Rafael Matesanz


This profile was prepared when Rafael Matesanz was elected to the Ashoka Fellowship in .
The New Idea
After working in the Nephrology Department of a well-known hospital in Madrid (Spain) and witnessing first-hand the inefficient organ transplantation system, Rafael Matesanz identified the need for an urgent change in the model. There are two essential aspects to transplantation: the organ donation, and the transplant itself, and neither can function without the other. In this context, Rafael considered that efforts should be placed on the process of donation, understanding it as the first step to a series of actions leading to a successful transplant.

Rafael recognized that the key to achieving authorization for organ donation was in the professional who addresses the family members during the short and critical period between the patient’s brain death or cardiac arrest and the physical death. The doctor is also the first link in a delicate chain of events that result in, if everything goes well, transplant. What that professional does or says, how s/he says it and his/her knowledge on the situation are essential factors to obtain the family’s permission.

Rafael designed and implemented three core measures to ensure a systemic change in the sector:

The first measure focuses on training and empowering the doctors in charge of communicating with the potential donor’s family, ensuring their ability to communicate effectively and guide the families towards the decision to donate. The transplant coordinator is the person in charge of leading this process, and the role must be undertaken by a doctor with a great deal of enthusiasm, creativity, team spirit, strength to overcome adversity and empathy with the donors’ families. Defining, identifying and training these coordinators is the "secret" ingredient that Rafael discovered in his early years as a nephrologist and that is today the mainstay of the ONT (National Transplant Organisation), organization he leads since its creation.

The second element is ensuring a transparent, agile and rigorous management model that guarantees effective coordination from the organ donation until the transplant. Every time a donation is authorized, more than 100 people have to activate and coordinate for the process to successfully take place.

For this, the coordination network is accompanied by a management system that addresses with the utmost quality and transparency challenges such as transportation, legal matters or coordination between teams and hospitals. Furthermore, in order to guarantee the principles of equality and equity in the criteria applied to waiting lists, these are established based on two essential aspects: geographic location and clinical situation. The donation is altruistic, without any financial remuneration, and both the donor and the receiver remain anonymous.

The third measure is to have the supervising body within a public institution. Traditionally, organ donation has been promoted by external organizations, with attention placed on the transplant or awareness raising rather than the donation process. Putting the public sector in charge of the coordination system, guaranteeing transparency and fairness, gives more authority, increased credibility, and encourages higher levels of trust from the actors involved (doctors, families, patients etc.).
The Problem
The Strategy
The Person

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