Goalkeeper Miguel Meneses, from under-15 São José. — Photo: Reproduction/SJEC Advisory
In Brazil, organ donation depends on the family's decision. Therefore, it is important that the person makes their family members aware of their decision while they are still alive. Currently, there are two ways to do this: the identity card and electronic authorization for organ donation.
After the brain death of 14-year-old goalkeeper Miguel Meneses was confirmed, the family chose to donate the teenager's organs, which should help save the lives of at least six people: the heart, corneas, kidneys and liver were harvested.
"Up to six people benefited from the donation of Miguel's organs. In the case of the heart, which is a very noble organ, within four hours it needs to be transplanted into another person. And the other organs, they take a little longer," said Karina Higa, nurse on the Donation and Transplant Committee at the São José Municipal Hospital.
According to data from the Ministry of Health, almost 50 thousand people are on the waiting list for an organ. The vast majority of them are waiting for a kidney, reaching just over 46 thousand people.
The country is a world reference in organ transplantation, but it still faces a challenge: finding donors. For this reason, dozens of people die waiting.
If you want to be an organ donor, there are two paths:
New identity card
With the new Identity Card, it is possible to identify yourself, on the back, as an organ donor after death.
To do this, the person will need to inform, when creating the new document, that they want this data included. Therefore, it is possible that when checking your identity, the medical team will know about your desire to donate and present it to the family before making the decision.
The document will also contain the blood type (A, B or O) and RH factor (positive or negative).
Attention: if you have already declared yourself a donor on your old ID, it is still valid until 2032. Anyone who does not have this sign on their old document and wants to be a donor can issue a new card.
Electronic authorization for organ donation
Since April this year, anyone who wants to be an organ donor can express and formalize their wishes through an official document, made digitally, recognized by a notary.
The process is completely digital, from the website www.aedo.org.br. Just access the form, fill it out and send it. After that, the document is sent to a notary's office that will contact the donor to confirm the data in a video call. The declaration has no cost.
After the declaration, the National Organ Donor Center will know, from the CPF consultation, that the person is a donor and, therefore, notify the family before the decision.
According to the National Council of Justice, which initiated the initiative, in one month, more than 4 thousand people registered as donors.
See below some details about organ donation and how it works in Brazil:
1) Who can donate?
Only people who have suffered cerebral death can donate solid organs, explains Gustavo Fernandes Ferreira, from ABTO.
"To be a solid organ donor, you need to be brain dead. It's not just any way – it has to be brain dead, the heart has to still be beating", says the doctor.
"[The patient] has already died, his brain no longer works and will never work again, he is dead. He is considered dead, his death certificate is already ready – but his heart is still beating, at the expense of the equipment, to allow time for the organs to be removed. This time is just a few hours that we have to donate", adds the specialist.
The cornea can be donated by anyone, regardless of how death occurred. In this case, the heart does not need to be beating. To donate marrow, on the other hand, the donor must be alive.
A person can also be a donor after death even if they have had diseases such as diabetes, hypertension, Chagas disease and hepatitis B and C. In these cases, the health of the organ is assessed before the donation is made (as happens when the deceased patient did not have these diseases).
In the case of hepatitis B and C, for example, the donation can be made to a patient who already has the disease. Even the liver can be donated, as long as it is in good condition.
2) Is there anything that prevents someone from donating an organ?
There are few impediments to being a donor after death, according to Gustavo Ferreira: HIV, cancer and severe infection in the organ that will be donated are some of them.
"If my relative has a severe active kidney infection, he normally cannot be a donor. The same thing applies to the lung, heart or liver", explains the doctor.
In the case of HIV, the transplant cannot be performed even if both people have the virus. (In the United States, this has already been done).
In the case of patients who die from Covid, a technical note from the Ministry of Health, from 2020, determines that there is an "absolute" contraindication for organ and tissue donation in case of a positive test for the disease.
3) Which organs can be donated?
Heart
Liver (can be donated while alive)
Intestine
Pancreas
Lung
Kidney (can be donated while alive)
Cornea (tissue)
Multivisceral
Marrow* (*can only be donated while alive; procedure is low risk)
Each organ has a different maximum time to be removed and donated to a recipient: this time is called cold ischemia time. For heart and lungs, for example, the deadline is 6 to 8 hours. For the liver, up to 12 hours. For the kidney, 24 hours.
According to experts, the most difficult organ to find is the lung – because it depends on additional factors, such as the size of the donor and recipient, which need to be compatible. The heart has the same problem. Intestine transplantation, despite having already been carried out in the country, is still in its infancy.
4) How does the transplant queue work?
In Brazil, almost all transplants are carried out by the SUS. Anyone who needs an organ is registered on a national waiting list, which is separated according to the state and region where the person is.
Several factors are considered in order of priority: location, compatibility or severity, and queue time:
Location:
"If someone dies in São Paulo [capital] today, this body will be made available to the macro-region of São Paulo [capital]. The entire state has four macro-regions: if there is no recipient in that macro-region, it goes to the entire state. If there is no one in the state, it goes to the whole of Brazil", explains Gustavo Ferreira.
Compatibility or Severity:
Each organ has its own allocation criteria: in the case of the kidney, for example, the criterion is immunological compatibility. Whoever is most compatible will be first on the list. In the liver, the criterion is severity: "the more serious the patient is, the higher he is on the list", says the doctor.
In addition, each potential recipient also waits in line compatible with their own blood type: AB patients receive from AB patients, O receives from O, and so on.
Queue time:
If all other criteria are tied between two compatible or equally serious people on the list, the waiting time will break the tie: whoever has been in the queue the longest will receive the organ.
