Global Perspective on Kidney Transplantation: Spain

Since it was first performed in 1965, the evolution of kidney transplantation (KT) in Spain has been determined by that of deceased donation. In 1989, a specific coordination model was implemented in Spain, which already counted on a Transplantation Law, had the technical capacity for the practice of KT, and a public national health care system (NHS) with universal coverage of the population. The so-called Spanish Model on Organ Donation and Transplantation helped the country evolve from 14 donors per million population (pmp) to >30 donors pmp in less than a decade (1). The basic elements of this model are displayed in Table 1. In the latest years, a set of innovative approaches have boosted the rates of deceased donation in the country, to reach 49 donors pmp in 2019 (2): ( 1 ) a broad implementation of the practice named intensive care to facilitate organ donation, defined as the initiation or continuation of intensive care measures in patients with devastating brain injury in whom curative treatment has been deemed futile, to incorporate organ donation into their end-of-life care plans (3); ( 2 ) the successful use of organs from aged and very aged donors following an old-for-old allocation strategy (4); and ( 3 ) the expansion of donation after the circulatory determination of death (DCDD), which has exponentially increased in the last decade, so it now represents nearly 30% of the overall deceased donation activity (5). As a result, KT progressively increased to 3423 procedures (72.8 pmp) in 2019 (Figure 1). There are currently 35,183 patients (748 pmp) living with a functioning graft, 55% of prevalent patients with ESKD (6). View this table: Table 1. Basic elements of the Spanish model on organ donation and transplantation Figure 1. Evolution of kidney transplant activity in Spain by donor type. The activity is represented in absolute numbers and rate of kidney transplants …