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Fábio GomesFábio GomesMay 1, 2009May 1, 2009

This work was adapted from my social policy master This work was adapted from my social policy master dissertation entitled: “Threats to equity in organ allocation dissertation entitled: “Threats to equity in organ allocation for transplantation: an analysis of Brazilian legal criteria” for transplantation: an analysis of Brazilian legal criteria” (2007), advised by Dr. Debora Diniz, (University of Brasilia, (2007), advised by Dr. Debora Diniz, (University of Brasilia, Brazil).Brazil).

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Examples of extensive media Examples of extensive media coverage on the issue of organ coverage on the issue of organ transplantation during 2009.transplantation during 2009.

Topics for evaluation of legal documents:Topics for evaluation of legal documents:

- principles of social justice; - principles of social justice;

- principles of access to health actions and services - principles of access to health actions and services (including specific criteria for organs); (including specific criteria for organs);

- transplantation program structuring; - transplantation program structuring;

- mechanisms that have influence on organs availability;- mechanisms that have influence on organs availability;

- sanctions related to breaches of the Transplantation - sanctions related to breaches of the Transplantation Law;Law;

- jurisdictions for transplantation policy regulation;- jurisdictions for transplantation policy regulation;

- transplant information transparency.- transplant information transparency.

Equity debate: Equity debate:

- - John Rawls´ principles of justice and John Rawls´ principles of justice and

- Amartya Sen´s multidimensional health equity approach.- Amartya Sen´s multidimensional health equity approach.

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Basic access criteria to organs Basic access criteria to organs

Federal Constitution, Health Organic Law (nº 8.080 of Federal Constitution, Health Organic Law (nº 8.080 of 1990) and Transplantation Law (nº 9.434 of 1997): 1990) and Transplantation Law (nº 9.434 of 1997):

- solidarity principle- solidarity principle

- equality principle- equality principle

Executive regulations (federal decree and ordinances Executive regulations (federal decree and ordinances from the Ministry of Health):from the Ministry of Health):

- compassion principle- compassion principle

- efficient distribution principle- efficient distribution principle

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Brazilian regulations on transplantation seek equity, but Brazilian regulations on transplantation seek equity, but two significant threats were found: two significant threats were found:

Omission to regulate weights Omission to regulate weights used to apply allocation used to apply allocation criteria for most types of organs (available on computer criteria for most types of organs (available on computer programs but not in regulations);programs but not in regulations);

Breakage of hierarchy between regulations Breakage of hierarchy between regulations in the in the establishment of a new allocation criterion based on establishment of a new allocation criterion based on clinical severity of disease (by means of an ordinance, not clinical severity of disease (by means of an ordinance, not considering a principle established by a decree).considering a principle established by a decree).

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Context of scarcity and regional Context of scarcity and regional inequalities;inequalities;

Stagnation in productivity observed after Stagnation in productivity observed after 2004 is being reverted! 2004 is being reverted!

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Chart 1. Selected organs Chart 1. Selected organs transplantation absolute transplantation absolute frequency recorded by the frequency recorded by the Brazilian Transplantation Brazilian Transplantation Program from 2001 to 2008Program from 2001 to 2008

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Chart 2. Selected organs transplantation absolute frequency recorded Chart 2. Selected organs transplantation absolute frequency recorded by the Brazilian Transplantation Program from 2001 to 2008by the Brazilian Transplantation Program from 2001 to 2008

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Table. Performance indicators of the Brazilian Transplantation Table. Performance indicators of the Brazilian Transplantation Program – 2006 and 2008Program – 2006 and 2008

Source: Source: (*) Ministry of Health – Brazil (2009); (*) Ministry of Health – Brazil (2009); (**) Council of Europe (for 2006) and Brazilian Registry of Transplantations – ABTO (for (**) Council of Europe (for 2006) and Brazilian Registry of Transplantations – ABTO (for 2008).2008). Legend: p.m.p= per million persons.Legend: p.m.p= per million persons.

Performance indicatorsPerformance indicators Situation in 2006Situation in 2006 Situation in 2008Situation in 2008

Number of transplants (*)Number of transplants (*) 15,13215,132

(50% - cornea)(50% - cornea)

19,12519,125

(50% - cornea)(50% - cornea)

Cornea transplantation rate (p.m.p) (*)

North Region

Southeast Region

52.73

9.79

69.83

67.64

16.64

98.36

SSolid organs transplantation rateolid organs transplantation rate (p.m.p) (p.m.p)

(*)(*)

North RegionNorth Region

Southeast RegionSoutheast Region

22.7722.77

4.534.53

30.8930.89

24.8824.88

2.772.77

31.8631.86

Persons in waiting list (*) 69,053

(49% - kidney)

68,906

(50% - kidney)

Donation rate (p.m.p.) (**)Donation rate (p.m.p.) (**) 5.5 5.5

(was 7.3 in 2004)(was 7.3 in 2004)

7.27.2

Greater attention must be taken to Greater attention must be taken to the relationship between the the relationship between the transplantation program, the transplantation program, the National Unified Health System National Unified Health System (SUS) and the Brazilian Welfare (SUS) and the Brazilian Welfare State.State.

More equitable results depend on: More equitable results depend on: improved program management, improved program management, strategic planning, greater strategic planning, greater transparency of information, transparency of information, revisions and eventual corrections revisions and eventual corrections of normative omissions.of normative omissions.

The program cannot act isolated The program cannot act isolated from SUS.from SUS. 10

Files available Files available

(both in English and Portuguese)(both in English and Portuguese)

through the following sources: through the following sources:

http://health.med.br

Email: fabio.gomes@camara.gov.brEmail: fabio.gomes@camara.gov.br

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