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Limited access to liver transplantation in Brazil

There is limited access to receiving a liver transplant in Brazil, according to a report published in Transplant International.

“The country averages five to ten liver transplantations per million, far lower than required,” Paulo Lisboa Bittencourt, MD, PhD, in the unit of gastroenterology and hepatology at the Portuguese Hospital of Salvador in Bahia, Brazil, and colleagues wrote. “Access to liver transplantation in the underprivileged North, Midwest and Northeast regions of Brazil is scarce.”

In Brazil, over 1,700 liver transplantations are performed each year, which is more than anywhere else in Latin America and third-most worldwide, the researchers wrote. However, the heterogeneity of the country leads to extreme variation across regions: The liver transplantation rate is 0.4 per million in the North and 12.9 per million in the South.

One approach to improving the rate has been a modification of the pediatric end-stage liver disease scoring system, in which the calculated score is multiplied by three if the candidate for liver transplantation is aged younger than 12 years. This has led to a decrease in waiting list time as well as a 6.1-fold increase in split liver transplants.

Further, Brazil’s Ministry of Health has led national education campaigns to increase organ donation. As a result, Brazil has increased the donor rate to 14.4 donors per million and now 56% of families have given consent to organ and tissue donation.

With the adoption of the model for end-stage liver disease score plus sodium to prioritize patients for transplantation, the researchers believe that legislation concerning organ donation will change.

Despite these improvements, overall access to transplantation remains limited due to geographical disparities and financial constraints.

“Improving primary care, diagnosis of end-stage liver disease, and referral systems for liver transplantation is an enormous challenge in an underfunded system,” the researchers wrote. “These conditions prevent the adequate diagnosis and management of patients with end-stage liver disease prior to referral for liver transplantation and during their time on the waiting list.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.