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3rd October 2024
European Donation Day, taking place on 5 October 2024, is an opportune time to acknowledge the remarkable progress being made in organ donation and transplantation in Europe and to discuss how to accelerate further achievements. Here, Dr Chloë Ballesté Delpierre, elected member of the European Society for Organ Transplantation Council (ESOT), shares her thoughts.
Organ transplantation is one of modern medicine’s most significant milestones, providing life-saving treatments to countless individuals. However, significant disparities persist in access to these procedures, leaving many without the care they need.
The number of patients receiving transplants in Europe varies widely, from 114.8 per million in Spain to just 7.6 in Bulgaria in 2019 – a stark disparity.1 As technological advancements and innovations like bio-artificial organs continue to transform patient care, they also underscore the challenge of preventing these inequities from widening.2
The 2023 Global Convergence in Transplantation Summit marked a significant step toward addressing such disparities, highlighting the critical need to standardise practices and ensure equitable access for all.3
Successful programmes in Spain, Portugal, Italy, Croatia and the UK provide valuable lessons for developing a blueprint for best practice throughout Europe. The deceased organ donor rate can also be used to evaluate successful practice, measured per million of population (pmp) in 2023.4
Spain’s programme with 49.38 deceased donors pmp, is regarded as a global benchmark.4 The country excels due to its robust three-tiered governance structure: specialised doctors in organ donation, a comprehensive reimbursement strategy and strong media collaboration.5
This structure, covering national strategy, regional coordination and hospital-level donor management, is key to its success and Spain’s commitment to innovation, including donation after circulatory death and expanded donor criteria, further strengthens its leadership in this space.5
Portugal with 37.13 deceased donors pmp is catching up with Spain and emerging as a global leader in organ donation.4 Of note is how Portugal capitalised on its close geographical, governmental and cultural ties with Spain to foster collaboration and knowledge exchange, which significantly strengthened its own organ donation and transplantation system.6 Other key strategies include a focus on tertiary prevention, reforms in dialysis governance and sustained financial commitment.6
Italy, with 29.39 deceased donors pmp,4 has developed a robust organ donation system coordinated by the National Transplant Network, with legal frameworks, cultural integration of altruistic donation and a national training strategy that has increased donation rates.7
Similarly, Croatia has built an efficient national transplantation network, with strong central governance, collaboration and resource-efficient management that ensures sustained excellence in organ donation practices.8 In Croatia, Spain, Portugal and Italy, intensive care doctors are also actively involved in organ donation.5-8
In the UK, organ donation and transplantation have seen significant progress, with 1,510 deceased donors (22.35 pmp) and 938 living donors in 2023/24, enabling 4,651 transplants – a 6% increase in deceased donors and a 3% rise in transplants from the previous year.9
The UK’s success stems from its integration of research with clinical practice, donor coordinators and impactful public awareness campaigns. These efforts are supported by robust funding structures and significant investments in infrastructure and technology.9
On the other end of the spectrum, Greece lags behind its European counterparts with 8.45 deceased donors pmp4 and an urgent need for systemic reform. The Onassis Foundation recommends establishing an independent national transplant organisation with strong governmental backing, implementing a ‘soft opt-out’ consent policy, integrating donor specialists in hospitals and focusing on public trust and education.10
Based on the success of Spain, Portugal and the UK, key priorities for Greece include expanding infrastructure, standardising the organ donation process, improving reimbursement systems and emphasising patient-centred care.10 A dedicated task force is advised to oversee these complex reforms.
To effectively build on the successful programmes described in this article, other countries must adapt these best practices to their unique cultural, legal and healthcare contexts.11
A flexible and aligned approach that balances local needs with European standards is required, along with collective efforts to close the gaps in organ donation and transplantation.
A recently developed 16-domain conceptual framework offers a comprehensive guide for developing and evaluating national programmes, focusing on responsiveness, efficiency and equity.12
This framework promotes a standardised approach that considers the diverse realities across jurisdictions, ensuring that all patients, regardless of their location or socio-economic status, benefit from the latest advancements in transplantation technology. This serves as a strong example, but additional initiatives across Europe are required to standardise clinical practices and ensure equitable access to transplantation.
ESOT is actively collaborating with the World Health Organization, among other stakeholders, on this matter, with a strong dedication to continuing the efforts to bridge the gap in Europe.
By working together, we can create a more equitable system, extending the benefits of organ transplantation to every corner of Europe and addressing disparities that hinder progress.
18th May 2023
Organ shortage is a major survival issue worldwide and a disproportionate supply and demand was worsened by the pandemic, resulting in a significant decline in global transplant numbers. Here, Chloë Ballesté Delpierre, associate professor, University of Barcelona Medical School, details how countries need to learn from each other’s best practices and work towards a common goal to resolve this ongoing issue.
Organ transplantation is a life-saving procedure for many patients suffering from organ failure. However, the demand for organs far outweighs the supply, leaving many patients on waiting lists for years. The disparity between supply and demand was only worsened by the pandemic, the impact of which has resulted in a significant decline in global transplant numbers. In Europe, the scarcity of donor organs is a persistent issue that has yet to be fully resolved.
Organisations such as the World Health Organization, the European Union Commission and the Council of Europe have all made efforts to increase organ donation rates. However, despite several isolated actions, there has been very little improvement overall. Approximately 30,000 organs are transplanted in the EU annually, far below the estimated 150,000 patients on the waiting list.
While living donations can be a life-saving option for patients, they pose several ethical concerns. The pressure to donate from family and friends can be overwhelming, and the possibility of coercion or exploitation cannot be ignored. It is essential to ensure that donors are not put at risk while in pursuit of helping patients. Therefore, it is important to develop robust deceased donation programmes.
Most transplanted organs in the EU are from deceased organ donors, but these are still in short supply in many countries. Due to the lack of homogenised practices, organ donation rates vary from country to country. Each country also has its own legal and cultural framework, resulting in different consent systems, procurement procedures and allocation criteria.
Efficient donation programmes should be identified and promoted, with the nomination of a national competent authority and professionalisation within hospitals. Doctors from ICU, anaesthesia, emergency and any other departments caring for patients with severe neurological conditions should be duly trained and given the responsibility to lead the organ (and tissue) donation programme in their hospital. Focusing on the clinical activity and ensuring a regulatory framework would avoid fragmentation and unequal access to transplantation for patients.
To address these issues, the EU Commission launched an ‘Action Plan on Organ Donation and Transplantation’ to improve organ donation and transplantation in Europe. Between 2009 and 2015, the total number of transplants increased by 17% and the total number of deceased organ donors increased by 12%. But Covid-19 took a toll on the transplant community, and it is still trying to recover. There are new calls for an updated action plan considering the pandemic’s impact.
Despite the challenges, some countries have significantly increased their donation rates. Spain has one of the highest donation rates in the world, with 40.8 deceased donors per million population (pmp) in 2021 compared with the global average of 6.4 pmp. This is due to a combination of factors, including a well-structured donation system and a strong commitment from healthcare professionals.
To improve organ donation rates across Europe, countries need to learn from each other’s best practices and work towards a common goal, and the European Society of Organ Transplantation (ESOT) Congress helps make this possible. These meetings provide a unique opportunity for the transplant community to come together to share their knowledge and promote progress towards a better future for organ transplantation.
As an elected member of the ESOT Council and a member of the Scientific Programme Committee for the ESOT Congress 2023 in September, I am honoured to be involved in crafting a state-of-the-art programme, which will ultimately improve outcomes for patients with terminal organ disease and increase equitable access to organ transplantation.
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