More countries hoping to copy Spain's organ-donation success
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* Mary Helen Spooner

Actions by Spanish physicians following the death of a British toddler in Spain may have outraged some UK tabloids, but they also helped highlight the policies that have made Spain the world leader in organ donations.

Megan Jones, 2, died of natural causes related to a viral infection during a family holiday in Spain in April, and her parents agreed to the removal of her liver and kidneys for transplant purposes. When her body was returned to the UK, however, other organs were found to be missing. (Spanish physicians are allowed to remove organs without permission during the postmortem process. They must seek permission to remove organs for transplantation.)

Heavy media coverage of the case drew attention to Spain's phenomenally successful organ donation policies, which have seen donations increase by 142% since 1989. Not only does Spain have the highest donation rate in Europe, with 34 donors per million people, but it is has almost 3 times the UK rate of 13 per million. Other rates range from 20 in France to 12.2 in Germany. In Canada, the donor rate is about 15 per million people.

Spanish officials had considered implementing a policy of presumed consent to boost the number of donors, but instead they created the Organización Nacional de Trasplantes (ONT), a network of transplant coordinators in 139 intensive care units across the country. ONT professionals identify potential organ donors by closely monitoring emergency departments and tactfully discussing the donation process with families of the deceased. (With presumed consent, people are assumed to be willing organ donors in the event of their death unless they or their families had specifically stated otherwise.) According to the ONT Web site ([www.msc.es/ont/ing/home.htm](http://www.msc.es/ont/ing/home.htm)), the number of kidney transplants from cadaver organs rose from 1477 in 1992 to 1998 in 2002. The number of liver transplants rose from 412 to 1003, and heart transplants from 254 to 310.

A survey by Spanish researchers found that of 200 families that declined to have their relatives' organs donated, 78% changed their minds after the process was explained in detail.

Spain's success has attracted attention across the EU. In September, officials from 6 countries met in Frankfurt to discuss transplantation and agreed upon a statement calling for governments to increase donations toward Spanish levels. — *Mary Helen Spooner*, West Sussex, UK