The Covid-19 pandemic caused, for the second consecutive year, a drop in the number of effective donors for organ transplants in Brazil, confirming the impact that the health crisis had on patients in need of organ donation.
Last year’s effective donor rate was 15.1 per million population (pmp), down 17% from 2019’s 18.1 pmp and 4.4% from 2020 , of 15.8 ppm.
On the other hand, the number of potential donors was the highest in the last seven years, reaching 57.7 pmp.
The high number of contraindications for donations, almost a quarter of the total potential donors (24%), reflects the reduction in the number of effective donors. In 2020, that figure was 15%.
The data are from the latest edition of the Brazilian Transplant Registry, an official publication of the Brazilian Association of Organ Transplantation (ABTO), which provides information from 2014 to 2021.
According to the report, the contraindication to carrying out donations at the beginning of the pandemic was a measure to prevent transmission of the coronavirus to transplant recipients, but data from existing scientific studies suggest that this risk is minimal or absent.
This understanding, however, was not reflected in the decrease in contraindication, with the loss of more than a thousand organs that could be donated and another 948 potential donors.
Ilka Boin, secretary of the ABTO board, explains that much of the damming of the two years of the pandemic was due to the delay in obtaining the results of tests for coronavirus from potential donors and transplanted.
“Before, the whole process, when the potential donor entered the hospital, it could take up to 48 hours to get the result of the RT-PCR exam, and this ends up harming the progress of the queue”, he says.
Boin says the association is in dialogue with hospital infection commissions and the National Transplant System to legislate on the possibility of using donor organs with positive but asymptomatic results for Covid, as is done in the United States and Europe.
She also believes that the outlook for 2022 will be positive, mainly due to the improved character of the pandemic. “Of course, we still have no way of knowing what our autumn and winter will be like, but we believe that if we can get back to the levels of 2019, it will be very good.”
In absolute numbers, 12,215 potential donors were registered in 2021, of which 3,207 were effective.
The region that most concentrated effective donations was the Southeast, with 1,564, followed by the South, with 867 effective donors.
The rate of donors per million population was higher in the South region, almost double the national average, with 28.7 pmp. The North had the lowest, only 2.4 pmp.
The kidneys correspond to the highest concentration of transplants performed, with 4,750 surgeries performed in 2021. This number, however, represents a drop of 1.5% compared to 2020, when 4,822 operations were performed. Compared to 2019, when there were 6,296, the decrease is 25%.
As indicated in a previous edition of the report, the live donor transplant rate, which in 2020 was the lowest recorded since the 1980s at 2.1 pmp, remains low but has increased by 28% compared to the previous year. , reaching 2.7 pmp.
“When you look at the curve of need and of effective transplants, we still do a lot less than what’s needed for some organs,” says Boin.
Another organ that had a reduction in the number of transplants in the last two years was the liver, with a decrease of 2% compared to 2020, from 2,067 to 2,033, and a drop of 10% compared to 2019, from 2,259.
The other organs had an increase in transplants in 2021 compared to 2020.
Despite this recovery scenario, there are still 48,673 people on the waiting list for organ transplants, the majority (56.7%) waiting to receive kidneys. The number of patients who died on the waiting list for an organ in 2021 was 4,214.
According to the data in the report, there was a 70% increase in the number of patients for kidney transplantation in 2021 compared to the previous year, a situation influenced by the damming in 2020, the first year of the pandemic.
The mortality of patients waiting for a kidney organ went from 6.6% to 10.7%, mainly caused by the high risk of death in this population in the face of coronavirus infection. “But these patients are, in general, more careful and, therefore, we recognize that mortality in the waiting list was not as high as expected, the aggravating factor is the exposure of the individual in high-risk environments, such as transport public”, says the doctor.
Regarding pediatric patients, 1,090 children are awaiting a transplant, 598 (55%) for corneas, 347 (31.8%) for kidneys, 78 (7.2%) for liver, 56 (5%) for heart and 11 (1% ) lungs. The number of transplants performed in the last year on children was 583, with 82 deaths occurring while waiting for an organ.
Scientific studies show that the two vaccines or the single Covid vaccine do not offer protection for this group, whether immunosuppressed patients, who are on dialysis, or those transplanted. Therefore, in this population, the primary vaccination schedule with three doses and a fourth dose for booster is recommended, especially in the face of the more transmissible omicron variant. “The fourth dose for transplant recipients and immunosuppressed people in general is vital,” says Boin.
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