Transplante de fígado e alocação dos órgãos no Brasil: entre Rawls e o utilitarismo

Rodrigues-Filho, Edison Moraes; Franke, Cristiano Augusto; Junges, José Roque

doi:10.1590/0102-311x00155817

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…From these propositions, it is not unreasonable to suggest that the institution of regional specialized TAAA management referral centers could improve the outcomes of this disease in Brazil, following the strategy previously determined by the SUS for the heart and liver transplant services [ 23 , 24 ] .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Analysis of 12 Years of Open Thoracoabdominal Aortic Aneurysm Repair in the Brazilian Public Health System

Anacleto¹,

Morales²,

Teivelis³

et al. 2022

Braz J Cardiovasc Surg

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Introduction Although endovascular correction is a promising perspective, the gold-standard treatment for thoracoabdominal aortic aneurisms and type-B dissections with visceral involvement remains open surgery, particularly due to its well-established long-term durability. This study aims to describe and evaluate public data from patients treated for thoracoabdominal aortic aneurism in the Brazilian public health system in a 12-year interval. Methods Data from procedures performed between 2008 and 2019 were extracted from the national public database (Departamento de Informática do Sistema Único de Saúde, or DATASUS) using web scraping techniques. Procedures were evaluated regarding the yearly frequency of elective or urgency surgeries, in-hospital mortality, and governmental costs. All tests were done with a level of significance P<0.05. Results A total of 812 procedures were analyzed. Of all surgeries, 67.98% were elective cases. There were 328 in-hospital deaths (mortality of 40.39%). In-hospital mortality was lower in elective procedures (26.92%) than in urgency procedures (46.74%) (P=0.008). Total governmental expenditure was $3.127.051,56 — an average of $3.774,22 for elective surgery and $3.791,93 for emergency surgery (P=0.999). Conclusion The proportion of urgency procedures is higher than that recommended by international literature. Mortality was higher for urgent admissions, although governmental costs were equal for elective and urgent procedures; specialized referral centers should be considered by health policy makers.

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Section: Discussionmentioning

confidence: 99%

Epidemiological Analysis of 12 Years of Open Thoracoabdominal Aortic Aneurysm Repair in the Brazilian Public Health System

Anacleto¹,

Morales²,

Teivelis³

et al. 2022

Braz J Cardiovasc Surg

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“…Although a significant achievement, organ replacement treatment has not yet met the growing demand, resulting in a shortage of available livers. As a result, predictive strategies have been developed, such as MELD (Model for End-Stage Liver Disease), which is widely used worldwide to help manage the fair and efficient allocation of organs for patients needing liver transplantation 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation in Brazil between 2010 and 2021: 30-day Survival

Nascimento,

Fabris,

Barros

et al. 2023

BJT

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Introduction: In Brazil, the Unified Health System is responsible for more than 95% of liver transplants, providing a more equal service essential to health. However, there is a shortage of organs due to the growing demand and challenges to achieve the success of the procedure, due to the severity of the underlying diseases that impact on post-surgery survival. Objective: To investigate the rate of liver transplantation in all federative units of Brazil between 2010 and 2021, as well as to evaluate its relationship with survival of patients undergoing the procedure. Methodology: This is an epidemiological, observational, analytical study of the non-concurrent cohort type, with data obtained from the Hospital Information System regarding hospitalizations that underwent liver transplantation, in all units of the federation (UF) of Brazil between January 2010 and December 2021. Results: A total of 17,254 liver transplants were performed in the country, at a total cost of R$ 1,657,439,379.00 financed by SUS in patients with a mean age of 53.78 years. Females had a lower probability of survival than male patients. Regarding the 15-day hospital stay, patients without a diagnosis of liver failure had a survival probability of 86.4% (95%CI = 85.7 - 87.2) and patients with a diagnosis of liver failure had a survival probability of 81.7% (95%CI = 80.0 - 83.4). The lethality described was 12.29% AND there was no difference in survival regarding age (p=0.13), length of hospital stay (p=0.31), alcoholic liver disease (p=0.14) and fibrosis and cirrhosis of the liver (p=0.22). The probability of survival was statistically similar among transplant recipients who received liver from a deceased or living donor. Conclusion: The number of donors remains insufficient in the face of the extensive waiting list. The impact of baseline conditions on survival after surgery shows a higher negative outcome in patients with liver failure and in the female sex.

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“…Embora tenha sido uma conquista importante, o tratamento de substituição do órgão ainda não foi capaz de atender a crescente demanda, resultando em uma carência de fígados disponíveis. Como resultado, foram desenvolvidas estratégias preditivas, como o MELD (Model for End-Stage Liver Diesease), que são amplamente utilizadas em todo o mundo para ajudar a gerenciar a alocação justa e eficiente de órgãos para pacientes que precisam de transplante hepático 4,5 .…”

Section: Introductionunclassified

Transplante de Fígado no Brasil entre 2010 e 2021: Sobrevida de 30 Dias

Nascimento,

Fabris,

Barros

et al. 2023

BJT

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Introdução: No Brasil, o Sistema Único de Saúde, é responsável por mais de 95% transplantes hepáticos, disponibilizando de modo mais igualitário um serviço essencial à saúde. Todavia, há carência de órgãos frente à crescente demanda e desafios para alcançar o sucesso do procedimento, devido a gravidade das doenças de base que impactam na sobrevida pós cirurgia. Objetivo: Investigar a taxa de transplante de fígado em todas as unidades federativas do Brasil entre os anos de 2010 e 2021, bem como avaliar sua relação com sobrevida dos pacientes submetidos ao procedimento. Metodologia: Trata-se de um estudo epidemiológico, observacional, analítico do tipo coorte não concorrente, com dados obtidos do Sistema de Informações Hospitalares referentes a hospitalizações que realizaram transplante de fígado, em todas as unidades da federação (UF) do Brasil entre janeiro de 2010 e dezembro de 2021. Resultados: Foram realizados no país 17.254 transplantes de fígado, à um custo total de R$ 1.657.439.379,00 financiado pelo SUS em pacientes com idade média de 53,78 anos. O sexo feminino apresentou probabilidade de sobrevida menor que pacientes do sexo masculino. Quanto ao período 15 dias de internação hospitalar, os pacientes sem diagnóstico de insuficiência hepática apresentaram probabilidade de sobrevida de 86,4% (IC95% = 85,7 - 87,2) e os pacientes com diagnóstico de insuficiência hepática com probabilidade de sobrevida de 81,7% (IC95% = 80,0 - 83,4). A letalidade descrita foi de 12,29% e não houve diferença de sobrevida quanto a faixa etária (p=0,13), período de internação (p=0,31), doença alcoólica do fígado (p=0,14) e fibrose e cirrose hepática (p=0,22). A probabilidade de sobrevida foi estatisticamente semelhante entre transplantados que receberam fígado de doador falecido ou vivo. Conclusão: A quantidade de doadores permanece insuficientes frente a extensa lista de espera. O impacto das condições de base na sobrevida após cirurgia, observa-se desfecho negativo maior nos pacientes com insuficiência hepática e no sexo feminino.

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Transplante de fígado e alocação dos órgãos no Brasil: entre Rawls e o utilitarismo

Cited by 3 publications

References 25 publications

Epidemiological Analysis of 12 Years of Open Thoracoabdominal Aortic Aneurysm Repair in the Brazilian Public Health System

Epidemiological Analysis of 12 Years of Open Thoracoabdominal Aortic Aneurysm Repair in the Brazilian Public Health System

Liver Transplantation in Brazil between 2010 and 2021: 30-day Survival

Transplante de Fígado no Brasil entre 2010 e 2021: Sobrevida de 30 Dias

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