Miguel Caleb was only 4 months old when his mother realized that his heart was too big for his age. Santos’ Alan Martins was 36 when a vein in his head ruptured.
The two are on opposite ends of the national organ donation program. In 2018, the boy needed a new heart on the eve of his 2nd birthday, after months of unsuccessful treatment. The man, victim of an aneurysm, was the donor of the first multivisceral transplant in the state of Rio de Janeiro, in 2018.
This year, the topic of organ donation became hot after presenter Faustão, 73, underwent a heart transplant due to heart failure. The episode shed light and raised doubts about donation and the waiting list for an organ.
To explain the donation process, the Sheet followed the routine of the Municipalized Hospital Adão Pereira Nunes, in Duque de Caxias, in Baixada Fluminense. The unit is one of the country’s references in organ procurement.
Today, there are 41,428 people waiting for an organ transplant and 26,880 waiting for a cornea transplant. According to the Ministry of Health, there was an increase in the list of 8.9% and 12.2%, respectively, compared to last year.
The waiting list is part of the SNT (National Transplant System) and is managed by the State Transplant Centers. States monitor the list and manage donations and where each agency goes. To do this, three basic criteria follow: severity of the patient who will receive the donation, compatibility of the organ with the recipient and age, that is, how long he has been waiting for the organ.
Donations are only made with the authorization of the family of those who died due to brain death — in general, trauma patients or those who have suffered a stroke. The latter was the case with Alan. On the morning of March 8, 2021, he felt a severe headache and became partially paralyzed.
Alan was taken to Adão Pereira Nunes Hospital, but he ended up not resisting and was declared brain dead.
“Brain death is the death of the brain, and it is the brain that controls the entire organism. With the death of the brain, the neurophysiological mechanisms cause the other organs to continue functioning, but it is a matter of time before they also stop”, he explains Roberto Andrade Simões, coordinating physician at Adão Pereira Nunes, CIHDOTT (Intra-Hospital Coordination for Organ and Tissue Donation for Transplants).
CIHDOTT is the committee responsible for identifying potential donors and activating transplant centers. It is made up of doctors, nurses, social workers and specialized psychologists to inform the family about the death of their relative and ask about the possibility of donating.
“At the end of the brain death protocol, we do what we call a family interview: you give the news of the death and then do the interview to find out if the family is in favor of donating”, says Gilberto Malvar, nursing coordinator at CIHDOTT at Adão Pereira Nunes.
“Our job is to explain the severity of the patient with suspected brain death, what brain death is and what are the steps to confirm it. If the family doesn’t understand, we can’t even talk about donation.”
From January to September, the Ministry of Health recorded a drop in family denials. People had greater acceptance of donating their relatives’ organs. There were 6,065 interviews during this period, with a refusal rate of 42.8%. Compared to last year, there were 5,575 interviews, with 45.4% of cases being negative.
“You cannot do an appealing interview without being careful. It has to be very technical, with a lot of empathy and humanization. We have to provide as much information as possible so that the family can make the most conscious decision possible”, says Malvar.
In the first nine months of this year there was also a 15% increase in effective donors compared to last year. Until September, 2,776 donations were made.
A single donor can help up to eight people. In Alan’s case, he donated his liver, pancreas and intestine to the same recipient. Furthermore, he also donated his heart, kidneys and corneas to other patients.
Alan’s sister, Angélica Martins dos Santos, says she was afraid when asked about the possibility of donating. But, upon reflection, she decided to continue with the process.
“I told Gilberto [Malvar], ‘why not donate?’ My brother was a good person, what belonged to him also belonged to others. And today it comforts me a lot [ter feito a doação]. Of course I didn’t like my brother dying, I preferred having him here. But I’m proud of him for helping a lot of people.”
After brain death and the family’s acceptance, a race against time begins to complete the entire donation process and deliver the donor for burial. It is provided by law that he be returned to his family in a dignified manner.
“We give special treatment to the donor, he is our most seriously ill patient. It’s not that ‘the patient is dead, leave it in the corner’ thing. Nothing like that. [Depois do aceite da família] Our war begins to keep the donor in the best conditions so that he can donate and be returned to his family”, says Simões.
A Sheet He followed an organ harvesting surgery at the beginning of December and witnessed all the care common to any other type of surgery — the difference is that, in the case of donation, the patient is dead.
All instruments used are sterilized, as is the operating room. In addition to surgeons and nurses, the donor is also accompanied by an anesthesiologist, responsible for maintaining blood circulation in the organs.
The donor was Raul (fictitious name), 64, who died as a result of trauma. He donated his liver and both kidneys. The donor’s brain death was confirmed on Saturday night, and the harvesting surgery was performed on Sunday morning.
Each organ has a specialized team to capture it and a different ischemia time (without blood flow). The liver can last 8 to 12 hours outside the body, while the kidney can stay out of the body for up to 24 hours.
This difference also changes the donation process. Organs with a shorter ischemia time already have their receptors defined at the time the capture is made. For example, in cases of heart transplantation, which lasts only four hours outside the body, the person who will receive it enters the surgical center at the same time as the donor. And this happens in different hospitals. So there are transport logistics for the organization to avoid any delays.
Raul’s liver already had the receptor defined. He was taken by helicopter to Itaperuna, a city in the northwest of Rio that is 285 km from Caxias. By car, the journey would take around 5 hours, but by air, the journey takes around 1 and a half hours.
The kidneys, as they had a longer ischemia time, were taken to the PET (State Transplant Program) in Rio. From there, the center analyzes who will be the people who will receive the organs — following the criteria of severity, compatibility and age of the disease. list— and directs them to the hospitals where the donation will be made.
The other end
Malvar says that the work at CIHDOTT, which makes the entire donation process possible, is arduous and often consumes the professionals who are in charge of conversations with families. But it is also a rewarding job.
“We have to deal with the height of human pain. We only deal with those who are losing their loved one, it takes a lot of mental strength. But we do the work, because we know that on the other side there is someone who really needs it. of transplantation.”
The boy Miguel, who received the heart on the eve of his 2nd birthday, is now 7. At 4 months old, he was diagnosed with dilated cardiomyopathy, a disease that increases the size of the heart’s ventricles and disrupts the pumping of blood to the rest of the body. .
The boy’s mother, Paloma Maria Barreto, says that her son spent 1 year and 9 months practically living in the Laranjeiras hospital, in the south zone of Rio, where he was undergoing treatment.
Without success and with his health worsening, Miguel joined the list waiting for a new heart. The organ, collected at the Adão Pereira Nunes Hospital, arrived 17 days later. The boy underwent surgery on May 18, 2018.
“I never asked for a child to die so that Miguel could live. I asked God for him to be cured, for him not to need a transplant. But our will is not the same as God’s, right?”, says Paloma.
“If it weren’t for the transplant, my son wouldn’t be here today. And I’m very grateful to this family who donated their son’s heart. Without it, Miguel wouldn’t be here today”, highlights the mother.
Five years after the surgery, Miguel is a boy with curly hair and a wide smile who dreams of playing football.