What Spain can teach Scotland about organ donation
From next year the organ donation system in Scotland is changing. Under the new "opt-out" regime, it will be assumed that people want to donate their organs for transplants after they die, unless they have stated otherwise. BBC Scotland's The Nine has been to see how a similar scheme in Spain works.
The doctors and nurses in the gleaming new intensive care unit at Vall d'Hebron hospital are focused on their duties, but they are happy for us to film them at work.
They're rightly proud of the care they give some of the most seriously ill patients in Barcelona.
But while we're there the relaxed mood suddenly changes and we are ushered out of the area quickly.
Along the corridor a young woman breaks down in tears as the doctors explain her mother will never wake up after suffering a stroke.
It is a reminder that every story of a life saved by organ transplant must begin with a heartbreaking moment.
In 1979 Spain moved to a "soft opt-out" organ donor register, similar to the one that will come into effect in Scotland and England from 2020.
It means that when someone dies, it is presumed they want to donate their organs – unless they have actively opted out of the system. But the approval of their family is also required.
In the UK, it is hoped this will increase the number of organs available for life-saving transplants but in Spain there was no significant increase in donations for a decade after the law changed.
Thirty years on the country's organ donation rates are the highest in the world and the number of donors per million of population is about 48.
This is double the UK figure and compares with 18 in Scotland last year.
Vall d'Hebron has pioneered the role of specialist doctors in promoting high levels of organ donation.
In the corridors of the intensive care unit, as the woman's family is learning of her death, Dr Alberto Sandiumenge talks to the doctor who treated her about her suitability as a donor.
Organ donation in the UK is largely co-ordinated by specialist nurses but Dr Sandiumenge is a fully qualified intensive care physician, as well as a transplant co-ordinator.
He told BBC Scotland's The Nine: "Being a doctor allows me to talk as an equal with the treating physician."
They call it "active detection" – moving from the trauma ward, to accident and emergency, to intensive care, constantly monitoring which patients might become potential donors.
Gemma Catalá was returning to the hospital for the first time since her husband, Jordi, died suddenly from a brain haemorrhage, just three months ago. He was 50.
She believes he would have wanted to be a donor.
She said: "My husband always said we should help other people. He was a very generous person.
"He used to tell me that when you die you disappear, so why don't we help other people?"
She says it helped her and her teenage sons to know that Jordi's death had allowed others to live.
"That's the first thing I thought – let's learn something from this misfortune, and that's what I told my kids.
"In that moment if I could have done something for my husband, and we had got an organ [from a donor], I would have accepted it.
"That's why I told my kids, in this moment, your dad is going to make some other families happy."
Jordi's organs went on to be given to three other patients.
For Dr Christopher Mazo, Dr Sandiumenge and their colleagues, the underlying principle of an opt-out system changes the nature of each conversation with a bereaved family member.
Dr Sandiumenge said: "We ask the family if they have any knowledge of their relative opposing to donation, because that's what the law says.
"More often, when we talk about organ donation, in the worst possible situation when their relative has just died, they actually approach the subject in a completely spontaneous way.
"They say, do you think he could be a donor? Do you think he can help others? So they approach the subject before we do."
But doctors involved in the so-called Spanish model seem convinced that a change in the law is not enough alone.
'Trust in the system'
Dr Teresa Pont has been working at Vall d'Hebron since the national system in Spain was set up.
Thirty years ago, the annual number of transplants performed at the hospital was around 80 or 90. Last year it was nearly 350.
Dr Pont, who is now the director of the transplant team, said there are many factors in the success of the Spanish model, from the opt-out Read More – Source