Under the leadership of the National Transplant Organization (ONT), Rafael Matesanz made Spain become a world leader in the field. Now, he publishes 'Management with soul' in The Sphere of books to transplant his model of success to companies.

What has caught my attention most in his book is that only 45 people work in the National Transplant Organization. Its mission is to get the best out of a national health system where thousands of people work. It is conceived as a nerve center, but its mission is to stimulate, coordinate and direct all people who have to do with transplantation throughout Spain. It is a completely horizontal system, which coordinates the 17 autonomous communities. Up to seven hospitals from different autonomous communities can intervene for a donation in Albacete.In a large multiorgan donation, up to 100 people from completely different points in Spain can participate. You have to make complex things simple and do everything very quickly. Why does coordination between the 17 communities for transplants work and not in other areas? It is one of the great virtues that the ONT has had and one of Great reasons to write this book. I have been asked many times: Is it not possible to transmit it to other sectors? And the answer is yes. For example, in cancer care. It is well known that there are differences in the treatment of cancers, depending on the Postal Code. It should not be like that. Isn't this work done on the topic of cancer? It is more word of mouth and the self-organization of professionals. Obviously, there is a contact between hospitals throughout Spain. Rather than having an organization dedicated to all this, the congresses of the professionals themselves do it. It is recognized that there are problems for patients from certain communities to access others. A quarter of the transplants done in Catalonia are from organs of other Autonomous Communities. There are communities that receive many more organs than they send, as is the case in Madrid, Catalonia, Cantabria or Galicia, among other things, because they have reference centers . For example, La Paz centralizes pediatric transplants in much of Spain. The children go to La Paz and are transplanted there. 80% of his team are women. For me, it has been fundamental and a luxury to work with women. I do not know if it has been searched or not, but, in nursing, which has been the engine of the ONT, the percentage of women became 100%. And then, in doctors there has been a female predominance at all levels. I have always understood myself much better with women than with men. What is the donor profile? There are very few young donors. In the 80s, the profile was that of a young biker, but that went down in history many years ago, fortunately. When we started to have reliable data, traffic accidents accounted for 42% of donors; Today they are 3%. 55% of donors are over 60, 30% are over 70 and 9% are over 80. The longevity record for donors is 94 years. That means that there is no age to donate and that these organs work. We are aged countries, where donors and recipients have advanced ages. If not, we would not have organs to transplant. The 20-year donor does not exist. How do you transfer your learning to a company? There is a general organizational aspect that is to transfer responsibilities to all parts of the company. The concept of redarchy and not having a centralized responsibility. In Human Resources, we have bet very clearly on training and have trained more than 20,000 professionals. We have moved that pride of belonging to the ONT and it shows. Any surgeon in Seville or Barcelona is proud to belong to the ONT, even if it does not depend hierarchically on it, nor is it the body that pays for it. Did you have to resist a lot of pressure from the politician or the journalist on duty to strain someone on the lists? At first, yes. When the ONT was created, the transplants were quite chaotic. There were quite a few pressures that came from doctors, politicians and journalists, people who have a certain social relevance and believe that, therefore, they can put pressure on them. How did they react to their refusal? Sometimes the reactions were hard and the "you don't know who you're talking to" came out. He also had to pass his desert crossing. The first years were very hard. I found myself in a chaotic situation. Some of the first heart transplants were done with the surgeon's card paying for the plane. So, what the Ministry did was to create the National Transplant Organization. The name was already conflicting because decentralization had begun and many of the nationals did not like anything at all. I found a very aggressive environment against the Ministry. Why did you accept the position? I was placed precisely for that. There was no one so unconscious to accept a position like that. The first two years were very difficult. There were very aggressive people, but who, in turn, really wanted to work. In a short time, the results were spectacular. In '89, we were in a catastrophic situation and in '92, we were the first in the world. It was a fundamental turning point. What helps most succeed is success. The spears became reeds. Denounces in the book that politicians surround themselves with a Praetorian guard, who professes a "canine fidelity" to the leader. There are a number of positions of trust that, instead of facilitating access to the minister, form a network that makes you completely impossible Get to him. Those who end up sending, in the end, are them. Anything you are going to ask has to go through them. It has always been much better when I have spoken directly with the minister, than when I have reached that second step that you do not pass. I've seen it repeated over and over again. Are politicians at the height of professionals? In general, no. It is a negative natural selection process. Politics is a very hard and poorly paid profession, which does not select the best. What health ministers did not measure up? I have lived 17 ministers. 17! It is said soon. I have been there 28 years, which means, year and a half by minister. What can be done when the average life expectancy of a minister in his post is a year and a half? Only two or three reached the four-year term. There have been very good and very bad people. I have worked very well with Trinidad Jiménez or Ana Pastor, who have been for me the two best ministers by far. And Mrs. Villalobos and Bernat Soria were a disaster, that is, it didn't matter if they were from the PSOE or the PP. It's not a party problem, but a person's problem. I have met very good people and disastrous people in all positions and have not depended on a match. In addition, I placed special emphasis on not depending on any party. Any attempt to make the ONT go to the right or to the left was the end. Hence the danger that they had appointed a politician as director of the ONT. That has been one of the great achievements that has allowed a continuity at the head of the ONT and that is at the base of its successes, not because it was me, but because that line has been maintained. Imagine that the director of the ONT had to be changed 17 times! It would be chaos. So the secret to the success of the National Transplant Organization has been to remain oblivious to the political ups and downs. We get it by force of many blows. It was not free at all. Government changes have always been complicated, because those who come look at you with all the distrust of the world. They think that you are one of the others. Until, in the end, you become part of the landscape. How did he not get fired? Nothing special. Actually, when the system consolidates, changing the status quo is very complicated, even if you don't like the director. I imagine that many times they did not change me for what they will say. Did you have to go into exile in Tuscany because of Celia Villalobos? Yes, that was the case. I faced her and when you face the power, all the doors close. Here in Spain I could do absolutely nothing. When Celia Villalobos arrived, everything changed and all the equipment that was then loaded. I think he had nothing personal with me, but I went on the lot. I was president of the European Transplant Commission and the delegate of Spain because they had chosen me as such. Celia Villalobos removed me as a delegate from Spain, who lost the European presidency. Others shut up without more, but I didn't shut up and it came out a lot in the press. It was a very frontal confrontation. Didn't I find a job in Spain with your resume? I had my medical position at Ramón y Cajal, because they couldn't take it away from me. When I contacted people and they saw that I was facing the Ministry, they fled me. It was as if he had leprosy. I was offered to organize the transplants in Tuscany and I was delighted. Not everyone can say he has had an office in Florence! In the end, Villalobos did him a favor. Of course. I spent three years in La Toscana, which now has more donors than Spain. When the Tuscans saw that this worked, they asked me to organize the oncology. I spent some great years until in 2004 Ana Pastor reminded me. So Pastor made a brave decision to face Villalobos, didn't they? They didn't get along very well either. It was a completely new stage and with Ana Pastor I worked perfectly. Did the cuts jeopardize their work? They made everything harder. The ONT suffered a 20% reduction in its training budget. What was serious was the decrease in budgets in hospitals, which meant fewer beds and staff. They were very complicated years. The system underwent a stress test, but it was even strengthened by everyone's effort. Does meritocracy work in this country or does cronyism still prevail? In transplants, meritocracy has worked. We have always tried to make it the most appropriate people who were on the site and at the right time. The Gordian core of the system is the transplant coordinators. We saw that there was what we called the burned coordinator, which is because asking the organs of families burns a lot. Then, the activity begins to fall in the hospital and you have to replace him in office. We were living in meritrocracy because we had to find the best. How do they tell that coordinator not to follow? We learned from other countries what not to do. There were coordinators who did nothing more than transplants. We decided that the intensivist doctor would remain in his position and also work as a coordinator. In this way, when this function was removed, he became an intensivist doctor again. That gave very good results. In many countries, the people who were often the solution, ended up being the problem. Therefore, we do not use the coordinator full time. In a hospital, not every day there are donors. You cannot have a person waiting all week for a donation. How are family members informed of the transplant option when a loved one is dying? With empathy. Contrary to what comes out in the American series, it cannot be done in a hallway. It has a whole technique. The first thing is that the family understands the brain death of the patient, which is not easy. There has to be a long conversation and for the family to let off steam. Many times, after that conversation, it is the family itself that offers the organs. This did not happen 30 years ago. At the moment, the idea of ​​donation is widespread among the population. There is only 14% who refuse to donate in these circumstances. It's a very low percentage, isn't it? Yes, very low compared to other countries. In England, it is 40%. He has been retired for two years, how does he adapt? I have assumed that the time has come and I have tried to enjoy every stage of life. The body no longer gives of itself. I don't see myself running the ONT. I try to travel and enjoy my family and my grandchildren and write books like this, which was a moral obligation. Of all the lives he has saved, which one has left the most mark on him? There has been one that I will remember all my life. He was a Basque boy named Ibai. He had a surgical accident and his entire intestine was necrosed. He was transferred to La Paz and the only possibility was to quickly transplant the entire intestinal package: liver, intestine ... Finding a donor of the same blood group and the same size was very difficult. We had very little hope of finding it, but it came up and they transplanted it. Several years have passed and the boy is still alive. It's one of those stories that fill you.

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