{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:50:41Z","timestamp":1791345041838,"version":"4.3.1"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Donation after brain death (DBD) has declined in Spain despite sustained transplantation activity and marked growth in donation after circulatory death (DCD). We examined whether this transition was driven by controlled or uncontrolled DCD and contextualized it alongside national trends in neurocritical care and organ utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a descriptive ecological analysis of aggregated national data from the Spanish National Transplant Organization, healthcare registries, and epidemiological sources for 2015\u20132024. Annual DBD, controlled DCD (cDCD), uncontrolled DCD (uDCD), donation\u2010potential indicators, mechanical thrombectomy, decompressive craniectomy, and organ recovery and utilization were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Actual DBD decreased from 1537 (33.0 per million population [pmp]) to 1246 donors (25.6 pmp). cDCD increased from 211 (4.5 pmp) to 1294 donors (26.6 pmp), whereas uDCD decreased from 103 (2.2 pmp) to 22 donors (0.5 pmp); thus, cDCD accounted for 98.3% of DCD activity in 2024. Donation\u2010potential indicators fell during the COVID\u201019 pandemic and partially recovered thereafter. Mechanical thrombectomy increased from 2160 to 8762 procedures and decompressive craniectomy from 456 to 729. In 2024, DBD donors generated more recovered and implanted organs per donor than Maastricht category III cDCD donors (3.6\u00a0vs. 3.1 and 2.8\u00a0vs. 2.3, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Spain's DCD expansion was almost entirely driven by controlled donation, while uDCD declined. These findings demonstrate a reconfiguration of deceased\u2010donation pathways but do not establish patient\u2010level substitution between DBD and cDCD. Linked individual\u2010level studies are required to determine the contributions of neurocritical care, end\u2010of\u2010life decisions, and perfusion technologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70695","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:49:23Z","timestamp":1790149763000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changing Brain Death Donation Dynamics in Spain: A National Overview of Neurocritical Care and Organ Donation Trends"],"prefix":"10.1111","volume":"40","author":[{"given":"Mario","family":"Royo\u2010Villanova","sequence":"first","affiliation":[{"name":"University of Murcia  Murcia Spain"},{"name":"Transplant Coordination Unit Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB)  Murcia Spain"},{"name":"Department of Intensive Care Medicine Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Antonio","family":"Encarnaci\u00f3n","sequence":"additional","affiliation":[{"name":"University of Murcia  Murcia Spain"},{"name":"Transplant Coordination Unit Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB)  Murcia Spain"},{"name":"Department of Radiation Oncology Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Manso","sequence":"additional","affiliation":[{"name":"Transplant Coordination Unit Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB)  Murcia Spain"},{"name":"Department of Intensive Care Medicine Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Moya","sequence":"additional","affiliation":[{"name":"Transplant Coordination Unit Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB)  Murcia Spain"},{"name":"Department of Intensive Care Medicine Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Ortin","sequence":"additional","affiliation":[{"name":"Transplant Coordination Unit Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"},{"name":"Murcian Institute for Biomedical Research \u201cPascual Parrilla\u201d (IMIB)  Murcia Spain"},{"name":"Department of Intensive Care Medicine Virgen De La Arrixaca University Clinical Hospital  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Coll","sequence":"additional","affiliation":[{"name":"Organizaci\u00f3n Nacional de Trasplantes  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Dom\u00ednguez\u2010Gil","sequence":"additional","affiliation":[{"name":"Organizaci\u00f3n Nacional de Trasplantes  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.q175"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2020.35.e94"},{"key":"e_1_2_10_4_1","volume-title":"Actividad de Donaci\u00f3n y Trasplante. Espa\u00f1a 2023","author":"Organizaci\u00f3n Nacional de Trasplantes","year":"2024"},{"key":"e_1_2_10_5_1","volume-title":"Estrategia en Ictus del Sistema Nacional de Salud: Actualizaci\u00f3n 2024","author":"Ministerio de Sanidad","year":"2024"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1511"},{"key":"e_1_2_10_7_1","unstructured":"ISRCTN87370545.The Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of Acute Subdural Haematoma (RESCUE\u2010ASDH14) www.isrctn.com\/ISRCTN87370545(First Received 14 November2019)."},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.4103\/1793-5482.110275"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1414905"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008796"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221143210"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k949"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.034919"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000517903"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2017-013328"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.37708"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000342652"},{"key":"e_1_2_10_18_1","first-page":"2165","article-title":"Improving the Outcomes of Organs Obtained From Controlled Donation After Circulatory Death Donors Using Abdominal Normothermic Regional Perfusion","volume":"19","author":"Mi\u00f1ambres E.","year":"2019","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.12.013"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13899"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16622"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2025.02.006"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2018.05.011"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbr.2015.04.028"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/HC9.0000000000000376"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/medsci13030188"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/medsci13040233"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70695","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70695","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:15:09Z","timestamp":1791342909000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":26,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/ctr.70695"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70695","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-07-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70695"}}