FOR Eva Perez, receiving the all-important phone call kickstarted a complicated mix of emotions.

“You are happy because your loved ones are celebrating that you received the call as it’s your chance to continue to live and to follow your dreams, but at the same time you know that there is another family, somewhere else, who are crying.”

It’s a confusing mish-mash of feelings – fear, hope, happiness, grief, responsibility – that Eva, now 55, knows all too well.

She was aged just 11 when doctors discovered that she was suffering from hepatitis – inflammation of the liver – which required extensive treatment and medication.

The first ever Spanish liver transplant only took place in 1984, at that time an experimental and highly dangerous procedure, so it wasn’t until 11 years later in 1995 when Eva was able to finally receive the life-saving surgery. 

Eva Perez Bech, now President of the National Federation of Liver Transplants and Illnesses, had two liver transplants in her twenties.

Two years on, she was pregnant with her son, Fernando.

“It was very difficult and complicated because the medication I was offered would have had damaging effects on the foetus, so I decided not to take it in order to save the life of the baby,” she told the Olive Press

Fernando was born prematurely, but an influx of medication following the birth failed to reverse the inevitable – Eva’s new liver was being rejected, starved of the crucial immunosuppressants she was forced to forgo during her pregnancy. 

During the festive period of 1997, she went under the knife once more.

“I was a lot more scared during the second transplant than the first. At 27 [in 1995], you are working, you live alone and independently, you don’t have any responsibilities”.

Eva was incredibly lucky, with a donor available within two months of giving birth: “I felt incredibly fortunate, because getting a transplant is not like buying something from El Corte Ingles. You can have all the technology in the world but the entire process is dependent on a family experiencing the worst moment of their lives, who have to stop grieving in order to decide to donate, to give life to someone else”. 

“The first family gave me life, the second gave me life with my son”, she said. 

Eva is one of tens of thousands of Spaniards who have benefited from the selflessness of grieving families.

Spain has been a world leader in organ donation for over 30 years. Credit: Cordon Press

She is also one of many to have benefited from Spain’s organ donation and transplant model, widely regarded as the best in the world.

In 2023, 5,861 organ transplants took place in Spain, meaning that Spain topped the global list for the 32nd consecutive year.

One in four of all donors within Europe and 5% of all donors worldwide are Spanish, with over 140,000 transplants having been carried out within the country since records began.

But why has the Spanish model had such success and longevity? 

According to Gonzalo Diaz, a postdoctoral researcher in Philosophy at the University of Granada who has extensively studied Spain’s donation system, several factors come into play.

“The opt-out system is one of the fundamental pillars of the Spanish system – unlike other countries, in Spain you are an organ donor automatically, unless you opt-out of the system”, he said.

Gonzalo Diaz has extensively researched the success of Spain’s organ donation and transplant model.

The opt-out system is the antithesis of the opt-in system, whereby potential donors have to explicitly state their desire to have their organs used after death.

The success of the system has seen other countries, such as the UK, adapt their policies in hope of replicating Spain’s model, which has a world-leading donation rate of 48.9 donors per million people. 

However, for Diaz, there are other vital cogs to the Spanish machine: “On one hand, it is due to the high levels of support and confidence that the Spanish population have for the national transplant and medical system.”

Spain’s success can be traced back to the creation of the National Transplant Association in 1989. Credit: Cordon Press

A recent study from Diaz and his colleagues found that over 90% of Andalucians were supportive of the system, whilst almost three-quarters want their organs to be donated after death.

In 1989, the Spanish Health Ministry created the National Transplant Organisation (ONT), an agency in charge of the coordination and oversight of donation, procurement, and transplantation activities.

Diaz believes that the organisation’s work has been integral to Spain’s success: “The work of the ONT and of all medical professionals involved in the process of donation and transplant is magnificent”.

“Their capacity to inform society of the importance of donation is incredibly persuasive and effective”, he added.

A 2017 study published in the American Journal of Transplantation likewise highlighted the importance of the ONT’s structure and function, claiming that ‘the Spanish success derives from a specific organisational approach to ensure the systematic identification of donation opportunities’, whilst simultaneously ‘promoting public support’ for donating organs after death.

It helps to in part explain how Spain’s model continues to flourish in the present day, with 2023 seeing a 9% rise in the number of organ transplants conducted in the country.

Beatriz Dominguez-Gil, head of the ONT, exclusively told the Olive Press: “The increase seen in 2023 has only been possible thanks to the constant search for new ways to increase donation and transplant activity, ensuring that one day in the future, this incredibly complex medical procedure will be available for every single patient that needs it”. 

Beatriz Domiguez-Gil is head of the ONT, Spain’s organ donation and transplant agency. Credit: ONT

Despite the success of the Spanish model, 4,790 patients remain on the waiting list, a number of whom will either die whilst waiting for an organ, or be removed from the list as they become too ill.

Discussing how Spain can continue to improve its model, Diaz told this newspaper: “I believe that addressing new technological challenges within the sector, maintaining high levels of training for medical professionals, and continuing to be transparent and honest towards the general public will be key”.

Nevertheless, Spain’s carefully nurtured model continues to be the best in the world. 

For Eva, nowadays working as President of the National Federation of Liver Transplants and Illnesses, her opinion is definite.

“It is clear in my mind that if I had not been born in Spain, I would not be here today”.

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