From March 3, 2025, Spanish workers who donate an organ or tissue while alive are entitled to special temporary-incapacity leave under a reform enacted by Organic Law 6/2024 of December 20 and published in the Boletín Oficial del Estado (BOE). The law amended Spain’s General Social Security Law and Workers’ Statute, recognizing donation-related medical incapacity as a special case of temporary incapacity due to common contingencies. The benefit is paid at 100% of the regulatory base, protecting eligible donors from the lower rates and waiting periods that can apply to ordinary illness leave.
The protection applies when employees need medical treatment connected with a living organ or tissue donation and are temporarily unable to work. The benefit is calculated from the regulatory base, rather than set at 100% of every worker’s usual gross salary. Eligibility does not depend on a minimum prior contribution period, extending coverage to workers with little or no previous Social Security contribution history.
The reform aims to reduce the income and employment risks that can deter medically eligible people from donating. Living donation in Spain takes place within a system coordinated by the National Transplant Organization (Organización Nacional de Trasplantes, ONT), with medical assessments and legal safeguards, including informed consent, remaining part of the process.
Comprehensive Coverage
The benefit can cover medically justified absence in the period leading up to the operation, including preparation and hospital admission. It also covers surgery and recovery until medical discharge. Payment begins on the first day of recognized leave. Depending on the worker’s coverage arrangement, the benefit is managed by the National Social Security Institute (INSS), the Social Marine Institute (ISM) or an authorized collaborating mutual insurance entity.
The amended Workers’ Statute also provides paid time off for impressive donation-related examinations and procedures carried out during working hours. This is separate from the temporary-incapacity benefit: one covers necessary appointments and procedures, while the other covers a medically recognized period when the donor cannot work.
Spain’s Commitment to Donation
Spain’s transplant system, coordinated by the ONT across the autonomous communities, distinguishes living donation from deceased donation and records activity by organ. Living donation is used principally for kidney transplants and, in selected cases, liver transplants. The ONT reported 6,335 organ transplants in Spain in 2025. It also recorded 2,547 deceased donors, while 408 living donors gave a kidney or part of a liver; the deceased-donor rate was 51.9 per million inhabitants. These figures describe different parts of transplant activity and should not be combined into a single donor total.
Until now, the level of financial protection for living donors often depended on collective bargaining agreements or voluntary company supplements. The new nationwide rules establish statutory protection for eligible employees, while the Social Security system or an authorized mutual entity administers the benefit. The reform leaves medical suitability assessments and consent safeguards in place; it addresses the employment and income risks associated with donation.
Wider Context and Related Protections
The special sick leave has no fixed duration. It lasts while the donor needs medical care and is unable to work, ending upon medical discharge. This allows recognized leave to reflect individual recovery needs and the medical circumstances of the donation.
Spain’s approach to supporting workers facing serious health challenges is developing. For example, workers with severe fibromyalgia may also qualify for a full disability pension if their symptoms prevent any form of employment, as detailed in this recent analysis of disability benefits. Together, these measures reflect a broader trend toward greater social protection for people facing extraordinary medical situations.
By providing a benefit at 100% of the regulatory base from the first day of recognized leave, alongside paid absence for impressive donation-related procedures, the reform reduces the financial and workplace risks borne by living donors. It supports Spain’s wider transplant policy without changing the medical authorization and consent requirements that govern donation.
