Deceased-donor kidney transplantation in Brazil, 2014–2024: temporal patterns, regional heterogeneity, and donation-context indicators
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Background
Deceased-donor kidney transplantation is a component of the Brazilian transplant system and takes place within a deceased-donation environment that includes donor identification, notification, family approach and authorization, organ allocation, and logistics. This study described temporal, macroregional, and federative unit-level variation in deceased-donor kidney transplantation in Brazil from 2014 to 2024, together with hospitalization-based indicators and contextual indicators of the deceased-donation environment.
Methods
This nationwide descriptive time-series study used publicly available secondary data from the Hospital Information System of the Unified Health System (SIH/SUS), the Brazilian Transplant Registry (RBT/ABTO), and the Brazilian National Transplant System (SNT). Indicators included the number of transplants, transplant rates per million population, kidney transplant waiting list stock, mean length of hospital stay, in-hospital mortality, potential donor notifications, and family interview and refusal proportions. The three databases were analyzed separately and in parallel, without linkage.
Results
The annual number of deceased-donor kidney transplants increased over the study period. The kidney transplant waiting list stock also increased. Mean length of hospital stay decreased, and in-hospital mortality decreased over time. Marked macroregional and federative unit-level heterogeneity was observed in transplant activity, hospitalization-based indicators, and contextual indicators of the deceased-donation environment.
Conclusions
Deceased-donor kidney transplantation increased in Brazil between 2014 and 2024, although regional disparities persisted. These findings support monitoring strategies that incorporate contextual indicators alongside measures of transplant activity. Because this was a descriptive study based on secondary data from distinct sources, the findings should not be interpreted as evidence of causal relationships.
