Validating potential organ and tissue donors in the middle of the COVID-19 pandemic: Scoping review and recommendations construction.

OBJECTIVE: To identify the available information to support registered nurses' clinical decisions in assessing and validating potential organ and tissue donors during the COVID-19 pandemic. METHOD: This is a scoping review developed in six stages. The sixth stage was developed with registered nurses who work in the Brazil Organ Donation System. To consolidate the information and prepare all assumptions, the legislation in force in Brazil was followed. RESULTS: Recommendations from 19 articles identified in the literature were analyzed; additionally, 52 professionals who work at Brazil Organ Donation System participated in the research. Four care assumptions were formed: investigation of community transmission, investigation of clinical situations, screening for COVID-19 signs and symptoms, and investigation of alterations presented in the physical examination. Such assumptions are formed by 34 care guidelines. DISCUSSION: Care assumptions were prepared to guide and support registered nurses during assessment and validation of potential organ and tissue donors. From this perspective, assumptions certainly promote safety, effectiveness and quality in the service offered during the organ and tissue donation process in the midst of the COVID-19 pandemic, in addition to empowering registered nurses in this scenario. Quality and bio-surveillance through the donation stages have been discussed extensively in recent times, to improve donation and transplantations by valuing care, safety, and quality of life of recipients. CONCLUSION: The care assumptions presented in this study support and subsidize the daily practice of registered nurses who work in assessing and validating potential organ and tissue donors, enabling these professionals to make decisions based on secure information.

The Impact of the COVID-19 Pandemic on Corneal Transplantation in Brazil.

PURPOSE: The purpose of this study was to evaluate the impact of the coronavirus disease 2019 pandemic on corneal transplantation (CT) in Brazil. METHODS: Data from patients who underwent CT at the Hospital Oftalmológico de Sorocaba (HOS), Brazil, were analyzed. National and state numbers of keratoplasties, patients added to the CT waiting list, and total patients on the waiting list were also obtained. Baseline prepandemic (from January 1, 2019, to March 31, 2020) data were compared with 2 time frames of the coronavirus disease 2019 pandemic: elective CT suspension period (between April 1, 2020, and September 31, 2020) and after elective CT resumption (between October 1, 2020, and April 30, 2021). RESULTS: Despite elective CT resumption after the moratorium, the monthly CT rates did not return to baseline at HOS (-14.7%, P = 0.007), São Paulo state (-19.1%, P = 0.001), or Brazil (-30.1%, P < 0.001). The waiting list increased significantly regionally (P < 0.001) and nationally (P < 0.001). Among optical keratoplasties performed at HOS after resuming elective CTs, the proportion of endothelial keratoplasties declined from 38.2% to 30.0% (P < 0.001), whereas penetrating keratoplasties increased from 33.2% to 39.5% (P < 0.001) when comparing with prepandemic data. CONCLUSIONS: Keratoplasty numbers dropped significantly locally, regionally, and nationally. Hence, the CT waiting lists had a progressive increase, with significant long-term implications. An estimated increment on monthly CT rates of approximately 34% in São Paulo state, and 91% in Brazil, is required for the CT waiting list to get back to prepandemic numbers over the next 2 years.

Validating potential organ and tissue donors in the middle of the COVID-19 pandemic: Scoping review and recommendations construction.

OBJECTIVE: To identify the available information to support registered nurses' clinical decisions in assessing and validating potential organ and tissue donors during the COVID-19 pandemic. METHOD: This is a scoping review developed in six stages. The sixth stage was developed with registered nurses who work in the Brazil Organ Donation System. To consolidate the information and prepare all assumptions, the legislation in force in Brazil was followed. RESULTS: Recommendations from 19 articles identified in the literature were analyzed; additionally, 52 professionals who work at Brazil Organ Donation System participated in the research. Four care assumptions were formed: investigation of community transmission, investigation of clinical situations, screening for COVID-19 signs and symptoms, and investigation of alterations presented in the physical examination. Such assumptions are formed by 34 care guidelines. DISCUSSION: Care assumptions were prepared to guide and support registered nurses during assessment and validation of potential organ and tissue donors. From this perspective, assumptions certainly promote safety, effectiveness and quality in the service offered during the organ and tissue donation process in the midst of the COVID-19 pandemic, in addition to empowering registered nurses in this scenario. Quality and bio-surveillance through the donation stages have been discussed extensively in recent times, to improve donation and transplantations by valuing care, safety, and quality of life of recipients. CONCLUSION: The care assumptions presented in this study support and subsidize the daily practice of registered nurses who work in assessing and validating potential organ and tissue donors, enabling these professionals to make decisions based on secure information.

São Paulo State Liver Transplantation Supply Chain Study.

BACKGROUND: The number of liver transplantations is increasing worldwide, and Brazil ranks in the second position. It has one of the biggest public health care systems, which is responsible for the coordination and financial funding of transplantation procedures. Meeting the demands of such a large system of transplantation has become a challenge, particularly when attempting to minimize costs of scarce and expensive resources. The aim of this study was to investigate the process of donation, the retrieval of organs, and the transplantation itself using engineering methods based on logistics analyses. METHODS: Three steps were used: study planning, data gathering, and data analysis. Researchers surveyed professionals to acquire raw information based on their observations, experience, and knowledge. Then, a data analysis was conducted, putting together all the information gathered during the previous steps. Bias was removed, and conflicting perceptions were resolved in order to have a standard view on the transplantation process. RESULTS: Data was gathered between 2014 and 2018 and included 5502 liver donors and 2678 (48.7%) patients who received liver transplants organs. A total of 2824 organs were refused because of logistics issues (transport and handling). Interviews of health care professionals enabled the design of a process map in which 4 stakeholders were identified: patient, physician, organ, and information. CONCLUSIONS: The liver transplantation process is analyzed based on a supply chain methodology applying this knowledge and putting together medical and engineering sciences to promote better efficiency and outcomes for the transplantation program. Future studies should focus on the implementation of these ideas aiming to promote optimization gains in any step of the process.

Solid Organ Transplantation Activities Evolution in Brazil: Analysis of 20 Years.

BACKGROUND: From 1968 until 1997, transplantation-related activities were not properly regulated and were informally practiced. During 20 years, many legal and political changes influenced it. OBJECTIVE: To provide a historical overview of the 20 years with a descriptive data analysis of a 20-year data set. METHODOLOGY: We investigated information from Brazilian Transplantation Reports between 1997 and 2017. In this way, we classified all data into 5 Brazilian macro regions: Center-West, Northeast, North, Southeast, and South. In total, we included 27 states (including Capital District) and limited study to the heart, liver, and kidney. RESULTS: We analyzed 2835 data entries and associated population information from the Brazilian Institute of Geography and Statistics. We observed 2 distinct groups, one uniquely formed by the North region, with figures significantly lower than the remaining regions. After 2003, Southeast, South, and Northeast regions indicated a growing movement, whereas Center-West indicated certain stability in 50 and ranging between 50 and 100 cases (yearly basis) after 2011. Recently (2016 and 2017), the South region indicates another crescendo movement suggesting another detachment from the other regions, but it is something not clearly observed and, if true, should be figured in new reports of Brazilian Association of Organ Transplantation. CONCLUSION: This study identified and observed the time-spatial progress of organ transplantation in Brazil. In conclusion, after analysis of this 20-year data consolidation related to organ transplantation in Brazil, we observed a public investment in implementing quality evaluation and safety to provide figures that deliver visibility to the numbers reported in this article.