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the demographic characteristics of donors, it is importIntroduction ant to underline that their age continues to rise in our country, as already stated before, so that 27% of In Spain, cadaver organ transplantation has become donors were aged 60 years or above (Figure 3). an accepted activity in our hospitals. The tasks of the Cerebral haemorrhage is the most frequent cause of Spanish National Health System (Sistema Nacional de brain death, with an incidence of 55.3%. At the same Salud) include all types of transplantation of solid time, we see a continuous and significant decrease in organs, of tissues and of haematopoetic precursors. head injuries due to traffic accidents, down to 23.4% The National Health System is, on the one hand, in 1997 (Figure 4). conscious that this modality of treatment must be Additionally, there is a significant and progressive offered obligatorily to all citizens living in Spain. At decrease in family refusal to donate organs (Figure 5). the same time, however, it is conscious that transplant units must be supported by a system devoted to the promotion of organ donation because progress in the development of transplant units is impossible without Evolution of transplant activity an increase in the number of organs obtained. Over the last 10 years, Spain has developed an organizational Continuous success in organ donation has resulted in system in charge of organ donation. Organ donation an increase in transplantation activity. This is is perceived as a medical activity which must be undoubtedly the result of an increase in the activity implemented by medical professionals and by paramedand professional qualifications of all respective specialical staff. ists in our country (Table 1). This system has been described previously and has Renal transplantation is largely based on cadaver proven highly efficient in achieving its objectives [1–4]. donor organs. During 1997, only 20 cases amongst 1861 renal transplantations were living donor transplants (i.e. 1% of the renal transplantation activity). Evolution of organ donation This is the second lowest percentage amongst the surrounding countries. Since 1989, Spain has experienced a continuous With respect to liver transplantation, the marked increase in organ donation. In 1997, 1155 donors were increase in transplantation activity has been followed registered, which implies an increase in the annual rate by an increase in the patient waiting list. In 1998, it of donation to 29 donors per million population was higher than in the preceding years. It must be (p.m.p.). To this one has to add an additional increase mentioned that the age of the recipients increased so of 10% which took place in the first 9 months of 1998 that 25% of these patients are age 60 years or above. which increased the rate to 31 donors p.m.p. (Figure The rate of heart transplantation is 8 p.m.p. This 1). These numbers are greatly above those registered number has increased slightly in recent years. In this in other countries (Figure 2). respect, Spain has an intermediate position relative to The increase in organ donation was paralleled by an the surrounding countries. The main cause why this increase in multiorgan donation which has risen to number has stabilized is the fact that the number of >80% in the last years. This permitted a spectacular patients for whom the clinical indication for this proincrease in the number of cadaver donor organs availcedure is given has not increased. able for transplantation. Lung transplantation has experienced a spectacular The profile of the organ donor has changed substanincrease of 42% over the preceding year, i.e. a total of tially in Spain over the last years [5]. With regards to 108 transplantations, 81 of which were bipulmonary (75%). This illustrates the important development of this medical surgical technique in our country. The Correspondence and offprint requests to: Dr B. Miranda, Organización number of patients with an indication for this procedNacional de Trasplantes, C/Sinesio Delgado, 8, E-28029 Madrid, Spain. ure increases. Consequently, the number of patients

Update on organ donation and retrieval in Spain