An Organ Transplantation Program was established in Catalonia in 1984: Six Tx and harvesting Hospitals + one Histocompatibility Lab + six Hospital Tx Coordinators (high profile medical doctors) + nine Advisory Committees (that meet regularly ever since) + the Donation and Transplantation Registry (data communication is compulsory, linked to activity payment and linked to a similar Registry for ESRD pats) + a Program for Organ Sharing through Consensus Decision-Making + a Program for Healthcare Personnel Donation Training + a Program for Social Promotion of Donation.

Currently there exist 23 authorised Harvesting Hospitals + 8 Tx Hospitals with 22 authorised Tx Programs.

Deceased donation progressed from 27.1 donors pmp in 1990 to 49.0 pmp in 2019.

Cerebrovascular accidents being by far the most prevalent cause of death, while traffic accident donors reduced from 16% in 2000 to 5% in 2019. Average age increased from 51.7y in 2000 to 59.7y in 2019 (48.7% older than 60y and 27.7% over 70y. Family consent has been stable between 80-85% over this period. Refusal to donate due to previous will of the donor oscillated between 30-35%; to unspecified family decisions in 40-45%; to religious causes in 3-5% and due to a miscellanea of causes in the remaining 15-20%.

Renal transplantation has had a steady progressive increase from 43.5 pmp in 1984 to 61.4 pmp in 2000 and to 115.1 pmp in 2019, leading the world activity ever since 1984. Living donation over the last three decades oscillated between 5% and 25% (16% in 2019). Most kidneys were exchanged within Catalonia. 10-15% were received from other parts of Spain. The Waiting List has remained stable around 1.000 pats over the last three decades in spite of the increasing activity, due to the broadening of Tx indications. Currently 58% of all ESRD pats are living thanks to a kidney graft. ESRD incidence was 110 pmp in 1990 and 165,3 pmp in 2019, the prevalence being 720 pmp and 1.435 pmp respectively.

Liver Tx activity has remained quite stable over the last 30 years around 25 pmp. At Dec. 31, 2019 the W.L. had 53 patients, at its lowest historical point. Cardiac Tx has also been quite stable over the last 20 years around 9 pmp. Current W.L. has 25 individuals. Lung Tx increased from 4.9 pmp in 2000 to 15.6 in 2019 with a quite stable W.L. around 55 pats. Pancreas Tx activity has remained stable over the last 30y around 3.5 pmp with also a quite stable W.L. around 30 pats.

The relative success of our transplant activity may be explained by a number of factors that will be discussed but the core of the model rely ever since was established in 1984 on the long lasting strong and efficient deceased donation organisation that include highly qualified medical doctors as transplant coordinators in each hospital.