SUS Waiting List: Understand how Faustão became the 2nd in line for a heart transplant
Updated: Aug 29, 2023
Some patients are treated with priority due to the severity of their medical cases. During the first half of 2023, Brazil performed a total of 206 heart transplant procedures, which represents an increase of 16% compared to the same period of the previous year, as reported by the Ministry of Health.
Approximately 3 million suffer from heart failure in Brazil - Photo Reproduction/Ckstockphoto/Envato Elements
In Brazil, the Health Unic System (SUS) plays a vital role in ensuring access to healthcare, including complex treatments, such as organ transplants. Recently, presenter Fausto Silva, popularly known as Faustão, was placed second on the list of people waiting to receive a heart.
The presenter's heart transplant surgery was performed on Sunday afternoon (27), at Albert Einstein Hospital and according to the doctors responsible for his case, the procedure was successful. But how did this happen and what does this situation reveal about the public health system in the country?
The Faustão Case
Faustão is one of the icons of Brazilian television, known for decades of career and highly successful programs. However, his personal life was rocked by a serious health problem: heart failure. This condition manifests itself when the heart cannot effectively perform its primary function, which is to pump blood to organs and tissues, impairing overall health and the quality of life of the affected individual.
This condition affects approximately 3 million Brazilians, according to data from Brazilian Society of Cardiology. The origins of this picture are diverse, but, in essence, heart failure represents the advanced stage of various diseases that affect the heart, including heart attack, high blood pressure, and heart valve problems. As a last resort for those undergoing treatment for severe heart problems, transplantation is recommended. That's what happened to the presenter.
Faustão had already undergone a series of medical procedures and, due to the severity of his condition, he was placed on the waiting list for a heart transplant at the SUS. What caught our attention was that Faustão became the second in line to receive a new heart, according to the Transplant Center of the State of São Paulo. As a result, Faustão's situation brought up important questions about organ donation, equal access to health in Brazil and a broad discussion about the waiting list in the SUS.
Priority
The medical team in charge of treating Faustão received an organ donation early on Sunday. The Ministry of Health reported that the presenter was placed as a priority on the waiting list due to the seriousness of his state of health, which was classified as critical. In the context of heart transplantation, the severity of the patient's condition is a determining factor.
"The selection generated for the offer of this recipient's heart, through the computerized management system of the state transplant system, brought 12 patients who met the requirements. Of these, four were prioritized, and the patient occupied the second position in this selection", said the Transplant Center of the State of São Paulo.
The medical team responsible for the patient at the top of the list chose to reject the organ. Thus, the transplant opportunity was directed to the second patient on the list, which was presenter Faustão. As informed by the Central, Faustão has blood type B, and the estimated waiting time for recipients of this group in search of a heart transplant ranges from 1 to 3 months.
Waiting List Operation
The waiting list for transplants in the SUS is a complex challenge. It is composed of patients in a serious condition who are waiting for a compatible organ, and the Priority order is based on the severity of each patient's health status. Patients who require continuous hospitalization, including the use of intravenous medications and circulatory support devices, are given priority compared to those waiting at home for an organ. The waiting criterion does not distinguish between surgeries performed in public hospitals or private institutions.
The process starts with the doctor in charge registering the patient in the single list of transplants, a list that is managed and maintained by the National Transplant Secretariat, belonging to the Ministry of Health. The order of priority in this list is established based on the registration chronology, that is, the date on which the patient entered it. Also, as mentioned, the severity of the patient's condition is taken into account.
Other determining factors include blood type, as a patient can only receive an organ from a donor who has the same blood type. Physical size is also relevant, as a tall and heavier person cannot receive an organ, such as the heart, from a significantly shorter and thinner donor.
Another crucial element to consider is the geographical distance, since the organ must be removed from the donor and transplanted to the receiver within a period of up to 4 hours. This is referred to as the "ischaemia time", which relates to how long the organ can remain outside the body. In other words, it is not feasible to establish a connection between two people who are very far from each other. In addition, ischemia time influences the decision to use a car or plane to transport the organ, with costs being covered by the SUS.
The Challenges of the Public Health System
Faustão’s case highlights significant challenges faced by SUS and the health system as a whole:
Available bodies: Brazil faces a chronic shortage of organs for transplantation. This means that many patients end up waiting for long periods. Today, in Brazil, more than 380 people are waiting for a heart transplant. For other types of transplants, the waiting list is even longer, such as the kidney, with almost 39,000 individuals waiting for a transplant.
Priority Criteria: Sorting patients on the waiting list is a complex process that involves rigorous medical evaluations. However, transparency and fairness in this process are issues that need to be addressed.
Need for Awareness: Faustão's case drew attention to the importance of organ donation. Donation awareness can help increase the number of organs available for transplant and thus shorten the waiting list.
