Renal transplantation in Brazil and its insertion in the global context

Abstract

Brazil is the second country in the word in terms of absolute number of renal transplants per year. However, considering its continental dimensions and total population, it occupies only the 33th place in terms of number of procedures per million of habitants. Many factors contribute for this fact. Brazilian legislation regarding organ transplantation is recent and was created with an average delay of 10 years compared to countries in the top of the efficiency list. Also, an enormous heterogeneity in distribution of renal transplant centers among Brazilian states also is a point of concern and in almost 25% of them there is none or only a few number of these procedures. In addition, a low rate of potential deceased donors notification aggravate this situation. Another point is that there is poor understanding of the population in regards to the brain death concept and deceased donation process lead to a low rate of conversion from a potential to an effective donor. In spite of using very rigid criteria to diagnosis of brain death, the major cause of this failure is family deny. In terms of patient and graft survival, Brazilian numbers are similar of United States and European centers. Five years graft survival rate is 86% for live donation and 73% for deceased. Five years recipient survival is 94% for live and 86% for deceased donors. While European countries and United States are looking for alternative strategies to increase number of renal transplantations as non heart beat and ABO incompatible donation, Brazil seams to have a lot to progress simply investing on strategies to make the actual model more efficient.