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Gomez-Aldana A, Rosselli D. Organ Donation Rates in Colombia, Different Geographies But Same Realities. Transplantation 2024; 108:e333-e334. [PMID: 39320452 DOI: 10.1097/tp.0000000000005079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Affiliation(s)
- Andres Gomez-Aldana
- Transplant Hepatology, Texas Liver Institute, University of Incarnated World, San Antonio, TX
| | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
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Salomão Pontes DF, Fernandes Ferreira G, Segev D, Massie AB, Levan M, Barbosa AMP, da Rocha NC, Modelli de Andrade LG. Regional Disparities in Kidney Transplant Allocation in Brazil: A Retrospective Cohort Study. Clin Transplant 2024; 38:e15446. [PMID: 39215436 DOI: 10.1111/ctr.15446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Brazil has a large public transplant program, but it remains unclear if the kidney waitlist criteria effectively allocate organs. This study aimed to investigate whether gender, ethnicity, clinical characteristics, and Brazilian regions affect the chance of deceased donor kidney transplant (DDKT). METHODS We conducted a retrospective cohort study using the National Transplant System/Brazil database, which included all patients on the kidney transplant waitlist from January 2012 to December 2022, followed until May 2023. The primary outcome assessed was the chance of DDKT, measured using subdistribution hazard and cause-specific hazard models (subdistribution hazard ratio [sHR]). RESULTS We analyzed 118 617 waitlisted patients over a 10-year study period. Male patients had an sHR of 1.07 ([95% CI: 1.05-1.10], p < 0.001), indicating a higher chance of DDTK. Patients of mixed race and Yellow/Indigenous ethnicity had lower rates of receiving a transplant compared to Caucasian patients, with sHR of 0.97 (95% CI: 0.95-1) and 0.89 (95% CI: 0.95-1), respectively. Patients from the South region had the highest chance of DDKT, followed by those from the Midwest and Northeast, compared to patients from the Southeast, with sHR of 2.53 (95% CI: 2.47-2.61), 1.21 (95% CI: 1.16-1.27), and 1.10 (95% CI: 1.07-1.13), respectively. The North region had the lowest chance of DDTK, sHR of 0.29 (95% CI: 0.27-0.31). CONCLUSION We found that women and racial minorities faced disadvantages in kidney transplantation. Additionally, we observed regional disparities, with the North region having the lowest chance of DDKT and longer times on dialysis before being waitlisted. In contrast, patients in the South regions had a chance of DDKT and shorter times on dialysis before being waitlisted. It is urgent to implement approaches to enhance transplant capacity in the North region and address race and gender disparities in transplantation.
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Affiliation(s)
| | | | - Dorry Segev
- Department of Surgery, New York University Langone Transplant Institute, New York, New York, USA
| | - Allan B Massie
- Department of Surgery, New York University Langone Transplant Institute, New York, New York, USA
| | - Macey Levan
- Department of Surgery, New York University Langone Transplant Institute, New York, New York, USA
| | - Abner Mácola Pacheco Barbosa
- Hospital of Medical School (HCFMB), Health Technology Assessment Center of Hospital das Clínicas, Botucatu, Brazil
| | - Naila Camila da Rocha
- Hospital of Medical School (HCFMB), Health Technology Assessment Center of Hospital das Clínicas, Botucatu, Brazil
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Codes L, Bittencourt PL, Mussi FC, Thibes M, Ferraz MLG, Andrade AGD. LIVER HEALTH IS OVERLOOKED BY ALCOHOL DRINKERS IN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23175. [PMID: 39046002 DOI: 10.1590/s0004-2803.24612023-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/08/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Chronic excessive use of alcohol is an important risk factor for several health and social conditions. METHODS A cross-sectional survey, in a sample representative of the Brazilian population,was conducted to evaluate the frequency of consumption of alcoholic beverages and behaviors concerning liver diseases. Participants were prospectively interviewed using a questionnaire regarding alcohol consumption and actions toward liver health. The study accepted at most one sampling error of ±2 percentage points and considered a 95% confidence interval. RESULTS One thousand nine hundred ninety-five subjects (1.048 women, mean age 44 years) from all Brazilian regions were interviewed. Most of the Brazilian subjects believe that alcohol abuse (63-87%) is the leading cause of cirrhosis and liver cancer, however, most responders (56%) had never been screened to assess liver damage related to alcohol consumption. A total of 55% of Brazilians drink alcoholic beverages. Among Brazilians who drink alcoholic beverages, 44% consume three or more drinks at a time, 11% consume more than 10 doses a day. Among those who consume 1 to 2 drinks a day, women (42%) consume more than men (32%) and more than the national average (37%). CONCLUSION There is a high frequency of alcohol consumption, especially among young people, and individuals from lower social classes, with frequent consumption among women. Despite the knowledge of its adverse impact on liver health, less than half of the Brazilians have been evaluated at least once for liver disease. Education and prevention strategies need to be implemented to reduce theharmful use of alcohol.
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Affiliation(s)
- Liana Codes
- Hospital Português, Salvador, BA, Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Paulo Lisboa Bittencourt
- Hospital Português, Salvador, BA, Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | | | - Mariana Thibes
- Centro de Informações Sobre Saúde e Alcool, São Paulo, SP, Brasil
| | | | - Arthur Guerra de Andrade
- Instituto Perdizes - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Silva AMD, Benites PT, Zulin MEG, Ferreira Júnior MA, Cardoso AIDQ, Cury ERJ. Global legislation regulating the donation, procurement and distribution processes of organs and tissues from deceased donors for transplants: A scoping review. Heliyon 2024; 10:e26313. [PMID: 38375299 PMCID: PMC10875591 DOI: 10.1016/j.heliyon.2024.e26313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Organ transplantation is one of the most successful advances in modern medicine. However, a legal system is necessary for its practice to be free from ethical flaws and to respect donors, recipients, and family members. Objective To map the global legislation regulating the donation, capture and distribution processes of organs and tissues from deceased donors for transplants. Method A scoping review according to the Joanna Briggs Institute was conducted in the following databases: Medline, CINAHL, Virtual Health Library, SCOPUS, Web of Science, Science Direct, and EMBASE, as well as gray literature, and reported according to the PRISMA extension for scoping reviews. Results We identified 3302 records, of which 77 were analyzed which enabled mapping the type of consent adopted and the existence of current legislation for harvesting organs and tissues after circulatory and brain death. Conclusion Opt-out consent predominates in Europe, and there is harvesting after brain and circulatory death. Opt-out predominates in the Americas, while Opt-in and harvesting of organs and tissues after brain death predominate in Asia and Oceania. The procurement of organs and tissues from deceased donors is practically non-existent in Africa.
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Affiliation(s)
- Aline Moraes da Silva
- Doctoral student in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Marcos Antonio Ferreira Júnior
- Graduate and Post-Graduation Program in Nursing, Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Elenir Rose Jardim Cury
- Post-Graduation Program in in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Aguirre-Villarreal D, Servin-Rojas M, Sánchez-Cedillo A, Chávez-Villa M, Hernandez-Alejandro R, Arab JP, Ruiz I, Avendaño-Castro KP, Matamoros MA, Adames-Almengor E, Diaz-Ferrer J, Rodriguez-Aguilar EF, Paez-Zayas VM, Contreras AG, Alvares-da-Silva MR, Mendizabal M, Oliveira CP, Navasa M, García-Juárez I. Liver transplantation in Latin America: reality and challenges. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100633. [PMID: 38058662 PMCID: PMC10696109 DOI: 10.1016/j.lana.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
Healthcare systems in Latin America are broadly heterogeneous, but all of them are burdened by a dramatic rise in liver disease. Some challenges that these countries face include an increase in patients requiring a transplant, insufficient rates of organ donation, delayed referral, and inequitable or suboptimal access to liver transplant programs and post-transplant care. This could be improved by expanding the donor pool through the implementation of education programs for citizens and referring physicians, as well as the inclusion of extended criteria donors, living donors and split liver transplantation. Addressing these shortcomings will require national shifts aimed at improving infrastructure, increasing awareness of organ donation, training medical personnel, and providing equitable access to care for all patients.
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Affiliation(s)
- David Aguirre-Villarreal
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Maximiliano Servin-Rojas
- Liver Transplant Unit and Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Aczel Sánchez-Cedillo
- Department of Surgery, Hospital General de Mexico Dr. Eduardo Liceaga, Ciudad de Mexico, Mexico
| | - Mariana Chávez-Villa
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Roberto Hernandez-Alejandro
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Juan Pablo Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Departament of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Isaac Ruiz
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l’Université de Montréal (CHUM), Canada
| | | | - Maria A. Matamoros
- Centro de Trasplante Hepatico y Cirugía Hepatobiliar, San Jose, Costa Rica
| | | | - Javier Diaz-Ferrer
- Department of Hepatology, Hospital Nacional Edgardo Rebagliati, Lima, Perú
| | | | | | - Alan G. Contreras
- Transplant Surgery, Intermountain Transplant Clinic, Salt Lake City, UT, USA
| | - Mario R. Alvares-da-Silva
- GI/Liver Unit, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Claudia P. Oliveira
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Miquel Navasa
- Liver Transplant Unit, Hepatology Service, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio García-Juárez
- Liver Transplant Unit and Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
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