On 14 December 2025, I listened to a radio programme about kidney transplants and was impressed by the magnificent work done by healthcare professionals in Spain to save lives —or at least to improve the quality of life of thousands and millions of people—, in general, but particularly in the case of dialysis patients in hospitals who are waiting for the generous donation of a kidney.
As a Spaniard, I am proud because, for several years now, Spain has been a leader in organ transplants.
"Spain is a world leader in organ donation and transplantation, for 34 consecutive years, thanks to a model coordinated by the ONT (National Transplant Organisation), which prioritises family awareness (85% acceptance), altruistic and anonymous legislation, and the crucial role of nurses and hospital coordinators, allowing for continuous transplant records and donation rates above the European average, even with older donors."
In 2025, Spain performed a total of 6,335 organ transplants -- 2% less than in 2024.This represents 129 transplants per million inhabitants, compared to 132.8 in 2024.
Last year, 2,547 people donated their organs after death. 408 people donated while alive (402 kidneys and 6 liver parts).The rate of deceased donors reached 51.9 per million inhabitants (higher than in other countries).
By type of organ, last year there were: 3,999 kidney transplants, 1,276 liver transplants, 556 lung transplants, 390 heart transplants, 103 pancreas transplants and 11 intestinal transplants. Heart transplants increased by 12% compared to 2024.
The level of excellence of the Spanish transplant system is based on three pillars: the solidarity of the public, a universal public health system, and a management model that revolves around the figure of the hospital transplant coordinator, usually an intensive care physician, and which operates with the ongoing support of the ONT and the Regional Transplant Coordination Centres.
In the programme I listened to, they talked about kidney transplants.
A journalist from the programme went to the Hospital Universitario de la Princesa in Madrid and spoke to Borja Quiroga (a Nephrology specialist). The journalist asked him how many days a week people undergoing dialysis attend. Borja replied that ‘Chronically ill patients attend dialysis three days a week, four hours a day. And so it continues until those who are able to do so receive a kidney transplant. It should be noted that our kidneys, when healthy, function 24 hours a day, seven days a week".
Dr Quiroga told the journalist that ‘patients on dialysis are on a waiting list until a compatible kidney donation becomes available. Dialysis therefore supplements the function of the kidney so that it can work properly for at least 12 hours a week’. He also commented that ’a healthy kidney filters 180 litres of urine every day".
He also said that ’to receive a kidney transplant, it is not necessary to go through the dialysis unit. Living transplants are performed around the world, and increasingly in Spain. Most of these donors are relatives --in some cases they are not related, for example a friend, and in some very specific cases there have been altruistic donors (people who say: ‘I want to donate my kidney to whoever needs it most’, and that is something crazy that sometimes happens)--". After this, the journalist asked him if that means that in many homes there are potential donors, but that perhaps they do not dare to take the step forward. Dr Quiroga replied: ‘That is our struggle: to make family members understand the importance of donating a kidney, because if you donate a kidney, you will be able to live a normal life, you will not have complications, it is an act of generosity, there is a surgical procedure, of course, but we need more generosity, because there are patients on dialysis and dialysis ultimately shortens life more than transplantation’.
Dr. Quiroga shows the journalist the dialysis machine, which he says is a purifier; this machine extracts almost half a litre of blood from the patient per minute. This blood enters the machine and passes through a ‘dialysis filter’, a piece of plastic made up of thousands of millimetre-long hollow threads. A liquid passes in the opposite direction, through the ‘dialysis fluid’, which balances what enters this fluid and the blood that enters through the other channel, so that when the blood leaves through the dialysis line (the small tube through which the blood exits), it is completely purified; and this purified blood is returned to the patient".
Isabel, the journalist, asks him, ‘What is the useful life of this machine?’ and Dr Quiroga replies: ‘This machine has been in operation for 168,000 hours, which is 19 years. So, if we have known about dialysis in Spain since the 1970s, we can imagine how many people this machine has been able to help...’.
Dr Quiroga also talks about the emotional strain seen in a dialysis ward, because some patients have complications. He says that some patients become very discouraged, because dialysis ages the person and some patients abandon dialysis. He adds that the treatment is hard, not only because of the treatment in the hospital, but also because many patients live far from the hospital, in a village, and therefore have to wake up at dawn to arrive very early for their dialysis session; for example, in the province of Guadalajara, where distances are enormous, a patient may have to travel from a village far from the capital, where the hospital is located, and arrive at the dialysis room at 8 o'clock in the morning. This means that the patient has to wake up at 5 o'clock in the morning, which adds a lot of emotional stress.
On another day, Dr Quiroga was on the radio station, talking about kidney transplants with the programme presenter.The presenter asked him if he knew of any cases of a husband or father who was afraid to donate a kidney to his wife or child, and Dr Quiroga replied: "We don't talk much with family members, but fear is natural and it's normal for them to be afraid to donate, because it's a surgical procedure and there are certain risks involved, but the benefits outweigh the risks. And family members need to know that the risk after donating a kidney is zero, that the donor can continue to live a completely normal life; you can live perfectly well with only one kidney."
The programme also featured two sisters (Marta and Elena), now adults, married and with children. Marta began to suffer from kidney disease and Elena spoke to Marta, saying: ‘You're not going to need dialysis, because I'm going to donate a kidney to you.’ And that's what happened. Naturally, Elena's children were a little scared, because their mother had to go into surgery. But the operation went very well.
Dr Quiroga explained that in the hospital they have to analyse the compatibility between the donor and the recipient. They also have to check that the donor does not have any diseases (such as diabetes) that could cause complications in the future.
In this regard, Marta knew that her husband could not donate a kidney to her because he had antibodies. Neither could her children donate to her. So the only option left was her sister Elena. After the Covid pandemic, Marta's kidney condition had worsened, making it urgent for her to start dialysis. That is why Elena did not hesitate to donate her kidney, despite being concerned because she has four children.
Dr Quiroga explained that, ‘in addition to being genetically identical, these two sisters, although not twins, underwent a new technique based on stem cell implantation so that Marta could adapt to Elena's cells and thus reject the immunosuppressants (medications accumulated over time)’.
The programme presenter told Dr Quiroga that the kidney transplant was possible thanks to the public health system, and Dr Quiroga replied: ‘Of course, without the public health system it would be impossible to manage a donation’.