Heart Transplantation, Democracy, and Collective Forgetting in Contemporary Spain

Throughout my life, Spain – the country where I was born and raised – has been the global leader in organ donation and transplantation, a horn we toot frequently and proudly. We hear about this every time new data on organ donation becomes available, every time someone wants to make an argument about the goodness of Spanish people. It has become a source of national pride in a country where national symbols are vigorously contested. Cities have built monuments honoring organ donors and transplant professionals, and the Organización Nacional de Trasplantes (ONT) – the institution that manages organ procurement in Spain – is considered the crown jewel of our national health care system.

On December 1, 2017, the ONT published a series of tweets celebrating the 50th anniversary of the first heart transplant, performed in South Africa in 1967. In reply, the Spanish Society of Cardiology posted a link to an interview with Dr. Josep María Caralps, referring to him as having participated in “the first successful heart transplant in Spain” in 1984. A quick search in different national newspapers confirmed that, as far as the official consensus goes, that is where the history of heart transplantation in Spain begins.

Without denying Dr. Caralps’s merit, this is a carefully curated version of the truth. Almost 20 years earlier, in 1968, Dr. Cristóbal Martínez-Bordiú – dictator Francisco Franco’s (1939–1975) son-in-law – transplanted the heart of Aurelia Isidro Moreno into the chest of Juan Alfonso Rodríguez Grille, who survived for a little over 24 hours. The Spanish Society of Cardiology, the ONT, and Spain’s national media have good reasons to draw a thick veil over this surgery. However, nothing justifies turning our backs on its casualties.

To understand Spain’s selective collective memory, we must first turn to Aurelia and Juan Alfonso. On the day she died, Aurelia was 48 years old. She lived in Meco, a small town near Madrid, was married to a construction worker, and had four children. She had sustained irreversible brain injuries after being hit by a truck and was in a coma. Juan Alfonso was a 41-year-old plumber originally from Padrón, in Galicia, who had moved to Madrid in search of opportunities and had a nine-month-old daughter. According to some sources, he suffered from cardiomyopathy caused by hemosiderosis, a disorder caused by excess iron. According to Martínez-Bordiú’s statement at a scientific conference held a few months after the transplant, Juan Alfonso had had anemia and a gastric ulcer in his youth, and at the time of the transplant he was suffering from frequent tachycardia.

The transplant from Aurelia to Juan Alfonso was not a secret experiment. It took place early on September 18, and news of the surgery opened most national newspapers the very same day. The newspaper ABC announced it on its front page and stationed reporters at La Paz Hospital for clinical updates. The next day, it expanded the story under the celebratory headline: “Success of the first Spanish heart transplant.” The article describes a standing ovation for Martínez-Bordiú as he entered a press briefing about Juan Alfonso’s progress. La Vanguardia, another leading national newspaper, published a similar ode, claiming that Spain had “entered the high scientific category of heart transplantation.”

Resignation quickly replaced triumphalism. Juan Alfonso died barely a day after the surgery. Tempting as it is for historians to consider this failure the reason why Martínez-Bordiú’s transplant disappeared from the official history of heart transplantation in Spain, let’s not forget that this procedure was still experimental at the time and even the smallest successes counted. Why, then, has Spain erased it from its collective memory?

The circumstances surrounding the transplant are, to put it mildly, suspicious. Dictators are not keen on transparency, and Franco was no exception. We have had to wait several decades to hear the families’ accounts of what happened that night at La Paz Hospital in Madrid. Apparently, neither Aurelia’s nor Juan Alonso’s families wanted to participate in the experiment. To this day, Juan Alfonso’s daughter questions whether her father even needed a heart transplant. However, the Francoist regime, and Martínez-Bordiú in particular, was determined to put Spain in the global organ transplantation race. The Francoist elites saw organ transplantation as an opportunity to signal modernity and development to the international community, so Martínez-Bordiú and his team used all their power to pressure the two families into agreeing to the surgery.¹ The families were working-class people living under a military dictatorship; they didn’t stand a chance. According to the doctors, they were doing this “for Spain.” It was their patriotic duty to serve as guinea pigs for the sake of propaganda.

More than 40 years later, Juan Alfonso’s daughter still carries in her wallet the last note that he wrote to his wife Estrella. The note reads like a death row prisoner’s last words or, more accurately, like the letters Franco’s victims would write in jail as they waited for their execution. “Give Dad my coat,” he writes, adding, “Don’t be afraid. God will help you raise our girl … Stay in Madrid if you can … I knew I was beyond remedy … A mountain of kisses and hugs. Juan.” He knew what awaited. Survival rates for heart transplant recipients were very low at the time and, although Martínez-Bordiú was the regime’s poster child, he was a mediocre doctor. Even during the dictatorship, rumors about his incompetence abounded. Decades later, he would be forced to resign from his position at another hospital, surrounded by accusations of corruption and medical malpractice.

The official, democratic history of organ procurement in Spain, the one we have heard all these years, is an epic story of collective achievement, modernization, democratization, and exemplary citizen altruism. This shameful episode of tyranny, arbitrariness, and death pollutes the narrative we are so proud of, so we erased it and gave the history of heart transplantation in Spain a new beginning. As the 1968 experiment faded into oblivion, so too did Aurelia’s and Juan Alfonso’s stories.

Far from being a mere anecdote, this incident captures the logic of Spain’s transition to democracy after Franco’s death in 1975 and reveals an uncomfortable truth about collective memory. In contrast with what happened in other European countries with similar authoritarian pasts – such as Germany, Italy, or Portugal – Spain’s young democracy did not break completely from the previous regime. Franco died in bed, was given a state funeral, and was buried in a mausoleum built by his victims’ forced labor. The reformist sector of his elites agreed with the moderate factions of the democratic opposition to arrange a gradual, contained process of democratization. With the fear of another military coup or even another civil war – like the ones that had brought Franco to power in 1939 – still hovering over their heads, democratic leaders compromised and agreed to start from a blank slate. This meant conveniently forgetting the crimes that Franco’s regime committed against the Spanish population, giving up the possibility of issuing reparations for the victims of the dictatorship, and allowing Franco’s collaborators to keep the privileges that they had amassed.²

As I write, the unidentified bodies of 140,000 of Franco’s victims still lie in mass graves, known torturers are still celebrated as honorary members of our state forces, and attempts to commemorate those who fought for freedom and democracy still meet relentless resistance from right-wing parties. For example, the conservative party Partido Popular systematically refused to condemn Franco’s violence until 2002. Extreme right-wing groups frequently vandalize public antifascist memorials. Madrid’s new conservative mayor went as far as to take down plaques commemorating Franco’s victims from the city’s main cemetery. Meanwhile, monuments to Francoist leaders remain untouched, and we walk streets named after war criminals. Even now that the chances of a new coup d’etat or civil war are laughable, our political elites are so invested in the narrative of a peaceful transition – which catapulted Spain to the promised land of modernity, development, and international legitimacy – that they are willing to sacrifice the victims’ memory. Six feet under, they still wait for their line in the history of our recent past.

In Spain, then, heart transplantation and democracy have more in common than one would think; they’re both built on forgotten dead bodies and their stories. In both cases, we swept under the rug some of the darkest, ugliest moments in our recent past to present a friendlier version of our history, both to the world and to ourselves. We have turned our organ procurement system into a national symbol and a reflection of the nation we yearned for so long to become. We celebrate its heroes and pioneers, but we do it selectively. And although Martínez-Bordiú deserves no remembrance, Aurelia and Juan Alfonso do.

Rebeca Herrero Sáenz

Rebeca is a Ph.D. candidate in Sociology at the University at Albany (SUNY). She is interested in the intersection between health and medicine, culture, and media, and is currently working on her dissertation on the evolution of the public discourse on organ donation and transplantation in Spain (1954-2019) and its implications for Spanish nationalism.

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