Organ Donation: Spain vs UK
Spain has the best donation rates in the world. The UK does not. Why?
1. Spain began its journey to the top with a 50% increase over 5 years - we in the UK are achieving likewise. Predicted 47% rise in donation over five years for March 31st 2013. Spain has a twenty year lead.
2. Even if all our identified potential Donation after Brain Death (DBD) cases were tested, and we had 100% family consent, we would still have 2/3 the donation rate as Spain.
- reflects different incidence of brain death (neurosurgery (decompressive craniotomies, coiling for subarachnoid haemorrhage), UK safest roads in Europe).
- end of life practices are different
ETHICUS, 2003 (Spain = Southern, UK = Northern)
Is this difference because of ICU capacity?
3. Consent (Family refusal in Spain 19%, UK 43%)
Rafael Matesanz, Spain’s guru, and pictured above says - NO, it is not presumed consent. They had presumed consent for a decade before they saw any rises. It is a whole hospital change that makes a difference.
So why do UK citizens living in Spain donate more often?
Are we in the UK, just less generous? I would hate to think so, especially when public surveys support donation so overwhelmingly.
Is it ethnic and cultural mix? I don’t know enough to comment on this.
But look at where potential donors fall off a donation pathway.
There is still work to be done in neurological testing, still work to be done in ensuring that, where donation is a possibility all families are approached, but the UK consent rate has remained stubbornly low.
4. It’s not all bad in the UK
- UK does have very good use of donated organs (little waste)
- UK does have a very good living donation rate
- the above two factors mean that transplantation in the UK is less behind Spain than the donation rates might suggest...
despite DCD being more common in the UK).
5. Hospital structure
Spanish transplant coordinators are full time intensive care doctors in a donation role, supported by full time nurses.
In the UK we have full time donation nurses supported by a doctor (Clinical lead for Organ Donation) 4 hours per week.
Spain has a long established education programme for their intensive care trainees. The UK has nothing (I’m working on it!).
6 differences, only one that favours the UK (our utilisation of organs).
However, I like point number 1 the best. We are on a 20 year journey.
47% increase over 5 years is what Spain achieved in its first 5 years.
So did WE!