Campaign underscores family has final say on organ donation

The Brazilian Liver Institute (Ibrafig) and the Brazilian Association of Organ Transplants (ABTO) have joined efforts in the campaign “Be an organ donor and let your family know,” launched in association with Green September to raise awareness about the importance of donating. The goal of the initiative is to remind people that families have the final say on organ donation. The plan is also supported by the Brazilian Hepatology Society and a number of NGOs.

According to data from the Brazilian Transplant Register (RBT), 1,126 people are in line for a liver transplant and over 45 thousand people are waiting for the transplantation of solid organs and tissues.

Hepatologist Dr. Paulo Bittencourt, head of Ibrafig, noted that a single donation may save the lives of eight people. He further noted, however, that during the nearly two years of COVID-9 pandemic, the number of donations in every million people sank to figures well below the target necessary to reduce the morbimortality facing people waiting for a transplant. This is why the campaign is urgent, he argued. “Without the family’s consent, there is no donation, even if the intention of the prospective donor is known by everyone around them.”

Approach

The opinion was shared by nephrologist Dr. Alexandre Tortoza Bignelli, coordinator at the Kidney Transplant Service of the Cajuru University Hospital (HUC), located in Curitiba city and well known in its specialty. Bignelli said to Agência Brasil that, at the moment of removal, the protocol is conducted with the family members of the person wishing to donate, “because this person is facing brain death and it is the family that must have the final say.” He explained that people may be organ donors while alive, but, in cases of brain death, it is not up to them but to their family members to decide. “If the family thinks differently, the removal cannot take place, so raising awareness is key.”

It must be known that the waiting list is just, the kidney doctor also pointed out. “Organ distribution follows criteria based on how severe cases are—in the case of the liver or the heart—or on compatibility or genetics (blood type). The organ will be distributed with equity among the population. No one on the list is favored, except children and teenagers of up to 18 years of age. In this age group, children are prioritized.” This does not mean, however, that there are no children on the wait list, Bignelli said. If removals took place in larger numbers, “these children could have higher chances of leaving the list.”

Survey

A survey entitled Organ Donation, commissioned by Ibrafig and conducted by the Datafolha Institute from August 2–7 this year, heard 1,976 people aged 18 and older, living in 129 municipalities and from all walks of life. The figures revealed that seven in every ten Brazilians would like to be organ donors after death. However, approximately half of these potential donors (46%) did not inform their families of their intention.

The research also showed that intended organ donations decline with age—the rate stands at 79 percent among respondents aged 18 through 24 and 55 percent among those aged 60 and older. The wish to donate also becomes more prevalent with schooling. It was expressed by 56 percent of people who graduated primary school, against 79 percent of Brazilian with a university degree. Income is another driver contributing to a higher proportion of intended donations: 55 percent among members of classes D and E, 78 percent within classes A and B.

Of all interviewees, 30 percent declared they did not wish to donate their organs upon death. Sixteen percent mentioned their desire to remain whole or not being manipulated after death, 13 percent presented religious arguments, 11 percent answered lack of desire or interest in donating, and nine percent mentioned existing health conditions.

Setbacks

ABTO’s Brazilian Transplant Register on January–July 2021 shows that the COVID-19 pandemic brought donation and transplant rates back to 2014 levels for donations generally, 2012 for livers and hearts, 2011 for lungs, and 2003 for kidneys.