After founding the Organizacion Nacional de Trasplantes (ONT), Spanish donation rates from deceased donors rapidly outpaced U.S. growth over the decade between 1989-1999. This analysis of the following decade, 1999-2009, demonstrates a markedly flattened growth curve for Spanish deceased donor organ procurement increasing only 2.4% from 33.6 to 34.4 donors p.m.p. (per million population) In comparison, over the same decade in the United States, deceased donation increased from 20.9 to 26.3 donors p.m.p. (25.8%).

Age Group comparison demonstrates a much higher donation rate among older donors in Spain. For example, donors aged >70, increased from 3.8 to 8.8 donors p.m.p. (132% increase) and now comprise 25.4% of all Spanish organ donors. In contrast, U.S. donors aged >70, increased from 1.0 to 1.3 donors p.m.p., comprising only 4.4% of total deceased donors.

Although older donors were more rarely used in the U.S, growth in donation over the two decades (1989-2009) was strongly associated with utilization of donors older than 65. (p<0.0122). UNOS regions demonstrate significant differences in utilization rates for older donors.

In conclusion, strategies aimed towards achieving U.S. donation rates equivalent to the Spanish benchmark, should target improved utilization rates for older donors in the United States.

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