Glowing heart over Chile, symbolizing organ donation

Organ Donation in Chile: How Reforms Can Save More Lives

Elliot Brynn in Health & Wellness December 2025 • 5 min read.

"A closer look at Chile's organ donation and transplant system reveals the challenges and opportunities for improvement."

The global shortage of organs for transplantation continues to be a critical issue in healthcare. Thousands of people die each year while waiting for an organ that could save or significantly prolong their lives, thanks to advancements in transplantation practices. Chile has historically had low donation rates, but recent legal reforms that established a presumed consent system have led to increased numbers. In 2017, a record 457 transplants were performed thanks to 173 donors.

Despite this progress, significant challenges remain, including the loss of potential organs within the system, which accounts for approximately 30% of those that could be available for transplantation. Issues related to family involvement in final donation decisions also persist. The Chilean health authority has implemented several legal, practical, and educational modifications to the system to improve outcomes.

However, comprehensive evaluations of these reforms and suggestions for further improvements are still needed. This article aims to assess the new regulations and their acceptance by the public and healthcare providers. It will also propose recommendations to foster the development of a Chilean transplantation model that effectively meets the needs of the population.

Understanding the Challenges in Chile's Organ Donation System

Glowing heart over Chile, symbolizing organ donation

Chile's organ donation and transplantation system is characterized by high demand due to the prevalence of chronic non-communicable diseases and low organ availability. Scarcity can be attributed to two main factors: losses within the system and the public's willingness to donate. Systemic losses occur within healthcare facilities due to the failure to identify potential donors or the inability to complete transplants due to management, logistical, or infrastructural issues.

The second factor involves the public's reluctance to donate, despite efforts to change this perception. In 2016, Chile's rate of effective donors was 6.7 per million population (pmp). This rate has remained relatively stable since 1998, peaking in 2006 and 2017 with 10 effective donors pmp. In comparison, Spain, a model for successful organ donation, averaged 34 donors pmp between 1998 and 2015, reaching a record of 43.4 donors pmp in 2016.

The Opt-Out System: Chile adopted a presumed consent model (opt-out) in 2010 through Law 20.413, intending to reverse declining donation rates. Initially, the law had adverse effects because it allowed individuals to express their unwillingness to donate during driver's license or ID renewals, a process with little reflection and high bureaucracy. By July 2012, 50.4% of the population had registered as non-donors.
The Reciprocity Principle: The most recent legal amendment (Law 20.673 of 2013) reduced the ways to express the refusal to donate (replacing Article 2 bis) to a formal declaration before a notary public. It also introduced an ethical criterion called the "principle of reciprocity," prioritizing individuals who have not registered as non-donors if several candidates are equally qualified for organ donation.
Centralized Coordination: In 2010, the system underwent significant changes with the creation of the National Coordinator of Organ and Tissue Procurement and Transplantation to improve coordination among healthcare institutions and implement transplant programs more effectively. All responsibilities previously held by the National Transplantation Corporation (a non-governmental organization founded in the early 1990s) were transferred to a governmental entity under the Ministry of Health (MINSAL).

This transfer involved not only responsibilities but also human capital, as several professionals from the Corporation took on leadership roles in the new structure. Changes included modifications to protocols, the incorporation of transplant indicators, and the creation of procurement units in nearly all self-managed hospitals nationwide. The Ministry of Health also improved public information by providing details on organ transplantation stages, regulations, procurement and transplant centers, the role of the Public Health Institute (ISP), the transplant referral network, and transplant data since 2014 on its website.

Moving Forward: Recommendations for Improving Organ Donation in Chile

Data indicates that Chile still lacks a deeply ingrained culture of organ donation and transplantation. In addition to addressing the shortage of physical and human resources, efforts must focus on increasing public awareness and promoting discussions within families. While presumed consent appears to be the most effective donation system—evidence suggests that countries with this system have a 28% to 32% higher rate of cadaveric donation compared to those with explicit consent—legal reforms are needed to increase resources, improve screening services, and end the practice of allowing families to override a donor's wishes.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.4067/s0034-98872018000600780, Alternate LINK

Title: Una Mirada Al Origen, Funcionamiento Y Desafíos Del Nuevo Sistema De Donación Y Trasplantes Chileno

Subject: General Medicine

Journal: Revista médica de Chile

Publisher: SciELO Agencia Nacional de Investigacion y Desarrollo (ANID)

Authors: Alejandra Zúñiga-Fajuri, María Del Pilar Merino, Mack Urtubia

Published: 2018-06-01

Everything You Need To Know

What is the main challenge facing Chile's organ donation and transplant system?

The primary challenge is the imbalance between the high demand for organs due to prevalent chronic diseases and the low availability of organs for transplantation. This scarcity stems from both systemic losses within healthcare facilities, such as failure to identify potential donors, and the public's reluctance to donate despite efforts to increase awareness. Addressing both these aspects is crucial for improving the system's efficiency and saving more lives.

How did Chile's adoption of a presumed consent (opt-out) system affect organ donation rates, and what changes were made to address initial issues?

Initially, the presumed consent model, implemented through Law 20.413 in 2010, had adverse effects. It allowed individuals to register as non-donors during driver's license or ID renewals, leading to over half the population registering as non-donors by 2012. To counteract this, Law 20.673 of 2013 reduced the ways to refuse donation to a formal declaration before a notary public and introduced the "principle of reciprocity," prioritizing those not registered as non-donors if equally qualified for organ donation.

What is the 'principle of reciprocity' in the context of organ donation in Chile, and why was it introduced?

The 'principle of reciprocity,' introduced through Law 20.673, prioritizes individuals who have not registered as non-donors if they are equally qualified candidates for organ donation. This ethical criterion aims to encourage donation by suggesting that those willing to donate should be given preference should they ever need an organ themselves. It's designed to promote fairness and incentivize participation in the organ donation system.

What role does the National Coordinator of Organ and Tissue Procurement and Transplantation play in Chile's organ donation system?

The National Coordinator of Organ and Tissue Procurement and Transplantation was created in 2010 to improve coordination among healthcare institutions and enhance the effectiveness of transplant programs. This governmental entity, under the Ministry of Health (MINSAL), took over responsibilities previously held by the National Transplantation Corporation. The Coordinator's responsibilities include modifying protocols, incorporating transplant indicators, creating procurement units in hospitals, and improving public information about organ transplantation.

Besides legal reforms, what other efforts are needed to improve organ donation rates in Chile?

Beyond legal reforms like the presumed consent model and the 'principle of reciprocity,' Chile needs to cultivate a more deeply ingrained culture of organ donation and transplantation. This involves addressing shortages of physical and human resources, increasing public awareness through education, and promoting discussions within families about organ donation wishes. Overcoming the reluctance to donate requires a multifaceted approach that combines legal, educational, and cultural initiatives to increase donation rates and save more lives.