Pros and cons of a regulated market in organs.

In a World Report about the pros and cons of a regulated market for organ donation in the USA (Oct 17, p 1315), Priya Shetty explores other solutions for tackling organ shortage. When analysing the situation in Europe, she states that “Spain, which introduced presumed consent in 1990, has seen donations double...” The real fact is that Spain has not changed its transplantation law since 1979. Our system applies a “soft presumed consent” policy, in which families are always approached and still get the fi nal veto. This law was in place for 10 years with little eff ect on organ donation rates, which remained quite low during the 1980s. It was not until 1989 that the Spanish deceased donation rates increased exponentially in line with the creation of the Spanish National Transplant Organization and the introduction of a new organisational model around the process of deceased donation. Spain’s outstanding transplant coordination network, based on intensive care physicians in every major and minor hospital throughout the country, is undoubtedly the major factor contributing to Spain’s superior organ donation rates. This centrally organised system, in addition to being responsible for public education and media relations, ensures that every potential donor is identifi ed and has the opportunity to become an actual donor, and that the approach to the family is optimum. Thanks to this system, the number of organ donors increased threefold from 550 in 1989 to 1577 in 2008 (fi gure). The commercialisation of organ donation has been widely rejected by the transplantation community and international bodies, and has been summarised and reinforced by the Council of Europe and the UN. Transplant commercialism is not really the way to solve the lack of organs. However, trying to modify the situation by changing the law from an explicit to a presumed consent policy does not seem to be the solution either. Moreover, in our opinion it might be quite dangerous for a specifi c country, because all the eff orts would concentrate on the law, forgetting about essential aspects such as those which deal with the real eff ectiveness of the system in place.