Organ availability in Europe: problems and results

Abstract

The treatment of choice for the majority of patients suffering from end stage organ failure is transplantation. Major progress in the field of ‘transplantology’ has been achieved during the last decade, resulting in higher survival rates of both grafts and patients. However, the potential impact of these advances is seriously hampered by one persistent problem, the shortage of donor organs. The most successful means of increasing organ donation has been the introduction of so-called presumed consent legislation. The comparison of figures between Eurotransplant countries which appear to have a presumed consent system must, however, be undertaken with caution. There are many differences in how these regulations are handled and practised by hospitals and doctors in charge of potential organ and tissue donors. These might be influenced by cultural and religious aspects but also by social and ethical considerations. Analysing the European data with regard to procurement rates undoubtedly reveals that the number of available organs is the highest in Spain followed by Austria and Belgium (all three have presumed consent). Apparently, presumed consent in countries such as Italy and France has not yet resulted in a similarly high donation rate. In contrast, donation figures in France, Austria and Belgium have recently shown a serious drop, indicating that both public and professionals may not automatically accept presumed consent regulations. What is the Spanish secret? Clearly, a number of major factors contribute to the accomplishments in Spain in recent years. For example, the appointment of many regional (part-)time transplant coordinators in addition to those in local hospitals, and a relatively high number of fatal road traffic accidents. Such factors may he unique to Spain, but are insufficient to explain this success.