SPAIN came close to surpassing itself once again in 2025.
With 6,335 organ transplants carried out nationwide, the country barely missed out on breaking the all-time record – one that it set just a year earlier.
The near miss, however, does little to diminish the achievement. For the 34th consecutive year, Spain remains the world’s leading organ donor by population, recording 52 donors per million inhabitants—more than double the European Union average.
Kidney transplants accounted for the largest share of activity, while heart transplants reached an all-time high.
Regional variation persisted, with Cantabria once again leading the country, even though Spain’s lowest-performing regions exceeded donor rates in nearly every other nation.
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Spain’s success is often attributed to its presumed-consent donation law, which considers citizens potential donors unless they opt out.
An academic review of the Spanish transplant system—frequently cited as a global benchmark—suggests this explanation is incomplete.
In practice, donations proceed only after consultation with the deceased person’s family, making trust and communication central to the process.
The study, funded by the Onassis Foundation, highlights Spain’s highly structured approach: a national authority that sets strategy, regional offices that manage logistics, and hospital-based transplant coordinators trained to identify donors and guide families through difficult decisions.
This professionalisation, combined with continuous auditing and stable reimbursement for hospitals, has allowed Spain to achieve world-leading results with relatively limited resources.
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Public confidence plays a crucial role. Surveys show that Spaniards express higher trust in their transplant system than the European average, contributing to comparatively low family refusal rates.
While Spain leads in donations per capita, the United States comes in second and tops the list in terms of the total number of organ transplants performed. According to Statista, the US reported 24,021 organ donations in 2024.
England followed in Spain’s footsteps in 2020, implementing the ‘opt-out’ or ‘deemed consent’ system. Data from the NHS shows that since April 2025, 2874 people have received a transplant, while 8259 remain on the waiting list.
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Looking ahead, Spain has launched a new strategy through 2030 aimed at expanding donor eligibility and advancing medical innovation, including donation after circulatory death.
Spain may not have broken its record this year—but its dominance in the medical world shows no sign of fading.
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