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.