ANALYSIS OF OUTCOMES AND REASONS FOR REFUSING ORGANS FOR TRANSPLANTS IN BRAZIL

Abstract

Introduction: In a scenario of insufficient organs to meet the total waiting list for transplants in Brazil, it is important to know the final outcome of the offers made by the National Transplant Center (CNT) of the Ministry of Health (MS) and the reason why the organs are refused by the transplantation teams, since only a small part of the offers made within the scope of the single national list are converted into transplants. General objective: To describe the outcomes and reasons for refusal of the organs offered for the single national list, managed by the CNT. Method: Descriptive retrospective cohort study, with a quali-quantitative approach, on the CNT solid organ offer outcome dataset and refusal reasons for solid organs, from 2014 to 2021. Results: Of the total of 22,824 organ offers in the period from 2014 to 2021 (n= 22,824), 8,483 (37%) were initially accepted and 14,341 (63%) were rejected by the transplant teams. Of the total number of organs accepted, 6,433 (76%) were effectively implanted and 2,050 (24%) were not used for transplantation. As for the outcome by type of organ, 511 hearts (16%), 212 lungs (12%), 2,149 livers (37%), 5,504 kidneys (54%) and 106 pancreas (5%) were accepted. 2631 hearts (84%), 1559 lungs (88%), 3617 livers (63%), 4677 kidneys (46%) and 1857 pancreas (95%) were rejected. 441 hearts (86%), 164 lungs (77%), 1738 livers (81%), 4014 kidneys (73%) and 76 pancreas (72%) were implanted. 2,050 organs were not used, 70 hearts (14%), 48 lungs (23%), 411 livers (19%), 1,491 kidneys (27%) and 30 pancreas (28%). Conclusion: In the evaluated period, the acceptance of the offered organ resulted in 37% of the total offers made for the national list, managed by the CNT. Of these, 76% had the effective implantation of the organ as an outcome and non-use in 24% of the outcomes. As for the type of organ offered, the highest rate of the “organ accepted” event corresponded to the kidneys (54%) followed by the liver (37%). The highest rate of the “organ refused” event was registered for the lung (88%), followed by the pancreas (95%). The highest rate of the “implanted organs” event was registered by the heart (86%) and the “unused organs” event was shown by the pancreas (28%), followed by the kidneys (27%). With regard to reasons for refusal, refusals due to logistics accounted for only 6% of the identified reasons. The highest rate of reasons for refusal was attributed to the group of events “donor conditions” (59%), followed respectively by “other reasons” unspecified (21%), “organ conditions” (9%) and “donor conditions”. recipient” (5%), with refusals due to “logistics” corresponding to the penultimate place. With this work, it is concluded that the use of the organs offered at the national level can be enhanced, based on a better understanding of the real reasons for refusal and the identification of opportunities for rescuing initially refused donors. It is also inferred that the refinement of the reasons for refusal could reduce the rates of non-use of organs, in order to contribute to changing the shortage scenario. The current record of the outcome and reasons for refusal made by the CNT offers important information, however, other studies are needed to debug the reasons for refusal of the organs offered for the single national waiting list for transplants, aiming to contribute to the planning of strategies for better use. of the organs offered.