Brazilian Transplant System Achieves Global Milestone as the World’s Largest Public Program
The recent case of presenter Fausto Silva’s heart transplant brought the issue of organ donation in Brazil to the fore again. Due to the speed with which the procedure was carried out, many people began to question the veracity of the public transplant system, fueling the narrative that Faustão was favored.
As a result, the Ministry of Health, together with the Government of São Paulo, published a note to refute these notes. In the publication, they emphasize that there was no type of irregularity and briefly explained how the transplant process works.
Luciana Bertocco de Paiva Haddad, assistant physician at the Abdominal Organ Transplant Service and coordinator of the Abdominal Transplant Outpatient Clinic at the Hospital das Clínicas of the Faculty of Medicine of USP (FMUSP), highlights: “He had a rarer blood type, type B , and, in addition, he received prioritization due to his clinical condition. All of this works in a super transparent and very rigorous way.”
World reference
The Ministry of Health states that the Unified Health System (SUS) has the largest public transplant program in the world, which guarantees that 87% of transplants are carried out with government resources. According to the doctor, the integrated coordination between the National Transplant System (SNT), the Ministry of Health and state health departments is very well done, mainly due to the country’s territorial extension, and this is fundamental to the success of the project.
Regardless of how the transplant is paid for, by the SUS or not, the chance of receiving an organ is the same. The doctor states that everyone has access to information and management of the waiting list, which demonstrates the smoothness of the process. Brazil is in second place on the list of countries that perform the procedure the most, behind only the United States — however, in the North American country the process is private. Last year alone, the number of successful transplants surpassed the 23,000 mark.
Difficulties
In the first half of 2023, the number of organ donors in Brazil broke a record, reaching the mark of 19 per million inhabitants and the Brazilian Association of Organ Transplantation (ABTO) set the target of 20 donors per million inhabitants by the end of the year. Also according to ABTO, the States of Santa Catarina and Paraná are those with the largest number of donors per individual.
Despite this, families’ rejection of donating the patient’s organs also increased — before the pandemic the number was 42% and today it is close to 50%. As a result, the waiting list to receive an organ is still long, with more than 65 thousand Brazilians, one of the highest numbers in the last 25 years, according to the Ministry of Health. For the doctor, this reality can be reversed from public policies that are responsible for educating the population, teaching them about the need and process of this attitude.
“We still have an insufficient number of donors to meet our demand, Brazil has a large number of transplants, but the need is even greater”, analyzes Luciana. Furthermore, the expert states that financing would need to be better, even though it is currently not bad. For this reason, Brazil ranks second among the most efficient systems in the world, below Spain. It is worth mentioning that the Spanish model is also public and was the main inspiration for the creation of the Brazilian system.
The process
The waiting list for receiving organs in Brazil has a bureaucracy that, according to the expert, is carried out in a transparent and rigorous manner by the Ministry of Health. “Entering the waiting list depends on each organ. For all of them, severity, blood type is considered and, in addition, there are some prioritization criteria that are different for different organs”, explains Luciana.
The process begins when the patient is included in a single list — both for private network patients and SUS patients — which is audited and professional teams have access to. From there, the data is published and updated daily. The listing is based on different criteria: blood type, compatibility of weight, height and genes and the patient’s severity. If these criteria are similar, the Ministry uses the registration order to select the transplant recipient and, in situations where the patient is in a critical condition, prioritization occurs.
To become a possible organ donor, you must inform your family of your desire, as there is currently no other action that needs to be taken. After the diagnosis of brain death and authorization from the family, the health team carries out an investigation into the history of the possible donor. Some points, such as chronic diseases and the use of injectable drugs, can compromise an organ, therefore, this medical evaluation is necessary to ensure the safety of the recipient and the medical team. “You need to inform your family, since the authorization for organ donation is made after the occurrence of brain death and it is the family that authorizes this organ donation”, explains the doctor.