Transplants in Spain

Some record-breaking numbers: 42.8 donors per million inhabitants in 2016 (compared to 20 in the UK, 10 in Germany and 30 in the United States) and undisputed leader in the number of transplants performed – 6 points above the US (the country with the second highest number of transplants).

Let’s start with the fact that every citizen of Spain, unless otherwise stated, is a potential donor. Of course, introducing such a law was only made possible when society was ready for it, and when the health system was able to guarantee the complete transparency, safety and reliability of all transplant-related procedures.

The legislative changes were accompanied by the work of experts, leaders in their specialty. Thus, for example, Dr. Barret performed the first full-face transplant in the world, Dr. Cavadas was the first in the world perform a double-leg transplant, and several operations performed by Dr. Juan Carlos García-Valdecasas –Chairman of the International Society of Liver Transplants– were a milestone in the history of liver transplants. His colleague, Dr. Antonio Alcaraz, was a pioneer in the application of minimally invasive techniques in kidney transplants. They are true leaders in medicine with indicators that represent international benchmark and specialists – pioneers in innovation.

Current legislation establishes that transplant operations only be performed in accredited public hospitals and for the citizens in the Spanish national health system; this system belongs to the European network of transplants (Eurotransplant), which organizes organ donations/recipients among participating countries.

LIVER TRANSPLANTS IN SPAIN

Hospital Clínic Barcelona is an international benchmark in liver transplants. Under the direction of the President of the International Society of Liver Transplants, Juan Carlos García-Valdecasas, this hospital in Barcelona has performed over 2,000 of these operations, including from a living donor, with the heart in cardiac arrest, and Domino liver transplantation. All of them with benchmark survival indicators and minimal complications: hospital survival rates are significantly higher than those of the European Liver Transplant registry, representing 99% of survival in the first year, 78% in 5 years and 70% survival in 10 years. And –particularly important for foreign patients– with the same survival rates for transplants using live and deceased donors.

HEMATOPOIETIC STEM CELL TRANSPLANTATION IN SPAIN

Hospital Clínic Barcelona is an international leader in bone marrow transplants, with vast experience (2,100+ of this type of transplant) and excellent results. The center focuses mainly on the treatment of the most complex cases (about 100 HSCT a year), achieving extraordinary results in autologous stem cell transplantation in autoimmune diseases and plasma cell dyscrasias, as well as in the allogeneic stem cell transplantation from unrelated donors and allogeneic transplantation for rare diseases.

Autologous transplants are used to treat autoimmune diseases, multiple sclerosis, Crohn’s disease and lupus erythematosus. Hospital Clínic Barcelona is one of the most active international centers in clinical trials in this field. Allogeneic transplants are also a successful treatment for idiopathic myelofibrosis, multiple myeloma, aggressive forms of lymphoma, chronic lymphocytic leukemia and paroxysmal nocturnal hemoglobinuria. In fact, several hematological diseases which have traditionally been considered incurable can now be treated successfully with this treatment. The treatment outcomes at Hospital Clínic in highly complex cases (average complexity of 3.36) are exemplary: survival rate of 70% in the first year and 55% in 5 years for allogeneic transplantations; 100% survival in the first year and 80% in 5 years after an autologous transplantation.

KIDNEY TRANSPLANT IN SPAIN

Kidney transplants are the most common type of transplant and have been performed the longest and most extensively, with outstanding results which, paired with the application of cutting-edge minimally invasive surgery techniques, exclusive characteristics of Barcelona’s major health centers, become even more relevant.

Under the direction of Dr. Antonio Alcaraz, the world’s first extraction of the kidney through natural orifices was performed at Hospital Clínic Barcelona, a technique that leads to unbeatable results, drastically reducing complications and pain; the hospital stay is also drastically reduced to a mere 48 hours. Of the 60 living-donor kidney transplants the hospital performs a year, 25 extractions are transumbilical or transvaginal.

The center has performed over 4,000 kidney transplants, and one in four live-donor kidney transplants are performed with the assistance of the Da Vinci Xi robotic system, a figure that should increase to 40% in the near future.

The specialists who work at Hospital Clínic have an exceptional level of experience: Dr. Alcaraz’s team performed 24 kidney transplants in March 2016 alone. The hospital’s survival rates are international benchmarks: 99% in the first year and 90% in 10 years.

Transplants for foreign patients

Transplants are one of the specialties in which Barcelona excels, not only for the enormous experience of the city’s doctors and health centers, but also for their use of innovative and minimally invasive techniques and benchmark results in terms of both survival indicators and in the number of post-operative complications. All this has made transplants one of the most sought-after specialties in Barcelona by foreign patients.

It is important to note, however, that under the current legislation, deceased-donor transplants are only performed for patients that belong to the Spanish national health system and the operations are carried out in accredited public university hospitals. There are no restrictions on living-donor transplants under current bioethical norms.

Foreign patients can only receive a transplant if the patient has his or her own donor. This limits the possibility of live-donor kidney and liver transplants; there is no limitation for international patients, both adults and children, for HPT (hematopoietic precursor transplantation).

The results of live-donor kidney and liver transplants (in the latter case, performed by extracting a small segment of the donor’s liver) guarantees at least the same percentages of success as a deceased-donor transplant. These are very safe procedures for donors, even more so in the most advanced hospitals where operations are performed with robotic systems and through natural orifices.

The donor can be a family member or a friend and only has to meet two essential requirements: the donor must be compatible and their donation must be voluntary, altruistic and uncoerced. In Spain, this second ethical condition is confirmed not only during the interviews with the doctors, but also through a judicial review, based on a careful analysis of all the circumstances after interviews with the donor and the recipient.

An exception to this rule are bone marrow transplants (HSCT, hematopoietic stem cell transplantation): in these cases patients can be treated in Spain without bringing their own donor. Three out of four patients who need HSCT will not have a compatible relative. In the case of allogeneic transplantation of non-related donor bone marrow, the search for a donor is done through a Spanish and then international data bank. According to the data from the Fundación José Carreras, the probability of locating a donor is 79% in three months, the average time spent searching for a donor was 36 days in 2014. If the available umbilical cord blood units are taken into account, this percentage can exceed 90% in adults and up to 100% in children.