Organ Donation: Spain vs UK

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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.
Screen Shot 2013-01-30 at 21.17.40

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
Pasted Graphic 4
ETHICUS, 2003 (Spain = Southern, UK = Northern)

Is this difference because of ICU capacity?

Screen Shot 2013-01-30 at 22.25.24

3. Consent (Family refusal in Spain 19%, UK 43%)
Screen Shot 2013-01-30 at 21.50.48

Source NHSBT


Why?

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?
Self selecting?

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.
Screen Shot 2013-01-30 at 22.26.13

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)
Screen Shot 2013-01-30 at 22.03.37

Source NHSBT

- 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...
Screen Shot 2013-01-30 at 22.05.24

Source NHSBT

despite DCD being more common in the UK).
Screen Shot 2013-01-30 at 22.27.48

Source NHSBT

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.

6. Education
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!

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