As measured by the number of the worldwide organ donation which is annually recorded by Organización Nacional de Trasplantes (ONT) and Europarat, Spain is for several years now a leading-edge. In 2020 there were 38 organ donors per million people in Spain while only 10.9 per million people in Germany.

It has been therefore often referred to the Spanish transplantation system in the debates about the increment of the number of donors. This system is distinguished on the one hand through the so called dissent solution according to which each citizen is considered an organ donor as long as he doesn’t explicitly disagrees. On the other hand Spain centralized and nationalized its transplantation system through founding the National Transplant Organization or Organización Nacional de Trasplantes (ONT).

The ONT is subordinate to the ministry of health and is responsible for donor identification, dealing with donors, conducting talks with the relatives and the organization of all the procedures relevant to the organ donation. In Spain the high number of organ donations is especially ascribed to the effort of the full-time transplantation coordinators. These are specially trained intensive care medics whose task is to find potential donors and conduct conversations with the donor relatives. The action plan of the European Parliament, adopted in 2011, demands therefore the employment of transplantation commissaries in hospitals on the European level.