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Author: Raquel Marques Landgraf
Translator: Larissa Kassner
Do you know what 6th-century BC Hindu surgeons and doctors Miguel Cendoroglo Neto and Fernando Bucal have in common? Both believed that life should be shared.
In Alexandria, the Hindus performed tissue grafts that allowed for the recovery of mutilations affecting the people of that historical era. Centuries passed, concepts of sterilization, surgical techniques, and medical science as a whole evolved and culminated in what we now know as organ transplantation.
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As for Brazil, the beginning can be defined in the 1960s, with the first transplant performed in the country, and by the year 1997, when legislation specifically aimed at this procedure was approved in Congress. Although it is a recent practice with even more recent legislation, the efficiency of this procedure and the benefits it brings are unquestionable, with Brazil being the second-largest country in the world in terms of organ transplants, second only to the United States. Despite all this visibility and competence, the country is still far from the ideal when it comes to organ donation.
Today in the country, there is a waiting list of over 66,000 people expecting to receive a transplant, and the number of viable donors is around 107,000 people. However, only 7,453 procedures were performed in the year 2020, and over 4,000 people died while waiting for a transplant in the same year. This alarming statistic reflects a society that has not yet understood how organ donation represents the ultimate reflection of a compassionate society. According to a 2009 survey by collaborators from the University of São Paulo (USP), the main reason for these low numbers was culture, with respondents claiming that the "fear of loss" prevented them from donating. Similarly, in 2019, DataFolha conducted a survey that pointed to a lack of knowledge about transplant legislation as one of the main reasons for the low donation rate. In a way, these two results intersect and merge into a term that is often talked about but little understood: taboo.
In an attempt to increase visibility on the topic, the Ministry of Health (MS) designated September 27 as the National Organ Donation Day and launched the Setembro Verde (Green September) campaign in 2015. This campaign aims to educate and raise awareness among the population about the importance of this act, spreading posters with the slogan "Donate organs, donate lives" and encouraging the media to discuss the topic more. This marketing mechanism has proven very effective for various public health issues that were once considered taboo, such as sexuality, prejudice, and drugs. Nevertheless, it has shown to be less effective for this specific campaign, as only 16 out of every 1 million people currently donate organs. A strategy adopted for the aforementioned topics was to introduce them into soap operas, movies, and hold open discussions in newspapers and social media, actions that were crucial in breaking the veil that had formed around these topics. However, these actions were not properly applied to organ donation, making this issue deficient and lacking in real exposure.
The case of TV presenter Fausto Corrêa da Silva, known as Faustão - regardless of the discussions about the legitimacy of his position on the recipient list - has brought more attention to the topic. It should be noted that the waiting list is based on the urgency that the patient presents in receiving the organ. For this reason, if there is a possibility of transplantation, the organ will be transplanted as soon as possible. Brazil has an average waiting time of 90 days for a transplant, and about 30% of patients on the list receive the organ within 1 month. In a reality with more donors, this time would be even shorter, providing a better quality of life for transplant recipients.
People in need of a transplant in Brazil, whether for organs or tissues, are on a single list. The order of this list is determined by the Transplant Center of the Health Secretariat of each state and controlled by the National Transplant System (SNT). The position is determined by the stability of the patient - a characteristic evaluated by many factors. In other words, the worse the condition, the higher up the list the patient is, obviously within the criteria of viability that the person presents.
Regarding the donor, there are two modalities: living and non-living donors. In the case of a living donor, the person must be of legal age and capable, and prior judicial authorization must be obtained. This group can donate organs such as a kidney, part of the intestine, part of the marrow, among others. It should be noted that donating marrow only requires registration at your city's blood bank, followed by a collection of only 20 ml of blood, and if there is a patient in need of this tissue, the person will be contacted, and the procedures will continue; otherwise, no invasive procedures will be performed. As for non-living donors, the main focus of the Ministry of Health campaign, individuals in intensive care units (ICUs) who have experienced a condition known as brain death, can be donors of viable organs.
This cellular death is incompatible with life, but with the right equipment, it is possible to preserve the viability of other tissues, allowing for their removal and donation. Organs such as the kidney, lung, heart, and tissues such as valves, corneas, bones, among others, may be needed to save another person's life, and this act could save them. For the transplant to take place, the donor must have a physical and blood type compatible with the recipient, and the recipient must be in a priority position on the list. The difficulty of these factors coinciding is well-known, which, in conjunction with the low number of donors, further reduces the likelihood of obtaining a donation.
Following the authorization of donation, the donor will undergo a surgical procedure, but no deformity will be visible during burial, as guaranteed by Brazilian law. It should also be noted that a specialized team will talk to the family after the confirmation of brain death, explaining all the procedures that will be carried out.
Finally, to become an organ donor, it is simply necessary to express your wish to your family so that they can allow the procedure when the time comes. However, if there may be any disagreement between this desire and the wishes of the family, or in an attempt to remove this responsibility from them, as it is a time of mourning, a written and signed document can be left authorizing the donation. This simple act can save the lives of other people, making it a heroic act that allows life to prevail even after death.
Donate organs to save the lives of people like Jorge, whose greatest dream was to hold his child in his arms, or like Martha, who was able to overcome leukemia.
Donate organs, donate life!
September 13th, 2022
Curatorship of the World Social Forum on Health and Social Security
USED MATERIAL
Os trabalhos do FSMSSS são revisados por Isadora Borba e Rafaela Venturella De Negri