The birth of intensive care units (ICU) in mid-20th century led to the development of medical technology that made life support possible. The arrival of mechanical ventilation in the healthcare setting facilitates the development of a medical specialty—intensive medicine—that assists severe patients requiring organ support to stay alive in specific units (ICUs). Respiratory support brought a new clinical situation—brain dead (BD)—that expanded the processes of donation and transplants in the developing world. BD is considered the «ideal donor».1

Thus, there is no need to mention the key role played by intensivists in the entire donation-transplant process. Actually, Spain leads the world ranking in donation and transplants due to the role played by the intensivist in the so-called «Spanish model».

The expansion of the donation and transplant activity in Spain turned traditional BD donation insufficient as the only existing medical treatment for thousands of patients in the waiting list of different transplant programs in Spain. Therefore, back in 2008 the so-called «Plan 40» was designed to develop new scenarios/models of donation.2 Intensive care units oriented towards donation3 and donation in asystole4 were two initiatives proposed to improve donation rates in our country.

In the scenarios proposed, intensivists play a key role and are responsible for the overwhelming increase in donation and transplant rates achieved over the last few years in Spain.

Intensivists need to take over tasks associated with this setting as another part of our job and, together with transplant coordinators (today almost 100 % of intensivists), improve clinical practice, training programs, and promote trials for the continuous improvement of the organ-and-tissue donation process.

From SEMICYUC these challenges5 can be facilitated by supporting, promoting, and training working teams in the development of educational programs for assistant physicians, residents, and nurses at the ICU setting; consensus documents and recommendations to recognize, assess, and accept the strategic value of this specialty and specialists in keeping the Spanish leadership in donation and transplants and putting Spanish healthcare at the forefront of transplant coordination.

In Spain there is a special sensitivity towards donation and transplants. However, the crucial role played by the ICUs and the specialists during this process is still unknown. Therefore, in order to empower this specialty, we should expose our job and role in the process of organ-and-tissue donation. Also, we should assess this activity as a priority within our units and for the future development of our specialty.