Brazil rethinks organ transplantation in wake of pandemic disruption

Brazil has been held up as a global example of organ transplantation—guaranteed in full and free of charge by its public healthcare system, which is responsible for financing and performing more than 88% of the surgeries in the country.1 In absolute numbers, Brazil is second only to the US in terms of how many transplantations it performs.

But the pandemic has given this exemplary system a shock.

By December 2022, 52 989 people were expecting to receive an organ from a deceased donor, the highest number in more than two decades, according to the Brazilian Association of Organ Transplantation (ABTO).2

The increase in the numbers on the waiting list is one of the many side effects of the pandemic.3 “Hospitals had to reallocate doctors and other health professionals to care for patients with covid-19, which ended up disrupting efforts to identify potential donors and organ procurement,” Gustavo Fernandes Ferreira, ABTO’s president, told The BMJ.

Those waiting for a kidney were the most affected. The pandemic caused the number of kidney transplantation surgeries performed to plummet from 6302 to 4777 between 2019 and 2021. Numbers recovered slightly (to 5306) in 2022 as pandemic restrictions were lifted, but the figures remain lower than those in the five years pre-pandemic.

Children were also severely affected. In 2022, 583 children between 0 and 17 years old underwent transplantations, the same as in 2021. Some 641 new children entered the waiting list, however, and 66 died while waiting for an organ.

“There was an expectation that the donation and transplant rates would grow again, but this is not what’s happening,” Ferreira pointed out. “The recovery has been …