RESUMEN
Objetivo:
Analizar acciones de gestión pública en materia de inversiones financieras y procedimientos de trasplante de órganos, células y tejidos en Brasil.
Método:
Estudio ecológico mixto (tiempo y lugar), realizado con datos del Sistema de Información Hospitalaria del Sistema Público Brasileño de Salud (SUS), del Departamento de Informática del SUS y del Sistema Nacional de Trasplantes, de 2001 a 2023. Se realizaron análisis de tendencias temporales, estadística descriptiva e inferencial.
Resultados:
Los trasplantes de órganos, células y tejidos se concentran en la región Sudeste del país, donde los costos aumentan. Las regiones Nordeste y Sur de Brasil tienen la lista de espera más larga, con tendencia creciente (R2 = 0,96), asociada a una tendencia decreciente en el número de trasplantes (R2 = 0,97).
Conclusión:
La diferencia en el número total de trasplantes y procedimientos realizados entre regiones de Brasil representa la necesidad de organización e inversiones con estrategias orientadas a la formación de profesionales y la sensibilización de la población.
DESCRIPTORES
Trasplante de Órganos; Obtención de Tejidos y Órganos; Costos y Análisis de Costo; Accesibilidad a los Servicios de Salud; Epidemiología
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Legend: MA = Moving Average; SO = Solid organs; pmp = Per million population.Note: (A) Moving average and trend curve of the waiting list for solid organs and corneas (R2 = 0.96); the waiting list for solid organs (R2 = 0.94); the cornea waiting list (R2 = 0.91); (B) Moving average and trend curve for the number of solid organ and cornea transplants (R2 = 0.97); the number of solid organ transplants (R2 = 0.94); the number of corneal transplants (R2 = 0.98); (C) Moving average and trend curve of the rate of solid organ transplants per million population (R2 = 0.93); the rate of corneal transplants per million population (R2 = 0.98); (D) Moving average and trend curve of the number of potential donors (R2 = 0.99) and actual donors (R2 = 0.99).
Legend: SO = Solid organs.Note: (A) Difference between the number of effective donors: North and Central-West < Northeast, South and Southeast; Northeast < Southeast (H = 85.807 (gl = 4); p < 0.0011); (B) Difference between the number of potential donors: Central-West and North < All regions; Northeast > Central-West and North; Northeast < Southeast; South > Central-West and North; South < Southeast; Southeast > All regions (F = 100.498 (gl = 4); p < 0.0012); (C) Difference between the number of family interviews carried out: North > South, Northeast and Southeast; Central-West > Southeast (H = 36.745 (gl = 4); p < 0.0011); (D) Difference between the number of family denials: North > Northeast, Southeast; Central-West > Southeast (H = 32.440 (gl = 4); p < 0.0011); (E) Difference between the percentage of completion: Central-West and North < Northeast, South and Southeast; North East > Central-West, North and South; South > Central-West, North and Southeast; Southeast – Central-West and North (F = 17.637 (gl = 4); p < 0.0012); (F) Difference between the percentage of family denial: North > Northeast, Southeast; Central-West > Southeast (H = 32.440 (gl = 4); p < 0.0011); (G) Difference in the cornea waiting list: North > Northeast, South; Southeast > Northeast, South; Central-West > Northeast, South (H = 40.286 (gl = 4); p < 0.0011); (H) Difference in the number of corneal transplants: North > All regions; Central-West > Southeast; Southeast > South, Northeast (H = 85.063 (gl = 4); p < 0.0011); (I) Difference between the number of people on the waiting list for solid organs: North > Southeast, Northeast, South; Central-West > Northeast, Southeast, South; Southeast > South (H = 60.815 (gl = 4); p < 0.0011); (J) Difference between the total number of solid organ transplants: North and Central-West > Northeast, South, Southeast; North East > Southeast (H = 82.616 (gl = 4); p < 0.0011); 1 Kruskal Wallis test with Dunn post-hoc test; One-way Anova test with Welch correction and Games-Howell post-hoc test.
Note: (A) Hospitalizations for collection and examinations for the purpose of donating organs, tissues and cells, and of transplantation: Central-West< South, Northeast and Southeast (p = 0.014; p = 0.002; p < 0.001); Southeast > South (p = 0.003); North East < Southeast (p = 0.018). (B) Hospitalizations for Actions related to the donation of organs and tissues for transplantation: North < Northeast, Southeast and South (p < 0.001); Central-West < South and Southeast (p = 0.005; p < 0.001); Northeast < Southeast (p = 0.024); (C) Hospitalizations for organ, tissue and cell transplantation: North < Northeast, Southeast and South (p < 0.001); Central-West < South and Southeast (p = 0.017; p < 0.001); Northeast < Southeast (p = 0.046); (D) Costs related to collection and exams for organ, tissue and cell donation and for transplantation: Central-West < Southeast, South and Northeast (p < 0.001; p = 0.020; p = 0.006); Southeast > South and Northeast (p = 0.007; p = 0.023); (E) Costs for Actions related to the donation of organs and tissues for transplantation: Southeast > Northeast (p = 0.010); North < Northeast, South, Southeast (p = 0.001; p < 0.001; p < 0.001); Southeast and South > Central-West (p < 0.001; p = 0.001); (F) Costs related to organ, tissue and cell transplantation: Southeast > Northeast (p = 0.016); North < Northeast, South and Southeast (p < 0.001); South and Southeast > Central-West (p = 0.003; p < 0.001); (G) Days of hospitalization for collection and examinations for the purpose of organ, tissue and cell donation and transplantation: Southeast –South and Northeast (p = 0.035; p = 0.001); Central-West – South, Southeast (p < 0.004; P < 0.001). (H) days of hospitalization for actions related to the donation of organs and tissues for transplantation: North < Northeast, South and Southeast (p = 0.013; p < 0.001; P < 0.001); Central-West < South and Southeast (p < 0.001); Northeast < Southeast (p = 0.002); (I) days of hospitalization for organ, tissue and cell transplantation: North < South and Southeast (p < 0.001); Northeast < Southeast (p < 0.001); Kruskal-Wallis test with Dunn Post-Hoc test.