Causas clínicas de recusa de órgãos para transplantes e proposta de catálogo de nomenclatura

Abstract

Understanding why organs are refusal when the list of transplant candidates is growing is a subject that must be addressed in order to change this scenario so that more organs are accepted, and more transplants are performed. The donation and transplant structure in Brazil is based on a public system, where organ allocation follows detailed criteria established by the Ministry of Health, using computerized systems such as SIG/SNT to manage waiting lists, locally and nationally. The complexity of the process includes multiple allocation stages, starting with regional lists and ending with the national list, ensuring that all organs offered have potential for transplantation. Although the number of transplants in Brazil is growing, a significant portion of the organs offered for the national list, managed by the National Transplant Center, are disregarded for transplantation. The lack of uniformity in the criteria for organ rejection by transplant teams reflects the continuous need for improvement. The heterogeneity in the reasons for refusals, as well as the lack of a standardized catalog of reasons, impacts the use of organs, indicating the importance of improving records to optimize the use of offers and increase the number of transplants. The objectives of this study were to describe the clinical causes motivating the refusal of organs (heart, liver, kidney, lung and pancreas) offered for the single national list of the Ministry of Health and to propose a standardized catalog of nomenclature. This is a descriptive, documentary and retrospective cohort study with a quantitative approach. The results indicated that the frequency of refusals due to “donor conditions” is 62% higher than in the other groups of refusals. There was a positive association between the reasons for refusal for the heart organ in the causes lack of ECO/CAT, followed by alterations in imaging tests; in the case of the liver, the two main positive associations were the causes user of distilled/fermented beverages, followed by the general cause “donor conditions” without detailed specification; For the pancreas, the main positive association was refusal due to age, followed by the cause of inhaled drug use; and for the kidney, the main positive associations occurred for the cause “donor conditions” without detailed specification, followed by the cause of age. In conclusion, it was understood that categorizing refusals only by macro reasons, without detailing the micro reasons, limits the understanding of the factors that affect organ refusals. There are variations in the micro reasons for refusal among the different types of organs, reflecting both the specific dynamics of each one and the strategies of the teams to balance the patients' needs and the ideal quality of the organ for transplantation. It is necessary to improve the information systems, standardize the nomenclature, and train professionals to ensure more detailed and accurate data, to contribute to strategies that reduce the number of refusals for the organs offered by the National Transplant Center. This work is aligned with the research line of Quality in Healthcare for Adults and the Elderly.