Factors influencing the adaptation of the Spanish Model of organ donation.

Spain is the only existing example of a large country (40 million inhabitants) with a continuous increase in cadaveric organ donation for a period of over 10 years, and, in parallel, with an increase in the overall number of solid organ transplantations. A proactive donor detection program performed by well-trained transplant coordinators, the introduction of systematic death audits in the hospitals combined with a positive social atmosphere, adequate management of mass media relations, and adequate economic reimbursement for the hospitals accounted for this success. Some regions of Italy, for example Tuscany, have successfully adapted this approach with excellent results. We can conclude that the "Spanish Model" can be partially or totally adapted to other countries or regions if basic conditions are guaranteed. An adequate and careful study of the local characteristics that influence organ donation directly or indirectly should be carried out before planning any specific action to improve organ donor rates.