Doctor is inspired by a Spanish model and makes SC a leader in organ donation

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The adoption of humanitarian practices reduced organ donation rejection in public hospitals in Santa Catarina. In 2007, out of every ten interviews carried out with relatives of patients diagnosed with brain death, seven refused to authorize the procedure. That number dropped to three in 2021, that is, the refusal that was 70% collapsed to 31%.

Reality changed after the intensive care physician Joel de Andrade, coordinator of the Santa Catarina State Transplant Center, was inspired by the model in Spain, which includes courses to teach professionals how to approach family members and audits. The European country remained in the lead for almost 30 years – until it lost the lead to the United States in the pandemic.

In Brazil, Santa Catarina became a reference and took the lead in organ donation rates, surpassing the Iberian country in 2021 through the SC Transplantes program. Over the last 18 years, the state has had the best rates in the country 14 times. In the other four years, he occupied the vice-leadership.

“We were adapting a management model for a Brazilian state that worked perfectly. For years we shared with Paraná, which adopted our style, the best results in Brazil”, says Andrade. Before, most patients awaiting a transplant were transferred to other regions.

For this work, Joel de Andrade was the winner in the Health category of the Espírito Público Award, given in November last year in Rio de Janeiro.

The civil servant spent three months in one of the best hospitals in Madrid and highlights the various educational tools of that system that inspired him.

“One of the main ones that we brought and implemented in 2010 was the Communication of News in Critical Situations Course, which teaches health professionals how to talk to families at the moment when they are going to give the worst news of all, death. Shows how to have empathy and welcome.”

The doctor says that from then on he discovered that the theories that families were against organ donation because they were unaware of the process were not valid.

“If they are not well treated at a critical moment like this, forget it, they will reject the donation. Only in this more welcoming approach, we have already had a drastic change in the numbers of Santa Catarina.”

For Andrade, it makes all the difference that the professionals who work at the hospital where a patient is hospitalized in serious condition, and who create bonds of trust with the family, are the ones who will understand the right moment to talk about organ donation.

Most donor search teams are ICU employees in Santa Catarina. When the patient is diagnosed with brain death, says Andrade, there is already a contact that started when the person was alive. Professionals do not go to the hospital to see the donor, they are there in the care process

“If the primary interest is to obtain organ donation, the professional fails. This attitude creates an impression that everything there is aimed at obtaining that consent.”

Andrew gives an example. He explains that if the deceased person’s mother says: “Pedro is a nice guy, he’s attending college”, he is alive in her mind, because she is conjugating the verb in the present tense. If she starts talking about him in the past tense, she demonstrates that she is more open to donating organs.

“One of the basic skills that we transmit at this moment is to understand what stage the family member is in. You have to use the medicine of time for the penny to drop. Often, asking for the organs is skipping the start.”

Another arm of the program is to form a network of coordinators and employees responsible for organ procurement. In the state, there are already more than 2,000 people trained.

“No one has managed to set up a network like that. We hold several meetings a year to have more people trained. If someone leaves, they end up taking the seed to other places, forming a critical mass.”

One of the aspects that also caught his attention in Madrid were the audits, which take place there in hospitals that receive donations, to identify their effectiveness.

In Brazil, he says, there is no control system to know the total number of final donors and the number of brain deaths. “It is this type of information that is so important that the audit brings.”

Another lesson learned and used in practice was the prioritization of education over advertising. “Many think it solves [investir em campanhas para diminuir a rejeição das famílias], but it doesn’t solve it. They are not effective anywhere in the world. Education, yes.”

A healthy patient diagnosed with brain death, after rigorous evaluation by at least three doctors and exams, can donate bones, tendons, skin, tissues and organs, helping hundreds of people.

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