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At the end of February of this year, the Unified Health System (SUS) of Brazil announced the inclusion of small intestine and multivisceral transplantation among the services offered. According to the Ministry of Health, until then the possibilities for people with intestinal failure were restricted to palliative treatments, such as “parenteral nutrition”, in which nutrients are administered directly into the blood stream. However, the procedure doesn't promote the same quality of life that a transplant can provide.
It is with advances in this line, added to the National Transplant System (SNT), that Brazil has become one of the main references for transplants in the world and is also the 2nd largest transplanter in the world, second only to the United States (that is, when it comes to absolute numbers).
To achieve this status, the SNT has a single waiting list for the entire country - which makes it possible to meet the eligibility criteria -, technology cutting-edge procedures and services fully funded by the Unified Health System (SUS), and professionals qualified for this task.
All of this is necessary since transplants are at another level of complexity. In this sense, data from the Ministry of Health and the Brazilian Organ Transplant Association (ABTO) indicate that the main bottlenecks in this segment in Brazil are in cultural and logistics issues.
But before we get into those two specific issues, let's see what the numbers say.
Transplants in Brazil in numbers
In recent years, Brazil has broken new records in the area of transplants. According to the Brazilian Transplant Report (RBT), carried out by ABTO, in 2023 the country held 29.261 transplants — an unprecedented and historic result, 11% more than in 2022.
As early as 2024, although the annual number has not yet been released, data from the RBT indicate that 14.3 thousand transplants were performed in first semester last year, while in the same period in 2023, 13.9 thousand were registered.
Although it is possible to look at absolute numbers, it is common to resort to PMP (per million population) as a metric for analyzing the transplant and organ donation scenario.
In this sense, we see Paraná as the leading transplant state in Brazil. As reported by the state news agency, people from Paraná are the country's main organ donors, with a rate of 42.8 donations per million inhabitants, while the national average is 20.3 pmp.
Meanwhile, the rate in other states is:
- 40.6 pmp in Santa Catarina;
- 39.6 pmp in Rondônia;
- 28.9 pmp in Rio Grande do Sul;
- 26.7 pmp in Rio de Janeiro.
Organ Donation in Brazil
The number of transplants is directly associated with the number of donors. According to the Ministry of Health, 4,580 organs, 8,260 corneas, and 1,512 bone marrow were donated in 2024, representing an increase of 3.2% in the number of donors compared to 2023. Among the most donated organs and tissues are:
- Kidneys;
- Liver;
- Heart;
- Pancreas;
- Lung;
- Cornea (tissue);
- Bone marrow (tissue).
To perform the transplants, consider the number of effective donors, which also showed growth. From January to September 2023, Brazil registered 3,060 effective donors, 17% more than the number seen in the same period in 2022, when 2,604 donors were registered.
Even so, the Ministry of Health estimates that, of 14 people interested in donating, just 4 they effectively donate. Within this issue, the main obstacle is family refusal. According to ABTO data, in 2024, about 45% of the families of potential donors did not authorize the donation.
While Brazil and many other countries are still struggling to obtain donors, Spain has remained the world leader in transplants for 33 years (not in absolute numbers, but relative) precisely because it has 52.6 donors per million population, more than double the Brazilian rate.
In other words, the main challenge of transplants is still the cultural issue.
Who is afraid of donating organs?
According to the Ministry of Health's 2024 campaign, “Organ donation: we need to say yes”, Brazil has more than 43,000 people waiting in line for a transplant.
Although the number of donors has doubled in the last 15 years - as demonstrated by Donation Report from SNT — donations are still limited by taboo, by misinformation and by preferences based on religious beliefs.
Organ donation can occur in life or after death. Some organs, such as the kidney and part of the liver, can be donated by a living donor.
However, organs such as the heart, lungs, and pancreas can only be donated in cases of brain death or cardiorespiratory arrest, and that is precisely where there is room for mistrust.
In these cases, there are a number of people who fear medical errors and suspect illegal trade. For example, in the case of brain death, many family members question whether there was in fact the total and irreversible cessation of brain functions.
With that in mind, state governments such as the Federal Government of Paraná use courses to guarantee the training of professionals - both to correctly assess cases of brain death and to inform, welcome and interview families for the donation of other organs.
Among other doubts, linked to taboo and misinformation, the campaign also attempts to demystify the procedure performed when someone dies; whether the family will have to bear any cost; and whether the organs leave the donor's body deformed for the wake. The answers are available here.
Logistical challenges
Organ transplant logistics in Brazil faces significant challenges that impact the efficiency and availability of procedures. The country's territorial extension requires complex coordination to ensure that donated organs reach the recipients within the feasible time for the transplant. Organs such as the heart and lungs have reduced ischaemia times — that is, the period between the interruption of an organ's blood flow and its new blood supply after the transplant — and require fast and efficient transport.
Data from the Ministry of Health indicate that, in certain Brazilian states, almost 60% of the transplants performed between 2014 and 2021 relied on air logistics, either through commercial or military flights. However, logistical problems, such as unavailability of flights or adverse weather conditions, resulted in the loss of 201 organs between January and August 2024, the highest number recorded in the last five years.
The limited infrastructure in some regions makes it difficult to transport organs properly, compromising the quality and viability of transplants. In addition, the lack of specific training for professionals involved in the process and excessive bureaucracy can delay critical procedures.
In this sense, investments in infrastructure, team training, and process simplification are possible solutions to improve transplant logistics in the country.
As an example, among the initiatives to reduce these challenges, the state of Paraná has stood out for the partnership between State Transplant Center And the Air Transportation Division of the Military House, designed to speed up organ transport.
Xenotransplants and artificial organs
The scarcity of organs for transplants has driven research into scientific innovations, such as xenotransplants and the development of artificial organs, aimed at reducing waiting lines for transplants.
Xenotransplants
Xenotransplants involve the use of animal organs, especially pigs, in human beings. Although this type of surgery has already been performed on 4 people, only 1 patient was still alive months after the procedure, as pointed out this matter from G1.
For this reason, in Brazil, researchers have advanced in this area with the creation of pigs that are genetically modified to provide compatible organs for transplants. In April 2024, the University of São Paulo (USP) inaugurated a facility dedicated to raising these animals under adequate sanitary conditions, aimed at producing genetically compatible organs for human use.
The project is the Xeno BR, coordinated by professors Silvano Raia and Mayana Zatz, who work on genetic modification of pigs to minimize immune rejection in humans. The first transplants using genetically modified pig organs are expected to take place in Brazil by 2025.
Artificial organs
In parallel, scientists are exploring 3D organ bioprinting, using human cells to create tissues that reproduce the anatomy and functions of natural organs. While promising, this technology is still in the early stages of research and development, with estimates indicating that it could take around a decade for these artificial organs to be used in patients.
Impact on the Transplant scenario
Brazil currently faces significant demand for organs for transplantation. In 2024, nearly 34,000 people were waiting for a kidney, with approximately seven patients dying daily in line.
Scientific innovations, such as xenotransplants and artificial organs, have the potential to reduce this demand, offering new alternatives for patients waiting for a transplant.
Despite advances, these technologies still face ethical, technical, and regulatory challenges before being implemented on a large scale. Therefore, it is necessary to continue researching and developing safety protocols.
