AVALIAÇÃO ECONÔMICA DO NÃO-DOADOR E DO DOADOR EFETIVO DE ÓRGÃOS E TECIDOS PARA TRANSPLANTES

Abstract

Introduction: Transplantation consists of replacing an unhealthy organ with a healthy one, through organ donation procedures, through living donors or deceased donors (in brain death or after cardiorespiratory arrest). In Brazil, although several protocols are opened daily due to family refusal and clinical contraindications, the majority do not become effective donors. In this sense, there is a gap in knowledge in relation to the cost spent on these open protocols in relation to the outcomes of effective donors and non-donors of organs and tissues. Objective: To evaluate the global cost of the potential organ and tissue donor and by outcome (actual donor and non-donor) in a reference service of the Unified Health System with the development of software to estimate costs. Method: This research was carried out in three stages. Firstly, a systematic literature review was developed. In the second stage, a retrospective cohort study was carried out to analyze costs based on secondary data from medical records of patients who died and had a brain death protocol opened to harvest organs and tissues in a reference service in 2019. In the third stage, software was developed to collect cost data on obtaining organs and tissues for transplants. Results: The systematic review highlighted the lack of studies that dealt exclusively with the maintenance of potential donors and eligible donors of organs and tissues for transplants and no studies using micro-costing using the time-driven activity-based costing method were found. The retrospective cohort of 101 potential donors and eligible donors resulted in a total average maintenance cost of R$11,003.78, relating to healthcare professionals, exams, medications and indirect costs. The federal reimbursement amount varied between R$5,073.08 and R$6,522.53. The average cost of the actual donor was R$18,614.42 (minimum R$4,863.47 and maximum R$37,506.80). The cost for non-donors due to family refusal was R$7,783.75 (minimum of R$2,314.67 and maximum of R$17,136.52). The non-donor cost due to medical refusal was R$6,618.47 (minimum of R$1,317.47 and maximum of R$10,468.26). Organs and tissues donated, however, not collected totaled R$ 96,290.33. In the third stage, an information technology tool was developed, based on the systems development life cycle theory, through incremental process and prototyping models to prepare these costs. Conclusion: It is necessary to carry out more feasibility reviews in terms of costs for the Unified Health System, in relation to the opening of protocols for the maintenance of potential donors/eligible donors, effective donors and non-donors of organs and tissues, as cost outcomes impact financial losses for the system. The technology tool developed can contribute to this process by optimizing and reducing the time required to collect cost information from potential organ and tissue donors, as well as providing quality information with fewer data inconsistencies.