Background: The euthanasia law entered into force in Spain in July 2021. A national protocol on organ donation after euthanasia (ODE) was officially adopted in July 2022. The guidance emphasizes that euthanasia should be prioritized over donation being the patient’s comfort paramount. 
Objective: To describe the experience on ODE in Spain.
Method: A retrospective study of cases of ODE performed since August 2021 to December 2022 and the post-transplant outcomes of the thoracic organs.
Results: In total, 49 patients donated organs after euthanasia, seven in 2021 and 42 in 2022. Donors were most frequently males (n=28; 57%) and mean age was 59.8 (SD: 10.6) years. Underlying diseases were amyotrophic lateral sclerosis (n=19; 39%), multi systemic atrophy (n=4; 8%), spinal cord injury (n=4; 8%), Alzheimer (n=3; 6%), multiple sclerosis (n=2; 4%), Parkinson (n=2; 4%) and other (n=15; 31%). All patients were directly admitted in the ICU (66%) or the ward (44%) except four who were transferred in a medicalized ambulance after receiving sedation at home. Patients were subsequently transfer to the operating theater where euthanasia medication was delivered and death declared. Of the 49 donors 96% were utilized donors. 135 transplant procedures were performed (69 kidney, 29 liver, 23 lung, 5 heart, 5 combined kidney-pancreas and 4 combined kidney-liver transplants). The mean organs retrieved per donor was 3.9 and the mean organs transplanted per donor was 3.3. Table 1

Organ recovery was based on abdominal (A-NRP) or thoracoabdominal normothermic regional perfusion(TA-NRP)(n=44; 90%) or standard rapid recovery (n=5; 10%). 2 hearts were recovered after the abdomen was perfused using A-NRP (an intra-aortic balloon occluding the iliac artery was previously inserted) while the 3 aortic arch vessels were vented. 3 hearts were recovered using  TA-NRP (the 3 aortic arch vessels were previously  vented) from the beginning of the procedure. Median time from administration of euthanasia medication to cardiac arrest was of 8.5 minutes (IQR 4-14). Table 2

Of the  131 recipients, mean age 57.4 (SD 12.3), (62.6%) were men. 2- year- heart survival is 80%. 1 of the heart recipients died at 28th post-transplant, due to pericardial tamponade. Of the 23 lung recipients, 7 (30.4%) presented primary organ dysfunction, of those two died at 6th month and another died at 12th post-transplant.
Conclusions: ODE is respectful with patient’s end-of-life plans and allows waitlisted patients to receive life-saving and life-enhancing organ transplants.