Brazil is a reference in organ transplant and has the largest public program for the procedure in the world — around 90% of surgeries are performed in the Unified Health System (SUS). THE organ donation is essential in this process. However, out of every 14 people who express an interest in donating, only four end up actually making the donation. The main reason for this is still the resistance of families.
To talk about the subject, Dr. Roberto Kalil welcomes Paulo Manuel Pêgo Fernandes, professor at the Department of Cardiopneumology at Incor, and Fernando Bacal, director of the Transplant Center also at Incor, at “CNN Vital Signs – Dr. Kalil Explains ”.
Throughout the conversation, experts highlight the importance of a donation and transplant system in Brazil, which, in addition to organs, also includes corneas, bones and skin.
“We calculate that one donor can save around eight lives”, says Bacal. Furthermore, the expert highlights that donations can improve the quality of life and give more dignity to those who receive them.
Fernandes explains more about the importance of this type of donation. “Today, we have an epidemic of motorcycle trauma, for example, in the city of São Paulo. Often, bone substance is lost, that is, the bone in the leg, arm, or skin is lost, with major burns.”
Organ transplant system in Brazil
According to the Ministry of Health, Brazil is, in absolute numbers, the second largest transplanter in the world, behind only the United States. The public health network provides patients with comprehensive and free assistance, including preparatory exams, surgery, follow-up and post-transplant medications.
In 2023 alone, almost 26 thousand organ, tissue and bone marrow transplants were performed, according to the Brazilian Association of Organ Transplantation (ABTO). Between January and March 2024, around 6,700 surgeries took place, more than 1,300 of which were related to the kidney.
“From a legislative point of view, I think perhaps the country is the most equitable,” says Fernandes. The specialist believes that the rules for the transplant system to work are a stimulus for donation. “This issue of it being a single list by gravity, and not by social or administrative qualification, is what motivates people to donate, because they know that their organ will be well used, it will be used by those who really need it”.
“Severity is what rules, regardless of the patient’s social class. The criteria that lead a patient to have a transplant are clinical priority and waiting time in line. So, transplantation does not have any social and economic privileges. Patients are in equal positions”, adds Bacal.
The organs with the longest waiting list are kidneys, liver, heart and lungs. “In Brazil, approximately 6,000 kidney transplants are performed per year, 2,200 liver transplants, approximately 350 heart transplants and 100 lung transplants per year. And the queues are more or less compatible with this number. In other words, the largest row is kidney, the second largest is liver, the third largest is heart, and the fourth largest is lung. Obviously this fluctuates, and there are states that have longer queues and others, shorter queues”, says Fernandes.
How does organ donation work?
In Brazil, the donation of organs and tissues from deceased people is only carried out after family authorization. Therefore, even if the person said in life that their desire was to become a donor, if possible, only family members can make the final decision. If the family does not authorize it, the organs will not be removed.
The deceased donor can donate organs such as: kidneys, heart, lungs, pancreas, liver and intestine; and tissues: corneas, valves, bones, muscles, tendons, skin, cartilage, bone marrow, umbilical cord blood, veins and arteries.
Donation can also be made by a living donor, who must be of legal age and legally capable, healthy and consent to the donation, as long as it does not harm their own health. Furthermore, according to Brazilian legislation, relatives of up to four degrees and spouses can be donors. The donation of organs from living people who are not relatives of the recipient is done with judicial authorization.
A living donor can donate one of the kidneys, part of the liver, part of the marrow or part of the lungs, blood compatibility is necessary in all cases. To donate an organ while alive, the doctor must evaluate the donor’s clinical history and previous illnesses.
“Intervivos donation is very suitable when, for whatever reason, it is very difficult to find a cadaver donor. For example, a child who has cystic fibrosis and is tiny has to have a lung transplant. So, either you reduce a cadaver donor, or you capture a wolf from the father and a wolf from the mother”, explains Fernandes.
This procedure, whose technique has advanced a lot in recent years, is well regulated by law. “You have to be related up to the fourth degree in relation to the person who will receive it. Or spouse, who can also receive or donate. If not in these cases, only with judicial authorization”, says Bacal.
Future of organ donation
According to experts, what still needs to improve in Brazil today is the spread of specialized centers. Bacal states, for example, that there are none in the northern region, which can make capture and implantation difficult. In the case of the heart, for example, which has less resistance, specialists need to carry out the entire process in around 4 to 5 hours. “If you have a donor in Amazonas to use in São Paulo, there is no time”, says Fernandes.
The two also emphasize that this process is strictly regulated. “Brain death in Brazil is highly checked, much more than in other countries. Our legislation is very strict, it is super rigorous, to make sure that there is no doubt that that patient is brain dead. Therefore, there is no risk of using an organ from someone who has not died”, says Fernandes.
“CNN Sinais Vitais – Dr. Kalil Interview” will air on Saturday, November 2nd, at 7:30 pm, on CNN Brasil.
Battery of tests on donors is a guarantee of safety in transplants
This content was originally published in Organ donation: a donor can save up to eight lives, says expert on the CNN Brasil website.
Source: CNN Brasil
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