The Minister of Health, Caroline Dariashas highlighted today the shared success that the National Transplant Program; a program, he has remarked, that combines self-improvement, effort, drive and generosity. This has been underlined during the presentation of the activity balance of the National Transplant Organization (ONT) in 2022, at a press conference in which she has been accompanied by Beatriz Domínguez-Gil, general director of the body attached to the Ministry of Health.
Last year, Darias detailed, a total of 5,383 organ transplantswhich represents a growth, compared to 2021, of 13% in the number of transplants and 15% in the number of donations.
Specifically, in 2022 a total of 3,402 kidney transplants (15% more than the previous year), 1,159 hepatic (+8%), 415 lung (+15%), 311 cardiac (+3%), 92 of pancreas (+12%) y 4 intestinal. It should also be noted that, with a total of 350 procedures, living donor kidney transplant activity represented 10% of all kidney transplants.
This number of transplants, he has detailed, was possible thanks to the 2,196 people who donated their organs after death, which places the donation rate at 46.3 deceased donors per million population (pmp). To these should be added the 355 people who donated a kidney (350) or part of their liver (5) while alive.
There has been an increase in all types of transplants, since a total of 3,400 kidney, 1,159 liver, 415 lung, 311 heart, 92 pancreas and 4 intestine transplants have been performed
Minister Darias thanked the work of all the professionals who participate in each of the phases of the donation and transplant process, as well as the coordination of the ONT and the autonomous communities and cities and the work of the security forces and bodies of the State, the Armed Forces, airlines, airport workers, ambulance drivers and all those involved in the logistics necessary to carry out this type of operation.
In the same way, he highlighted the wide network of collaborations established by the ONT with all the scientific societies that represent the health professionals involved in the donation and transplantation process. Likewise, it has underlined the generosity of Spanish society, highlighting the high percentage of acceptance of donations by families (84%) at the time of the loss of a loved one.
Spain remains the world leader in donation
The Minister of Health has also highlighted the level of excellence that the National Transplant Program registers worldwide. Thus, the transplant figures for 2022 in Spain represent a rate of 113 per million population (pmp) and an average of 7 donors and 15 daily transplants.
The rate of 46.3 deceased donors pmp in Spain is also much higher than that reached by the rest of the world, according to data from the Global Donation and Transplantation Observatory, managed by the ONT as a Collaborating Center of the World Organization for Human Health.
Thus, in 2021 Germany registered 11.1 donors pmp, Australia 16.3, Canada 19.3, the United States 41.6, France 24.7, Italy 24.1, the United Kingdom 19.8, Sweden 19.3 and the European Union, as a whole, 19.5.
Pioneers in donation in asystole worldwide
As Darias has highlighted, the growth registered has also been possible thanks to the constant search for new ways to increase activity and for transplant therapy to reach all patients who need it.
Thus, last year it was possible to resume the strategic lines of the ONT’s ‘Plan 50X22’, which seeks to reach 50 donors pmp and exceed 5,500 transplants per year.
In this sense, it is worth noting the growth of 38% compared to 2021 in the asystole donation, a determining initiative for the expansion of transplantation. Thus, with a total of 913 donors, 42% of donors in 2022 have been in asystole.
As Carolina Darias has remarked, Spain is the only country in the world that transplants all types of organs from donors in asystole, a procedure that has gone from being exclusively renal to becoming multi-organ, thanks to the generalization of the preservation procedure based on circulation devices extracorporeal (ECMO)
Thus, in 2022, 1,299 kidney, 375 liver, 152 lung, 37 cardiac, and 20 pancreatic transplants were performed with organs from asystolic donors. To these was added the world milestone of the first intestinal transplant in asystole performed by the La Paz University Hospital in Madrid which, after the good results obtained, performed a second intestinal transplant with the same characteristics. Adapting to the profile of potential organ donors in Spain is another pillar of the ’50×22 Plan’.
Los deceased donors due to traffic accidents remain at very low figures, at only 4.3%. The main cause of death for donors is stroke. Regarding age, more than half of the donors (57.3%) are over 60 years old, 28% over 70 and 5% over 80. The longest-lived donor registered in 2022 was 90 years old.
Another necessary adaptation has been living with COVID-19, including organ transplantation from donors with positive PCR for SARS-CoV-2, after an individualized assessment and adequate selection of recipients. Until December 31, 2022, there were 180 transplanted patients from 84 donors with this condition.
Added to the generosity of all donors, since 2021, is that of people who request assistance in dying: 49 people have been donors after dying in these circumstances and have made transplants possible for 135 patients.
Solutions for urgent or difficult-to-transplant patients
Over the years, formulas have been sought to prioritize patients in a very serious clinical situation and solutions for those with difficulties in receiving a transplant due to their characteristics. In this sense, in 2022 the transplantation of 253 zero-urgency patients and 188 children stands out. Likewise, 153 hyperimmunized kidney patients (for whom it is very difficult to find a compatible donor) have been transplanted, thanks to the ONT’s PATHI program, which, with this figure, reaches its all-time high.
Despite last year’s growth and the high transplant activity in Spain, a significant number of patients remain on the waiting list. As of December 31, 2022, the waiting list stood at 4,746 patients. Of them, 66 were children. This number of patients on the waiting list is similar to that registered in 2021 (4,762 patients).
Crossover kidney transplant
Spain, on the other hand, also performed 24 kidney transplants thanks to the Crossover Kidney Transplant Program. Eight chains were completed, two of them involving five transplants initiated by two altruistic donors. 26 hospitals from 13 autonomous communities and 22 histocompatibility laboratories, coordinated by the ONT, participate in the Program.
In addition, the asystole donor heart transplant program is consolidated in Spain. There are 52 transplants carried out since January 2020 (9 pediatric).
National Marrow Plan
As of January 1, 2023, Spain has 474,455 bone marrow donors available in the Spanish Registry of Bone Marrow Donors (REDMO). Of these, 21,903 are donors who joined in 2022.
The ONT and the autonomous communities, together with the Josep Carreras Foundation, Scientific Societies and Patient Associations, are working to reach 500,000 registered donors.