The last beeps of Ana Segundo Urbano’s heart rate monitor still ring in the heads of her parents, Puri and Salvador. Until then peek an ending that indicated that her daughter’s heart had stopped beating after she received the euthanasia that ended years of suffering. But those sounds took on a different nuance when the transplant coordinator at the Gregorio Marañón hospital in Madrid sent them the letter he had received from the person who now had Ana’s heart in his chest.
“We heard the final whistle, but not the one that was heard when he started beating again in another operating room,” Puri says. The one of those who, through the doctor – donors cannot know who their organs go to or vice versa – told them: “I have your daughter’s heart and that’s why I’m alive”.
Since the euthanasia law came into force in 2021, 154 people have donated organs and received help to die with dignity, of which 442 recipients have benefited. “Not only do we benefit the patients,” says Beatriz Domínguez-Gil, director of the National Transplant Organization (ONT), “but it is also good for the families (of those receiving euthanasia).”
Donations from patients at the end of life – such as euthanasia or some phases of palliative care – are part of the ONT’s 2026-2030 strategy, which aims to consolidate Spain as a world leader in transplants, a position in which it has remained for 33 consecutive years, with a record of 52 donors per million inhabitants in 2024.
Domínguez-Gil presented the strategy this week at the XX Meeting between communication professionals and transplant coordinators, in San Lorenzo de El Escorial (Madrid). “Will it increase the availability of organs? Certainly, but above all it has the objective that people who want to become donors realize their desire to die and donate organs”, he assured.
This was the case of Ana, who died in 2023 at the age of 27. His parents explain in a video conference that the first thing he did when he was 18 was donate blood and register as an organ donor.
He was born with spina bifida. His life was full of medical tests and rehabilitation, but he was “relatively normal”. Until 2013. Fluid started to build up in my lower back, causing pressure. They performed an operation that did not completely solve the problem. “She had pain that we couldn’t calm with anything. She discovered what her end would be: she would lose mobility and would surely die of asphyxiation,” says Puri. He told us: “Since they will not be useful to me, someone will be able to enjoy the life that I will not have.”
“She couldn’t stand the pain, she wouldn’t heal, she couldn’t be cured, there couldn’t be a second operation. She didn’t want to remain confined to bed with only her eyes moving, so she asked for euthanasia,” continues her mother.
After the initial refusal of the surgeon who operated on her, the operations were rapid. Gregorio Marañón organized a medical team that validated his intention, he turned to another specialist who ratified it, as required by law. And finally, the application of the aid in dying provision in the Community of Madrid was approved by the Guarantee and Evaluation Commission.
The process was very difficult for everyone. “It’s difficult for any parent to let go of their children, but we were clear about one thing: they are not your property. She was an adult, it was her body, her suffering, no matter how much it broke our hearts, we were clear that we respected her decision,” Salvador says.
Ana knew she didn’t want to live like this. He considered suicide if he were denied benefits but, even then, he thought his organs would be lost if he did so.
Managing the end of life
Donation after euthanasia is a good example of how the transplant process has changed since they began to become widespread in the 1980s (the first was in 1965). José Miguel Pérez Villares, sectoral coordinator of transplants in Granada, explains that at that time all the attention was on the recipient; in how many organs arrived on time, how many did not. “Later, in the nineties, we began to look at the families of the donors, at how, through the solidarity and generosity of the donation, their pain began to be less strong,” he continues.
In 1999, live kidney donation arrived. “There we no longer ask for a family, we begin to interact with the donor himself. And that’s what happens now with controlled asystole, of people with terminal illnesses who express their desire to be donors when they fall asleep. It’s about giving them the right to manage the end of their life with their own values,” says Pérez Villares.
In this entire process the figure of the transplant coordinator is fundamental. Ana Isabel Tur Alonso, responsible for this responsibility at the Hospital de la Fe (Valencia), explains that the first thing that must be made clear to patients is that their decision to receive help to die has nothing to do with that of donating organs, and that one thing will not prevent or favor the other.
Sensitive and calm people
“Most of those who come to us already have the intention to donate. They are sensitive, calm, stable people who are very clear about what they want. They ask a lot of questions because they want to know what it will be like, what they will feel”, says Tur Alonso.
In these cases euthanasia cannot be performed at home. It must be performed in the operating room, in order to use the organs. But, like at home, patients can choose how they want to be accompanied, whether they want music. “We have to be honest and transparent about what can and cannot be done, but always with empathy. It creates a great bond with these people, who normally struggle for a long time to die and want to do it in their own way. Our challenge is to make this something warm, welcoming, intimate,” he adds.
Usually, tests are done to try to find out if your organs can be used. Whenever the person wishes, for example, a serological analysis is carried out to verify that there are no infectious diseases, which would prevent a possible transplant.
One of Ana’s worries before she died was that her organs would not be useful, her father says: “She was afraid that all the drugs she had taken had damaged them. Especially her liver, because the drugs were very intense. Until the last moment she had two things in her mind: ‘I’m going to die’ and ‘I want the organs to help as many people as possible.’
They say he greeted everyone in a peaceful and natural way, maintaining his “cheerful, outgoing, with a lot of dark humor” character. When the agreed day arrived, he said goodbye to the cats, they went to the hospital and all three stayed together until the last moment. Since then, many friends and family have also decided to become organ donors.
