“There is something magical about seeing a heart beat again after a transplant”

Inspiring people


Rafael Matesanz (Madrid, 1949) founded and then led the ONT (Spain's National Transplant Organization) for 28 years. For almost three decades, he helmed an organization committed to fighting death. We sit down with Dr. Matesanz to talk about his early career, key moments in his life and what has changed since he retired.

Did you always want to be a doctor? Do you come from a family of doctors?

I became a doctor by a process of elimination. Looking back, I started university at 16 with very vague notions about the various academic fields. I liked biology in general and found medicine more appealing than many of the other technical programs, which didn't resonate with me as much. I had an uncle who was a doctor, but we weren't close. I wouldn't say that it was a family-inspired calling, but it worked out well.

Tell us about nephrology. What appealed to you about this specific discipline?

When I went into nephrology in the 1970s, it was the only specialty that could treat patients with a machine—dialysis—and transplantation, an option that wasn't available at the time for other organs like the liver or heart. Specialists in this field also cared for the most critically ill patients who were suffering multiple organ failure, which always affects the kidneys. It was known as a “hard” specialty, and when you're young those things are appealing, at least that was the case back then. Nowadays, young doctors have a different set of values, largely aimed at other specialties.

You headed the ONT for 28 years as its founder and champion. That's a long time...

I spent 17 of my 45 years as a working physician at hospitals and 28 in management positions. The two periods complement each other and were both personally very rewarding, but there is no doubt that the founding and development of the NATIONAL TRANSPLANT ORGANIZATION represents the cornerstone of my professional life. It is what I am known for, what I most identify with, and what best defines my career.

What are the most memorable moments of the almost three decades you spent at the ONT?

Receiving the Príncipe de Asturias Award for International Cooperation in 2010 and, that same year, the European Parliament's almost unanimous approval of the European Directive on Transplants, which we at the ONT had spearheaded. Those two moments, and the satisfaction of knowing that hundreds of thousands of patients have received transplants thanks to this organization, are the best reward for all my efforts.

How come Spain has been the world leader in donations and transplants for 26 years? These figures often go unnoticed, but they have a lot of merit... What is the key to the success of the “Spanish Model”?

It is an organizational and management model that always tries to have the right person at the right place at the right time. The transplant coordinators are key, as are the intensive care doctors, who are incredibly well trained in carrying out the entire donation and transplantation process. The ONT is what drives the whole system, responsible for training, agreeing on protocols, providing constant support. Ultimately, it is a very well-organized system that sees constant improvement and which has kept us in the top spot worldwide for 26 consecutive years and will probably continue to do so for many more to come.

How would you describe a living donation? It is one of the most altruistic acts imaginable...

One thing is donating a kidney or part of a liver to a family member who needs it as their best treatment option. It is a calculated risk that makes perfect sense to take on. But then there are cases, limited to the kidneys, where a person donates through the ONT to the wait-listed patient who would most benefit from the organ. They are known as “good Samaritan” donors, and it is undoubtedly the most outstanding example of altruism that I have ever encountered, because they don't even get to know the recipient. So far there have been 14 of these donors in Spain, and many more have offered to donate but were turned down for health or other reasons. It is a truly stunning gesture that has very few equivalents in other aspects of life.

What are the most common transplants?

In terms of organs, the kidney is the most common, because a deceased person can donate both, plus there is the possibility of living donations. This is followed by the liver and, far less common, the lung and heart. If we include cells and tissues, then cornea, bone or marrow transplants are even more common.

Do you think some day transplants will no longer be necessary?

Transplants treat a wide array of diseases, because the only thing they have in common is the act of replacing a damaged piece of the organism with one that works. As new therapies emerge, the need in relation to certain diseases decreases, for example in the case of hepatitis C and its new treatments. However, in general, I think transplants will always be needed.

Is there a case that had a particular impact on you?

I remember the case of a Basque boy called Ibai who urgently needed a transplant after his entire intestinal tract had to be removed after a botched surgery. He needed no less than five organs of the same size and blood type, something incredibly difficult to find under any circumstances let alone in a matter of days. However, against all statistical odds, a donor was found in time, and the child underwent transplant surgery at the La Paz Hospital in Madrid and is perfectly healthy now. It is difficult not to be moved by something that incredibly miraculous.

Is a transplant a small miracle?

There is something magical about seeing a heart beat again after a transplant or a kidney producing its first urine in the operating room or a patient being able to breathe again after receiving a new lung. It is the fight against death and disease and succeeding thanks to a spirit of solidarity and modern medicine. Anyone who helps to make it happen and doesn't experience it as a small miracle should probably do something else.

How have transplants evolved (techniques, treatments, etc.) from when you began at the ONT to when you left a little over a year ago?

Everything is changing all the time. We're seeing a lot more transplants, the donors are older (doctors transplanted the liver of a 94-year-old donor) and so are the recipients. Surgeries take less time, the organs are preserved better and longer, treatments to combat transplant rejection and complications have improved... Everything is improving, which means the survival rate of recipients is too.

Are there trends with respect to donations and transplants?

I wouldn't call it trends, but it is true that certain donations are more common at particular moments in time. For example, umbilical cord donations were very popular for a while, whereas now there is a lot more talk about marrow. Or for example, living donations went from being a rarity in Spain to something much more common...

Do you think people are aware of the number of lives that are saved thanks to transplants?

I think so. We calculate that in Spain, with a population of 46 million, at least 500,000 people have received organ, tissue or cell transplants. This means that most people will probably know of someone within their extended circle who has needed or received a transplant and therefore value its benefits.  The culture of organ transplantation has permeated Spanish society, which in turn benefits that society; it benefits all of us.

Do you think there is a growing awareness of the importance of being a donor? With blood it seems easier, but when it comes to organs, the fear factor goes up. What do you think?

Based on what I said earlier, I think so, yes. When it comes to organs, our goal is for people to see donations after death as something completely normal that everyone should consider as long as there are no medical contraindications. The excellent results obtained so far show that this is the right approach and that the number of non-donors is shrinking. Living donations are a different story, and here it is important to keep highlighting the advantages, but at the end of the day, it is a very personal decision that everyone has to make after weighing the pros and cons. Other donations, like marrow, are increasingly well understood and embraced by people. We're heading in the right direction.

A Brief Taste

The best moment to enjoy a glass of wine?

A glass of very cold, good white wine as an aperitif, with the right kind of tapa, is a real treat.  As for reds, I prefer them as part of a good meal. In both cases, shared with family or friends.

A song to accompany a glass of wine.

Any song that brings to mind a pleasant moment of sharing a drink with my loved ones.

A place to get lost in.


What do you do in your free time?

Read, write, walk, listen to music, travel around the world and on the internet... I rarely get bored.

A flaw and a virtue.

A flaw: shyness, and a virtue: will power.

What did you want to be as a child? And as an adult?

When I was a child, I said I wanted to be an architect, but I'm not sure why. As an adult, I'm happy with who I am. I've come to accept myself.

Categorías: Inspiring people