I'm an expat in Spain

Eight days after my name was placed on Spain’s kidney transplant waiting list, my phone rang. A kidney had become available. Could I come to Doctor Peset University Hospital in Valencia immediately?

I had imagined months or years of waiting. Suddenly there was no time to think. Somewhere, a stranger had died and, amid another family’s grief, I had been offered the possibility of continuing to live.

I didn’t think I’d ever need to call upon this service. In 2019, I left London and moved to Valencia to work as a freelance writer. I spoke schoolboy Spanish and had always loved my visits to Spain. And I found the Spanish warm, friendly and sunny by disposition.

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But in July 2024, I became unwell. I suddenly had very high blood pressure. I became convinced that I was having a stroke and went to hospital. My blood pressure had risen above 200, but the scans revealed a different disaster: my kidneys were failing rapidly. 20 years before, I had been diagnosed with glomerulonephritis – a congenital condition causing damage to the tiny filters inside your kidneys- by the NHS. But it had never caused me any issues; the trail went cold and was never followed up upon. That could not happen in Spain, where you have a unique ID card, regardless of address.

In Valencia, I was hospitalised for two weeks and put on various drips to stabilise me. There were no other symptoms except my raised blood pressure, which is why kidney failure can sometimes be a silent killer.

That diagnosis began 15 months of operations, appointments and, eventually, dialysis. Three mornings a week, an ambulance collected me at about 7am and took me to hospital, where I spent four hours connected to a machine that cleaned my blood.

I was told I needed a new kidney urgently, and in October 2025, was formally admitted to the transplant waiting list. Mine was exceptionally short even by Spanish standards – a donor kidney was found within a week and I was booked for surgery.

The operation took several hours, and it was not without complications.

At first the new kidney produced more than two litres of urine a day — an output I regarded with the enthusiasm other men reserve for football results. Then tests showed that my body was rejecting it. I was readmitted and underwent plasmapheresis, a process that filters harmful antibodies from the blood. I spent weeks in isolation while the team fought to save the organ. They succeeded.

Now my life is relatively normal. I return to the hospital every month for blood and urine tests and take a cocktail of antirejection drugs three times a day. I have been told to expect to need another transplant within eight years, but at the age of 59 my life is recognisably my own once again, with no restrictions on my activities of which I am aware.

All this happened within Spain’s tax-funded National Health System. It is not automatically free to everyone in the country: entitlement depends on circumstances such as residence, employment, pension status, or reciprocal arrangements. As a covered resident, however, I received consultations, emergency treatment, dialysis, surgery and weeks in hospital without a bill at the bedside. Like many patients, I make a contribution towards prescription costs.

It’s fair to say that if I’d gone through this life-altering event in the UK, my experience would have been entirely different.

Spain leads the world in deceased organ donation. Its transplant success is sometimes credited simply to its opt-out law, under which adults are presumed willing to donate. Britain now has a similar system, introduced 2015, yet the results are still different. In Spain, a national authority coordinates the system, while specially trained hospital teams identify potential donors early.

In 2025, Spain carried out more than 6,300 organ transplants, including almost 4,000 kidney transplants, and recorded 52 deceased donors per million people. This has meant it has led the world in deceased organ donation for 34 consecutive years.

By contrast, NHS Blood and Transplant reports that over 8,600 people are currently waiting for a life-saving organ transplant in the UK, while deceased organ donation rates have faced recent declines. In a typical recent year, around 1,400 to 1,500 deceased donors provide the gift of life, but nine people die every week as a result of waiting too long for an organ. In Spain, that number is 50 per year.

My care in Spain felt more intimate than care I have received in the NHS. I remain in contact with doctors and nurses, address them by their first names and count some as friends. When I told my consultant how frightening it had been to face kidney failure alone in a foreign country, he rejected the premise. “Nonsense,” he said. “You speak our language, the nurses adore you and you have become one of us.”

Silvia, one of the nurses, later wrote: “We know your blood family is far away. But you have become part of our family. We love you, and I love you.” Another nurse, Ángel, has become a close friend whose wise counsel I still seek. This warmth did not replace clinical excellence; it accompanied it. They knew my fears, my jokes and my habit of using one to conceal the other.

I never learned the identity of my donor, nor the circumstances of their death. I know only that my life now contains a debt I cannot repay. Every morning and evening I take anti-rejection drugs to persuade my immune system to tolerate this stranger’s kidney.

Spain gave me a donated organ and then fought to save it when my body tried to destroy it. When illness found me, far from my blood family, Spain’s sanidad pública gave me another family — and made sure I did not face it alone.

Eugene Costello’s collected essays, written during his kidney treatment, are published as ‘Or The Bull Kills You: Life and Death in Valencia’ (£9.99, Amazon)

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