Spain's National Health System has maintained its position as the global leader in organ transplantation for more than three decades, a standing reinforced by 2025 data showing a rate of 53.2 deceased donors per million population and more than 6,300 transplants carried out — figures the country's health authorities say place it well above all other nations. Spain ranked first that year in both renal and pulmonary transplant activity.
The figures come in the context of a wider global picture: according to the World Registry report managed by Spain's National Transplant Organisation (ONT), 183,896 organ transplants were performed across 96 participating countries in 2025, a 4% increase on the previous year.
The so-called "Spanish transplant model," widely described in the scientific literature and recommended by the World Health Organization (WHO), rests on two structural pillars: the 1979 Transplant Law — progressively updated to reflect scientific and technological advances — and a universal-access public health system that, by its nature, allows any patient to receive a transplant without discrimination.
Coordination operates across three levels. The ONT harmonises policy between the central health administration and Spain's regional administrations. Beneath that, a network of authorised organ-procurement hospitals each maintains a dedicated transplant coordination unit. Leading those units is the hospital transplant coordinator, who is described by the ONT as a central element of the model's success.
Under Spanish law, organ donation is altruistic, free, voluntary, confidential, anonymous, and non-commercial. The legal framework operates on the basis of presumed consent: all persons are considered donors unless they have expressed otherwise. In practice, however, a procedure exists to establish whether the deceased had at any point objected — including through statements made to family members or attending medical staff. A donor card, available via the campaign "Eres perfecto para otros," serves as a written expression of the wish to donate.
Living donation — the procurement of organs from living donors where medically possible — is also regulated, requiring donors to be of legal age and in good physical and mental health. The donation of cells and tissues, including bone marrow, falls under a separate but parallel framework; bone marrow donors must be healthy individuals between 18 and 40 years of age, free of transmissible diseases or conditions that would place them at risk through the act of donation.
Several verified sources, together with artificial intelligence, were used in the preparation of this article. The content was reviewed by our editorial team prior to publication. Disclosure provided in accordance with Article 50 of the EU Artificial Intelligence Act (AI Act).
