Kidney Allocation System for Transplantation in Brazil

摘要

Purpose of Review Worldwide allocation systems are subjected to regulatory and ethical unique themes prevailing under the local socioeconomic and health care system. We sought to describe kidney allocation system, local transplant regulatory environment, and some general information concerning reimbursement in Brazil. Recent Findings Under a universal health care program, the national transplant system coordinates national transplant activity. Organ procurement occurs through a combination of organ procurement organizations and hospital commissions. Donation after circulatory death is still prohibited. Allocation system is primarily based on HLA compatibility within regional waiting list. In 2017, the number of effective deceased donors was 16.6 per million population (pmp, 23rd in the world) and the number of kidney transplants was 28.8 pmp (33rd in the world). Bundle reimbursements are provided by the federal government for organ procurement and transplantation. Given the wide geographical disparities among the 26 states, performance and outcomes vary considerably. The combination of late referral, inadequate maintenance, and long cold ischemia time results in high incidence of delayed graft function (60-70), increases costs, and is associated with inferior long-term allograft survival. Cost-effective strategies have been implemented to increase the number of transplants, reduce delayed graft function incidence, reduce geographical disparities, and improve long-term graft survival.