Access to Organs for Transplantation: Analysis of Brazilian Legal Criteria

1. 12th World Congress on Public Health (April 27-May 01, 2009-İstanbul)Health and Geopolitics199.01 Access to organs for transplantation: An analysis of the Brazilian legal criteria and context Fábio Gomes May 1, 2009 This work was adapted from my social policy master dissertation entitled: “Threats to equity in organ allocation for transplantation: an analysis of Brazilian legal criteria” (2007), advised by Dr. Debora Diniz, (University of Brasilia, Brazil).

2. The Brazilian Unified Health System (SUS) has a broad, complex and productive public transplantation program, which can benefit from informations that sponsor its improvement. Examples of extensive media coverage on the issue of organ transplantation during 2009.

3. 1. Learning objective: Criteria used by the Brazilian Transplantation Program (BTP) to allocate organs • Topics for evaluation of legal documents: - principles of social justice; - principles of access to health actions and services (including specific criteria for organs); - transplantation program structuring; - mechanisms that have influence on organs availability; - sanctions related to breaches of the Transplantation Law; - jurisdictions for transplantation policy regulation; - transplant information transparency. • Equity debate: - John Rawls´ principles of justice and - Amartya Sen´s multidimensional health equity approach.

4. 1. Learning objective: Criteria used by the Brazilian Transplantation Program (BTP) to allocate organs Basic access criteria to organs • Federal Constitution, Health Organic Law (nº 8.080 of 1990) and Transplantation Law (nº 9.434 of 1997): - solidarity principle - equality principle • Executive regulations (federal decree and ordinances from the Ministry of Health): - compassion principle - efficient distribution principle

5. 2. Learning objective: Threats to equity in access to organs related to legal criteria Brazilian regulations on transplantation seek equity, but two significant threats were found: • Omission to regulate weights used to apply allocation criteria for most types of organs (available on computer programs but not in regulations); • Breakage of hierarchy between regulations in the establishment of a new allocation criterion based on clinical severity of disease (by means of an ordinance, not considering a principle established by a decree).

6. 3. Learning objective: Trends of performance indicators • Context of scarcity and regional inequalities; • Stagnation in productivity observed after 2004 is being reverted!

7. 3. Learning objective: Trends of performance indicators Chart 1. Selected organs transplantation absolute frequency recorded by the Brazilian Transplantation Program from 2001 to 2008

8. 3. Learning objective: Trends of performance indicators Chart 2. Selected organs transplantation absolute frequency recorded by the Brazilian Transplantation Program from 2001 to 2008

9. Table. Performance indicators of the Brazilian Transplantation Program – 2006 and 2008 3. Learning objective: Trends of performance indicators Source: (*) Ministry of Health – Brazil (2009); (**) Council of Europe (for 2006) and Brazilian Registry of Transplantations – ABTO (for 2008). Legend: p.m.p= per million persons.

10. Conclusions • Greater attention must be taken to the relationship between the transplantation program, the National Unified Health System (SUS) and the Brazilian Welfare State. • More equitable results depend on: improved program management, strategic planning, greater transparency of information, revisions and eventual corrections of normative omissions. • The program cannot act isolated from SUS.

11. Files available (both in English and Portuguese) through the following sources: http://health.med.br Email: fabio.gomes@camara.gov.br