rate of cadaveric organ donors increased from 14.3 per million population (p.m.p.) in 1989 to 21.7 donors p.m.p. in 1992. Total solid organ retrieval rate increased by 81% and renal transplants by 44% during the same period (from 1039 to 1492, i.e. from 26 to 38.8 renal transplants per million population, 99% of which were kidneys from cadaveric donors). This successful approach has overcome obstacles such as untrained or undertrained staff, failure to identify donors, or reluctance to approach grieving families.