BRUSSELS - DECEMBER 3rd, 2008

RAFAEL MATESANZNATIONAL ORGANIZATION

FOR TRANSPLANTS (ONT) - SPAIN

ACHIEVING SUCCESS

IN E.U. TRANSPLANT SYSTEMS

Kidney Transplants

Liver transplants

Heart Transplants

65511(39% LIVING D).

20366(10% LIVING D).

5313

WORLD TRANSPLANT REGISTRY

ANNUAL GLOBAL ESTIMATES – TOTAL FIGURES

TOTAL ESTIMATES: 96820 SOLID

ORGAN TRANSPLANTS

LUNG TRANSPLANTS: 3051 PANCREAS TRANSPLANTS: 2551

http://www.transplant-observatory.org

•RENAL TRANSPLANT.................43 years

•LIVER TRANSPLANT...................36 years

•BONE MARROW TRANSPL........33 years

•HEART TRANSPLANT.................27 years

•PANCREATIC TRANSPLANT......24 years

•LUNG TRANSPLANT....................19 years

•SMALL BOWEL.............................16 years

U.C.L.A. Registry-2006

LONG TERMSURVIVAL

UNIVERSAL PROBLEM

662 429

1,3201,906

0

500

1000

1500

2000

2500

Kidney Liver Heart Lung

Dea

ths

in t

he

WL

(a

bso

lute

nu

mb

ers)

0.0

1.0

2.0

3.0

4.0

5.0

Dea

ths

in t

he

wai

tin

g li

st

(pm

p)

Absolute numbers Rate (pmp)

Total in the EU

4,317 persons (12 persons/day)

Total in the EU

4,317 persons (12 persons/day)

DEATHS ON WAITING LISTS – EUROPEAN UNION 2007

34.3DECEASED ORGAN DONORS P.M.P. -2007

16.9PMP

5,8 PMP

8293

8089

26,6 PMP 2918

9.4PMP

198

UE / 27

UE /27

34.3

13.2

25.3

2123.9

10.7

2119.2

18.713.2

19.9

14.5

17.2

24.5

10

1511.4

15.1

30 DONORS PMP

20 DONORS PMP

10 DONORS PMP

<10 DONORS PMP

21.1

21.6

ORGAN DONORS p.m.p. 2007

2.1

1.213.1

14.1

8.5

0

26.9

5.8

550 1550

550687

778 832 86996010371032

11551250

13451335141014481494154615091550

1334

14,3

17,820,2

21,722,6

26,829

33,932,5

33,733,934,635,133,834,1

2725

33,631,5

0

200

400

600

800

1000

1200

1400

1600

1800

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007

0

5

10

15

20

25

30

35

40

NUMBER RATE pmp

ORGAN DONOR IN SPAIN SINCETHE START OF O.N.T.

44,3

ORGAN DONORS PMP-2007 SPAIN / REGIONS

30.4

40.0

48.6

32.0

45.6

25.8

34.0 33.0

37.217.4

29.2

74.2

34.2

41.7

26.241.1

>40

>35

>30

34.315-30

1182

98710171039

1240

1371

14921488

1633

1800

1707

1857

19962023

19381924

2032

21312125

22002157

2211

900

1100

1300

1500

1700

1900

2100

2300

RENAL TRANSPLANTSIN SPAIN

14 544 50

123170

313

412468495

614

698700

790

899960954972

103310371040107010511112

0

200

400

600

800

1000

1200

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

LIVER TRANSPLANTS - SPAIN

THE SPANISH MODEL

WAITING LIST DECREASESPAIN - 2005

-10%

-20%

-30%

-26,7

-10,3

-13,7%

-2%

LIVER KIDNEY HEART LUNG

-26,7%

-10,3%

IMPROVEMENT OF

ORGAN DONATIONIMPROVEMENT OF

ORGANIZATION

PHILOSOPHY OF THE SPANISH MODEL

NATIONAL

R

RR

R

REGIONAL

H

H

H

H

HOSPITAL

TRANSPLANT COORDINATION NETWORK

< 20 56 118 158

1988 1990 1992 2008

NUMBER OF TRANSPLANT COORDINATION TEAMS

46%

16%

29%

9%

I.C.U. NEPHROLOGY OTHER OP. ROOM

MEDICAL DOCTORS = ( 199 )FULL TIME DEDICATED = 6 %PART TIME = 94%

NURSES = ( 129 )FULL TIME = 32%PART TIME = 68 %

TRANSPLANT COORDINATION TEAMS SPAIN 2008 ( N =158 )

74%

9%

7% 5% 5%

I.C. UNITS NEPHROL. OTHER

EMERGENCY ANESTHESIA

3,8 3,7 3,67

20,4

3035,5

74,2

2000 2001 2002 2003 2004 2005 2006 2007

ORGAN DONATION IN LA RIOJA¡¡¡74, 2 DONORS PMP!!!

NEW COORDINATIONTEAM

T.C.

T.C. T.C.

T.C.TRANSPLANT

COORDINATORSINSIDE

THE HOSPITALS

GREAT EFFORT IN MEDICAL TRAINING

MORE THAN 4000 HEALTH PROFESSIONALSRECEIVED ALL KIND OF TRAINING RELATEDWITH ORGAN DONATION THROUGH THE LAST 18 YEARS SIN THE CREATION OF ONT

CENTRALOFFICEAS A SUPPORTAGENCYIN FAVOUR OFORGANDONATION

NOT JUST A SHARING OFFICE

QUALITY PROGRAMMEIN ORGAN DONATION

1998-2006

•A 9 YEARS “ON LINE” CHART REVIEW•ALL SPANISH REGIONS•129,230 DEATHS IN ICU•16,041 BRAIN DEATHS (12.4%/ ICU - DEATHS)•8,466 ACTUAL DONORS(52.8% OF BRAIN DEATHS)

AREAS FOR IMPROVEMENT:•FAMILY REFUSAL:.....................13.1%•BRAIN DEATH DETECTION: ......1.2%•DONOR MAINTENANCE :........... 3.2%•OTHER...........................................1.6%TOTAL.........................................25-30%

QUALITY PROGRAMMEIN ORGAN DONATION

POSSIBILITY OF EXTERNAL AUDIT:89 EVALUATIONS PERFORMED

HOSPITAL REIMBURSEMENT

)ESTIMATED MEAN VALUES(

EUROS )€(

Multi-organ procurement

6.000

Renal procurement 4.500

Multi-organ + tissue 7.500

1 hour of operating room: 1.500 €(

41 HOSPITALS WITHTRANSPLANT

PROGRAMMES--------------

63% OF THEDONORS

(21 DONORS pmp)

63%

120 HOSPITALSWITHOUT

TRANSPLANT PROGRAMMES-----------------------

37% OF THE DONORS(13 DONORS pmp)

37%

2006

GREAT ATENTION TO THE MEDIA

COORDINATION NETWORK

SPECIAL PROFILE

INSIDE THE HOSPITALS

BRAIN DEATH AUDIT

HOSPITAL REIMBURSEMENT

TRAINING OF PROFESSIONALS

ATENTION TO THE MEDIA

THE SPANISH MODEL & TRANSPLANTATIONORGAN DONATION

THE SPANISH MODELHAS BECOME A CENTRAL REFERENCE FOR ORGAN DONATION ALL OVER THE WORLD

COLLABORATINGCENTRE - WHO

LET’S MOVE INTO …

A MORE INTEGRATED EUROPE OF TRANSPLANTATIONS

DONACIÓN SIN FRONTERAS LE MODÈLE ESPAGNOLTHE LIFE - YEARS SAVED BY A DECEASED ORGAN DONATION

YEARS 15 30 45 60

TRANSPLANT OF SIX ORGANS: 55,8 YEARS

MEAN DONOR: 30,8 YEARS

LIVER: 16,1 AÑOS

HEART: 14,5

KIDNEY –PANCREAS: 12,9

KIDNEY: 7,2

LUNG: 2,1