Spain's high rate of organ donation may hinge on local use

EDITOR—Barber et al draw attention to the high refusal rates in the UK as a major reason for poor transplantation rates in the UK, and contrasts these with the Spanish rate for 2004 of 33.0 per million population (comparable figure for 2005 is 35.1/1000 000).1 A similar comparison for the refusal rate may be helpful. The UK transplant team's figure of 41% refusals must be contrasted with an average for Spain of 16.8%, with regional data varying from 9.6% to 30.5%.2

Historically transplantation rates in Spain have been high in areas with a strong regional identity and lower in central rural Spain, although these differences are declining. Anecdotally, one reason for Spain's low refusal rate may be a public belief that organs will be used locally and will therefore benefit people “like the donor.” One wonders whether the perception in Britain is that organs may be used at a distance as a result of central coordination, whereas the Spanish system ripples the offer of organs in a cascade.

By contrast, the suggestion that UK coordinators are not as active as their Spanish equivalents in asking relatives for permission to use organs now seems unfounded.