Building upon Spain’s national universal healthcare system, established in the 1960s, the Organización Nacional de Trasplantes (ONT)—Spain’s National Transplant Organization—has evolved into an international benchmark for effective and ethical transplant organization, integrated management system for organ, tissue and cell donation and transplantation. The ONT operates under a universal and non-discriminatory framework, ensuring equal access to organ and cell transplantation for all patients. Over the decades, it has transplanted more than hundreds of thousands of transplant recipients. A key to its success has been the creation of a professional network deeply committed to organ donation, built on the principles of brain death confirmation and later expanded to include donation after circulatory death (DCD) in controlled asystole. Through continuous innovation and meticulous coordination, Spain has become the world leader in organ donation and transplantation rates. The ONT stands out as a model of solidarity, transparency, and absence of commercial interests, demonstrating how an ethically grounded and well-structured system can achieve global excellence in transplant medicine.