Brazilian transplant system
Brazilian transplant system is supported and funded by the Ministry of
Health. It is a consolidated and regulated system that is totally public
and comprises the entire country, with a territory of 8.5 million square
kilometers, divided into 26 states plus the Federal District, where
Brasilia is located.
The actual number of cardiac transplantation performed in 2016 (357
procedures) was far below the predicted number of cardiac
transplantation required by the Brazilian population. In addition, there
are important disparities among country regions and states, being most
of the transplant centers located in South-East. Rate of effective
donors in 2016 was 14.6 per million of population which ranks Brazil in
the 27th spot according to the International Registry
in Organ Donation and Transplantation
(www.irodat.org/publications).
Brazil’s Mid-West region has a population of 15.4 million into three
states plus the Federal District. In 2016, the rate of effective donors
was 9.6 per million and the number of transplants was 3 per million of
population (47 transplants). Instituto de Cardiologia do Distrito
Federal is a tertiary care heart center with 150 beds that has a
dedicated heart transplantation and mechanical circulatory support
program over a decade. It is located in Brasilia, and it is the only
high-volume program (> 30 heart transplants/year) in
Mid-West. Recipients come from different parts of the country, but they
are mostly from the same region. Donor allocation policies follow
specific criteria in which prioritized patients (inotrope dependence,
intra-aortic balloon pump or temporary mechanical assist devices,
mechanical ventilation) have preference regionally before a national
coverage. Logistics for long-distance procurement (>200
kilometers) in our center is organized and funded by Brazilian Airforce
that provides military planes and personnel destined to this mission,
coordinated with local police at the procurement site.