Abstract
The Brazilian National Transplantation System coordinates and regulates perhaps the largest public transplantation program worldwide. Since its implementation in 1997, the number of kidney transplantations increased from 920 (5.8 pmp) in 1998, to 4,630 (24.1 pmp) in 2010. This growth was primarily due to the increased number of effective donors (from 1.8 pmp in 1998 to 9.3 pmp in 2010), with a corresponding increased number of kidneys transplanted from deceased donors (3.8 pmp in 1999 versus 9.9 pmp in 2010).The number of kidney transplantations from living donors has not increased significantly, from 1,065 (6.7 pmp) in 1998 to 1,641 (8.6 pmp) in 2010, either as a consequence of the observed increase in the deceased donor program or perhaps because of strict government regulations allowing only transplantations from related donors. From 2000 to 2009, the mean age of living donors increased from 40 to 45 years, while it increased from 33 to 41 years for deceased donors, of whom roughly 50% die of stroke. There are clear regional disparities in transplantation performance across the national regions. While the state of São Paulo is ranked first in organ donation and recovery (22.5 pmp), some states of the Northern region have much poorer performances. These disparities are directly related to different regional population densities, gross domestic product distribution, and number of trained transplantation physicians. The initial evaluation of the centers with robust outcomes indicates no clear differences in graft survival in comparison with centers in the USA and Europe. Ethnicity and time on dialysis, but not the type of immunosuppressive regimen, decisively influence the measured outcomes. Since the implementation of national clinical research regulations in 1996, Brazilian centers have participated in a number of national and international collaborative trials for the development of immunosuppressive regimens. Besides the challenge of reducing the regional disparities related to access to transplantation, further improvements can be obtained by the creation of a national registry of the outcomes of transplanted patients and living donors, and also by the promotion of clinical and experimental studies to better understand the transplantation-related immune response of the Brazilian population.
Highlights
The Brazilian public health system is characterized by free universal coverage, which includes full ambulatory and hospital medical care along with provision of several drugs, including those listed in the exceptional drug program, part of the high-complexity outpatient treatment of rare or low-prevalence diseases (MS/SAS Ordinance no 105, from 29/03/99).[1]
Two internationally acknowledged areas belong to this program: organ transplantation and treatment of carriers of the human immunodeficiency virus (HIV)
The Ministry of Health (MoH) earmarks approximately one billion reais for the program each year, the money being spent on organ procurement, hospitalization for the surgical procedures, hospital readmissions for complications, outpatient follow-up and provision of immunosuppressors
Summary
The Brazilian public health system is characterized by free universal coverage, which includes full ambulatory and hospital medical care along with provision of several drugs, including those listed in the exceptional drug program, part of the high-complexity outpatient treatment of rare or low-prevalence diseases (MS/SAS Ordinance no 105, from 29/03/99).[1]. In 1997, the Brazilian transplantation organization and legislation have been improved and regulated, with the yearly establishment of a decentralized network of collaborators, divided in three fully integrated hierarchical levels: 1 national level (MoH, in Brazilia); 2 regional level, within the structure of each State Health Authority; 3 intra-hospital level (Figure 1).
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