Panorama geral sobre causas de não efetivação e não consentimento familiar na doação de órgãos no Rio Grande do Sul

Abstract

Introduction: This study investigates the rates and causes of the failure to complete organ donations and the lack of family consent in Rio Grande do Sul (RS), from 2017 to 2023. Objective: To provide insights for improving the organ donation process and identifying weaknesses in the transplant care system in RS. Methodology: Ecological study with a sample of patients reported to State Transplant Centers registered as potential donors. The data on donation completion were analyzed analytically and comparatively using statistical tests to check the normality of the completion variables in parts per million (ppm/year) between Rio Grande do Sul, Santa Catarina, and Brazil, and family refusal between RS and SC. Significant results were considered with a p-value < 0.05. Rates of causes for non-completion of transplantation and reasons for family refusal in RS were verified. Analysis was conducted using IBM SPSS Version 25. Results: A significant difference in family refusal was found between RS (27.9% ± 2.7%) and SC (22% ± 3.3%) (p = 0.003). Donation completions (ppm/year) from 2017 to 2023 showed a significant difference between RS (20.3 ± 4.8), SC (42.3 ± 2.7), and Brazil (17 ± 1.6) (p < 0.001). Post-hoc testing revealed differences between RS and SC (p < 0.001) and between SC and Brazil (p < 0.001). In RS, family refusal was the primary cause of non-completion (27.93% ± 2.53%), followed by medical contraindications (17.64% ± 5.92%). The total number of non-completion causes increased until 2021 (75%) and stabilized in 2023 (65%). The main reasons for family refusal in RS were not being a living donor (82.5 ± 17.6 per year) and family opposition (33 ± 11.8 per year). Conclusion: Organ donation completion rates in Rio Grande do Sul were significantly lower than those in Santa Catarina and similar to those in Brazil, closely linked to family refusal. The stabilization of non completion causes indicates the need for ongoing interventions. Training programs for professionals delivering bad news and the adoption of protocols inspired by the Spanish model are essential to improve state indices.