Lorraine Williamson
For the 34th year in a row, Spain has retained its position as the world’s leading country for organ donation — not through headlines or slogans, but through a system that consistently delivers when lives depend on it.
New figures released by the Ministerio de Sanidad
Measured by donors per population, Spain once again topped the global rankings with 52 donors per million inhabitants.
Behind the statistics: consent, coordination and timing
Every transplant begins with a decision taken at the most difficult moment imaginable. Families, faced with sudden loss, choose to say yes to donation. That human choice remains the foundation of Spain’s success.
From there, the system moves fast. Transplants require near-perfect coordination between intensive care units, transplant teams, laboratories, and emergency transport services. Organs cannot wait. Delays cost lives.
Health Minister Mónica García
Kidney transplants dominate, while heart surgery hits new highs
As in previous years, kidney transplants accounted for the majority of procedures, with 3,999 carried out in 2025 — almost identical to 2024.
Liver transplants reached 1,276, a slight fall year on year, while lung transplants dropped to 556.
The most striking development came in cardiac surgery. Spain performed 390 heart transplants in 2025, a new national record and a 12% increase on the previous year. Many of these cases involved highly complex patients, underlining how Spain is not only transplanting more organs but tackling increasingly difficult procedures.
Regional performance that outpaces most of the world
While donation rates vary between autonomous communities, the broader picture remains exceptional by international standards.
Cantabria once again led the table, with an extraordinary 103 donors per million inhabitants. All regions except the Balearic Islands exceeded 40 donors per million, with thirteen regions above 50.
According to the Organización Nacional de Trasplantes
Why Spain and the US are hard to compare
Although the United States ranks second globally, experts caution against direct comparisons.
In Spain, donors are typically older and more likely to have underlying health conditions. In the US, a higher proportion of donors are young people who die in preventable circumstances, including traffic accidents, gun violence and drug overdoses. The numbers may look similar, but the social and medical realities behind them differ sharply.
A new transplant strategy through 2030
Looking ahead, Spain is not standing still. The ONT has launched a new national strategy running through to 2030, aimed at strengthening every stage of the donation and transplant process.
One priority is reducing refusals. In 2025, 22% of families approached declined donation. Officials believe improved communication and emotional support during these conversations could lower that figure without pressure.
Spain is also expanding eligibility criteria safely. Last year, donation between people living with HIV was authorised under strict medical protocols — a move designed to widen the donor pool without compromising patient outcomes.
Four heart transplants in 63 hours: a first for Spain
The annual figures were published alongside an extraordinary clinical milestone in Madrid. At Hospital 12 de Octubre
Cardiologist María Dolores García Cosío
The challenge, she explained, was not only surgical skill but logistics. A donor heart can only remain viable for a limited time. Every movement must be precise.
Close to capacity — and still moving forward
Spain did not break its own transplant record in 2025, but the margin was narrow. More importantly, the system continues to function at near-maximum capacity without faltering.
Decades of public trust, medical expertise, and coordination have created something rare: a healthcare model where compassion and efficiency reinforce each other — and where the next record always feels within reach.
Sources: