According to the Ministry of Health, Social Services and Equality, Spain has been the world leader in organ and tissue transplants for 24 years. In 2015, there were 13 transplants per day performed in our country, or more than one transplant every two hours. These figures make the Spanish donation and transplant system a global reference. 

A large part of the credit for this success belongs to the Catalan Transplant Organisation (OCATT). Created in 1984, this organisation was a pioneer in creating a system for extraction, distribution and transplant of organs and tissues based on coordination between hospitals which has been exported to other countries.

OCATT is currently working on two public cooperation projects, both financed by the European Commission and managed by FIIAPP, aimed at establishing a transplant system in Croatia and Moldova similar to the one in place in the European Union.

Taking advantage of the monographic training course on the Spanish transplant system being held at our headquarters in Madrid, OCATT Director Jaume Tort answered some questions on the project he has been working on since 2013 in Moldova, a country with strong Catholic beliefs.

What are the strengths of the Spanish model?

It’s a donation system based on coordination between hospitals that has been shown to be, over the years, the best system in the world, and that allows you to expand it to other countries reliably, because you know and have the experience that it works.

There are students—in more established countries like Croatia—that are nearly at Spain’s level at the moment, and they’re copying, in the best sense of the word, the Spanish model. And Ibero-America is also increasing its number of donations very rapidly, also by applying the Spanish model. Since it’s accepted and recognised that we are the leader, everything is much easier, because you have a basis for working with confidence.

During the project, training courses were held for Moldovan specialists, both in Moldova and in Spain and France. What have been the biggest challenges and difficulties of the project in Moldova?

 The difficulties are in the setting, it’s a poor country. Along with Albania, it’s the poorest country in Europe, and that means that in the context of healthcare, hospitals don’t have reasonable minimum conditions for working on donation and transplants. Maybe in the most basic things, yes, but at this level, which requires intensive care units, there is still a lot of work to be done.

Another basic issue is the cultural and social profile of the professionals, which is very conservative and individualistic. Teamwork is an issue that needs to be promoted and worked on in the country.

So clearly it’s a complex setting. There’s also an added factor in the field of donation, because they are coming from a history of organ trafficking and, therefore, the image society has of organ transplantation is negative and needs to be changed. This situation makes the work even more difficult, but at the same time more interesting.

How would you describe the experience of leading the project in Moldova?

 Very interesting and attractive, but complex at the same time, because the organisational and administrative cultures of the governments are different. Even in the way the ministry works is much more pyramidal and extremely bureaucratic. On top of that, there are very few management instruments, which means that the work is a bit hierarchical, and you need a great deal of flexibility and impetus in these things, so these structures make it difficult.

You have to chip away at it, in a good sense, keep talking to people and have them see our experiences. To bring as many people as possible to our country, or to France, which has been the country co-leading the project. This experience has been very positive because the Moldovan professionals were able to come, and they’ve seen another working environment. If they have the experience of seeing what is being done in a country objectively, they learn better and much faster.

How would you describe the experience of leading the project with France?

The experience with them has been fantastic, no problem, perfect. Coordinating with the people from the French Biomedicine Agency has been perfect. They have marvellous professionals and a fantastic team. For example, if on occasion a professional coming from France couldn’t make it, a Spaniard would fill in, and vice versa.

How do you think the work with the Moldovan professionals will be in transmitting what was learnt in the project to society and the rest of the professionals?

 That’s going to be harder to do, and it’s going to be in the hands of the team at the Moldovan transplant agency. The coordinators are going to have to do the work of raising awareness internally in the hospital, because they are the people who are trained and motivated for that, and they are the ones who understand the subject of transplants.  They are going to help the country, within their environment. At the societal level, the Moldovan transplant agency is also going to take responsibility for doing this.

Now that the project is ending, could you tell us about the current system of transplants in Moldova going forward?

In the area of donation and transplants, they are in a position to perform kidney and liver transplants on a fairly normal basis. They’re already doing some with great caution.

They need a certain amount of time to get used to the donation process that exists. They have some donors but, even so, it’s necessary to keep insisting, and there’s still a need to look after the people leading the donor theme in hospitals.

So while they are already doing transplants, they are in the first phase. I’m sure that the time and willingness of the professionals is going to bring them good results, but we’re still at the beginning.

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