Organ Donation: Everything You Need To Know As A Foreign Resident In Spain

Whilst most foreign nationals moving to Spain make a Will to ensure that their estate is disposed of in the way they wish, many don’t think about organ donation.

If you come from a country where organ donation is an opt-in activity it may come as a shock to learn that, in Spain, there is presumed consent. Unless you have explicitly stated that you don’t want your organs used, the default position after your death is that they will be considered for donation.

Spain Is A World Leader In Organ Donation

Spain can boast that it contributes 24 per cent of the total number of donors in the European Union and 5 per cent of those registered globally even though the country only represents 11 per cent of total European population and 0.6 per cent of global population. 

It has the highest donation activity in the world with 47 donors per million people, against the USA in second place with 44.5 donors per million.

Minister for Health, José Miñones, recently praised, “The solidarity of Spanish society and the greatness of the families who every day say yes to donations that allow many lives to be saved or improved.”

In 1989 the Ministry of Health created the Organización Nacional de Trasplantes (ONT), an agency in charge of all donation and transplantation activities in Spain. The ONT then created a model for organ donation that saw donations double from 15 per million to 30 per million in its first decade. 

The Spanish Model has become globally recognised as the most successful due to a few pioneering factors:

• It allows medical professionals to identify donor opportunities not just in intensive care, but also emergency departments and other hospital wards.
• It considers donations from people aged over 65, an age which is much higher than many other countries. In Spain over 10 per cent of deceased donors are over 80.
• Where many countries only consider organ donation in the case of brain death, Spain also considers it in the case of circulatory death i.e. heartbeat and breathing has stopped.
• It is an opt-out model; unless you have expressed your opposition to organ donation via a Living Will or informally to next of kin, you are presumed to be eligible for organ donation.

What Happens After You Die?

Unless you have filed a Living Will that states that you do not wish to be a donor for all, or some, of your organs or you have communicated your wishes to next of kin or legal representatives who are contactable in the event of your death, you will be considered for organ donation.

In Spain, the organs that are considered for donation after death are the heart, liver, kidneys, pancreas, stomach, lungs and intestine.

If you die in a medical facility, the medical staff who are appointed in charge of transplant coordination carry out a few checks:

1. Investigate whether the donor made their wishes clear to any relatives that are contactable, or to the professionals who have treated them at the health centre, through any notes made in the clinical history, or whether they have a Living Will registered in the Advanced Directives Registry.
2. Examine the documentation and personal belongings that the deceased carried for anything that indicates total or partial opt-out.

If those checks don’t identify any opposition, the coordinators must then present any relatives present at the health centre with information on the need for organ donation, what is considered for donation and the practices that are carried out around the process.

One important thing to understand is that the medical professional who makes the decision about your suitability for organ donation after death must not have been involved in your health care leading up to your death nor have certified your death. 

What Happens If Your Child Dies

If your child, or an adult you are legally responsible for, dies you need to remember that the default position is that the organs will be donated. By the very nature of it, the donation of organs needs to happen very quickly following the death of a person. Therefore you, as parent or legal guardian, will be asked to consent to organ donation almost as soon as your loved one dies. 

It’s critical that you think ahead and have agreement on what you will do regarding organ donation of your child or loved one that you’re legally responsible for and that you are fully aware of the procedures that will take place.

Lynn and her husband lost their child, Leon, after moving to Spain at a time they were completely unaware about the laws and procedures around organ donation. So, at a time of total devastation about losing Leon, they had to face being asked for consent by medical staff who were professional, yet direct. Luckily, in their case, they’d had previous ‘what if’ discussions in their marriage and had always held the belief that the family should donate organs where possible. However, they had no knowledge of the logistics around procedures.

Lynn remembers, “It sounds stupid, but nobody explained what my son’s body would look like after organs were donated so I wasn’t prepared to see the large incisions on his body that had been stitched up.” 

She went on to say, “I went to the funeral home in my local town only to find Leon wasn’t there and was more or less told it was my fault, because I’d agreed to organ donation. His body went from the hospital to a transplant centre and that delayed his arrival at the funeral home. I assumed his organs would be taken at the hospital where he died but that wasn’t the case.”

Lynn mentioned, “They couldn’t tell me exactly who Leon’s organs went to, but they were able to tell me the age and gender.”

Official information mentions that bereaved families often stay in touch with organ transplant coordination teams for up to five years. Lynn’s experience, as a foreign resident who wasn’t fluent in Spanish, was very different and she feels that her family would have benefited from talking to a liaison person from the transplant team.

Despite the confusion and trauma of the time, Lynn does sometimes reflect that there are three people out there who are living because of Leon’s organ donation. It’s not a comfort, but it’s some good out of a terrible situation.

Who Do Your Organs Go To?

In the case of both living and deceased organ donations, the personal information of donors and recipients are protected by a number of European privacy laws as well as medical ethics so your relatives won’t be told the identity of anyone who receives one of your organs. 

In the case of living donation, it may be the case that the identity of the recipient is known since the majority of organs donated in these situations are between close relatives. 

You are not able to dictate the characteristics of who you want your organs to go to so you can not, for instance, state that you want organs to go to people of particular age ranges, gender, sexuality, lifestyle etc.

What If You Don’t Want To Donate Organs?

Donating one’s organs after death is the most altruistic final act you can do and the Spanish government very much encourages people not to record anti-donation wishes. Many lives are saved every year through organ transplantation.

However if you have strongly held religious or personal beliefs that rule out you donating your organs after death you should visit your local health centre to discuss your options.

It is possible to make a Living Will and file it with the Advance Directives Registry. This is done by filling out a form which allows you to stipulate your wishes around organ donation, as well as your wishes around end of life care and intervention. Your health centre can give you information about the process for your region.

Since medical professionals check the personal belongings you have with you at death, another option may be to get a wallet sized card made up or a piece of jewelry that states, in Spanish, that you don’t wish to donate. Those options are particularly useful if you don’t have relatives or close relations in Spain who are likely to be with you in the event of your death.

On the flipside, if you want to make the discovery process easy for medical professionals to identify that you have no issue with organ donation, you can get an official card that says you are happy to donate. As said, the donation system is opt-out so the card simply saves a little time.