Spain has topped global organ donation statistics for decades – a success that also has very concrete implications for expats living in Spain.

Spain Expat Press Editorial Team

A day to say thank you

Every year on the first Wednesday in June, Spain marks the “Día Nacional del Donante de Órganos y Tejidos”, the National Organ Donor Day. On this day, hospitals, patient organisations and the Spanish National Transplant Organisation ONT (Organización Nacional de Trasplantes) thank all donors and their families. At the same time, the public is reminded how vital organ donation is for thousands of severely ill patients.

Spain as a global leader

Spain has long been regarded as an international role model in organ donation. For around 34 years now, the country has recorded the highest number of organ donors per million inhabitants worldwide, clearly ahead of other European states and even the United States. In recent years, the donor rate has been around 50 donors per million inhabitants, while the EU average is roughly half that.

This leading position has very concrete effects: in 2024 and 2025, more than 6,300 organ transplants were performed in Spain each year – a historic high. Behind these figures are people whose lives have been saved or significantly improved by a transplant.

The “Spanish model”: Why does it work so well?

Spain’s success is based on a combination of organisation, professionalism and a strong social attitude towards donation.

• Central coordination by the ONT
  The ONT coordinates a nationwide network of transplant coordinators in almost all hospitals with intensive care units. This allows potential donors to be identified in time and ensures that all medical and logistical steps are managed efficiently.

• The key role of donor families
  Although Spain formally operates under a system of “presumed consent”, in practice relatives are always fully informed and involved. The high level of trust in doctors and coordinators contributes to the fact that consent to organ donation is frequently given.

• Expansion of donation after circulatory death (asistolia)
  Spain is also a leader in so‑called “donación en asistolia”, organ donation after cardiac arrest. This area has grown strongly in recent years and has significantly increased the overall number of donors.

• Ongoing public awareness campaigns
  Campaigns with clear messages and real‑life patient stories have helped to frame organ donation as a positive, solidarity‑driven act closely linked to community and mutual support.

What does this mean for expatriates in Spain?

For expatriates living in Spain, Spain’s leading role is far more than just an abstract statistic.

• Access to one of the world’s best transplant systems
  Anyone integrated into the Spanish healthcare system – whether via the Seguridad Social or specific agreements – benefits from a highly efficient transplant network. Many transplants are performed in public hospitals that enjoy an excellent international reputation.

• National rules also apply to foreign residents
  As a rule, Spain’s organ donation regulations apply to everyone in the country, including foreign nationals. At the same time, the family’s wishes are central in practice, which is why it is very important to talk openly about the topic within the family.

• A different donation culture than for example German‑speaking countries
  Unlike Germany, where an opt‑in system still applies, Spain uses a presumed‑consent or “opt‑out” model, even though practice remains very family‑oriented.

How can I make my position on organ donation clear?

Even if foreign residents in Spain are not familiar with every detail of the system, there are some simple steps to clarify their own stance.

• Talk to your relatives
  In reality, talking to your family is the most important step. If loved ones know exactly what you would have wanted, it makes an extremely difficult situation a little easier and supports the work of the medical team.

• Get informed
  The websites of the ONT and the regional health authorities offer accessible information about organ donation, processes and the legal framework. Many patient organisations also provide material in several languages or help people navigate the system.

• Consider documents from your home country
  Anyone who already has an organ donor card , of course, continue to carry it. What really matters, however, is making your wishes clear within your Spanish environment (partner, family, close friends).