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OBJECTIVE: To position the Brazilian Transplant System within the context of the 4 Strategic Lines of Action proposed by the Pan-American Health Organization. METHOD: A specialist analysis was conducted through comparative analyses of the 4 Strategic Lines of Action, objectives, and indicators outlined in the Action Plan, along with the donation and transplantation system in accordance with Brazilian transplantation law. Subsequent to an in-depth review of the document issued by the health authority, a series of meetings involving 8 specialists in organ donation and transplantation were conducted. During these meetings, discussions were carried out with the objective of numerically interpreting each strategy presented in the document, and recommendations constructed. RESULTS: Four strategies were evaluated and only 2 of them the third (81,3%) and the fourth (90%) do not achieve the indicators to complete the objective related to equitable access to organ, tissue, and cell transplants in Brazil. CONCLUSION: The recommendations developed carry importance, as they are innovative and contribute to the establishment of priorities when shaping public policies. The report not only highlights indicators that were not satisfactorily met but also provides insights into the recommendations formulated to improve those indicators that have already been achieved and to work toward achieving those that have not yet been realized. Additionally, these recommendations can justify actions and establish priorities for research efforts in the field.

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Global conflicts and humanitarian crises have resulted in an unprecedented number of refugees and migrants. This challenges the limited resources of health care systems and jeopardizes the availability of transplant care for these deserving migrants and refugees. This was the basis for a workshop held during the Congress of the Transplantation Society (Buenos Aires, 2022). We elaborate on the proceedings of the workshop entitled "Transplantation in the Context of Migration and Refugees," organized by the Ethics Committee of The Transplantation Society and Declaration of Istanbul Custodian Group. Transplant providers from around the world shared strategies of how each region has responded to providing access to care for refugees and migrants in need of transplant services. The potential exploitation of this vulnerable group leading to illicit organ removal was addressed for each region. The Transplantation Society, Declaration of Istanbul Custodian Group, and global transplant community should continue to focus on the status of refugees and migrants and collaborate on strategies to provide access to transplant care for this deserving population. Global cooperation will be essential to provide vigilant oversight to prevent exploitation of this vulnerable population.

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Chile made several legal, practical and educational changes to the organ donation and transplant system in recent years, to improve its results. However, studies evaluating these reforms and suggesting further corrections are still pending. Our aim is to assess the new regulations and their reception by both the population and health care providers. Proposals are made to promote the development of a model of Chilean transplantation able to respond to the needs of the population.

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Chile made several legal, practical and educational changes to the organ donation and transplant system in recent years, to improve its results. However, studies evaluating these reforms and suggesting further corrections are still pending. Our aim is to assess the new regulations and their reception by both the population and health care providers. Proposals are made to promote the development of a model of Chilean transplantation able to respond to the needs of the population.

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Tissue storage is a medical process that is in the regulation and homogenisation phase in the scientific world. The international standards require the need to ensure safety and efficacy of human allografts such as skin and other tissues. The activities of skin and tissues banks currently involve their recovery, processing, storage and distribution, which are positively correlated with technological and scientific advances present in current biomedical sciences. A description is presented of the operational model of Skin and Tissue Bank at INR as successful case for procurement, recovery and preservation of skin and tissues for therapeutic uses, with high safety and biological quality. The essential and standard guidelines are presented as keystones for a tissue recovery program based on scientific evidence, and within an ethical and legal framework, as well as to propose a model for complete overview of the donation of tissues and organ programs in Mexico. Finally, it concludes with essential proposals for improving the efficacy of transplantation of organs and tissue programs.

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INTRODUÇÃO: Ainda que o Brasil possua um dos maiores programas de transplantes públicos do mundo, verificou-se que há pouca divulgação desta área em relação aos fatores que determinam um déficit na captação de órgãos e tecidos para transplante. O processo de doação de órgãos precisa do apoio da sociedade para que esta seja beneficiada. OBJETIVO: Determinar os fatores que influenciam na decisão familiar no processo de captação de órgãos e tecidos no Hospital Metropolitano de Urgência e Emergência do Estado do Pará. METODOLOGIA: Um estudo transversal prospectivo, de caráter exploratório, descritivo e de abordagem quantitativa. Participaram os familiares de pacientes que estiveram nas unidades de internação. Amostragem não probabilística, definida pelo critério de intencionalidade proporcional, com 50 entrevistados. Foi utilizado um formulário como instrumento para coleta de dados. Foram realizadas análises de independência a partir dos testes estatísticos Qui-quadrado com nível de significância de (n) de 5% no software SPSS. RESULTADOS E DISCUSSÃO: OS dados sociodemográficos demonstram predomínio de mulheres, a maioria na faixa economicamente ativa e tinham o ensino fundamental completo ou maior. Em relação ao fator religião, nenhuma foi antagônica à doação e captação de órgãos. Os entrevistados apresentaram fatores predominantes: "ajudar ao próximo" e "decisão pessoal", desse modo, observamos que a vontade é um fator inerente ao ser humano. 52% dos entrevistados ainda acham que é necessário que esteja escrito na carteira de identidade se é ou não favorável à doação de órgãos. A Televisão correspondente a 82% dos veículos de comunicação utilizada pelos entrevistados. É clara a falta de conhecimento da população sobre o Hospital Metropolitano estar envolvido com o tema transplante quando 92% não sabiam dessa relação. CONCLUSÃO: Identificamos fatores que influenciam a decisão em doação de órgãos de familiares, como: sexo, religião, unidade de internação, veiculação de informações, e acima de tudo o fator humano como maior influência. Conseguimos traçar um perfil da população abordada. Se faz necessário divulgar e discutir o tema entre o meio científico e a população leiga, pois somente a família tem permissão para o consentimento à doação

INTRODUCTION: Although Brazil has one of the largest public transplantation programs in the world, it was found that there is little disclosure of this area in relation to the factors that determine a deficit in the harvesting of organs and tissues for transplantation. The organ donation process needs the support of society for it to be benefited. OBJECTIVE: To determine the factors that influence in family decision in the process of harvesting of organs and tissues in the Metropolitan Hospital Urgent and Emergency of Pará country. METHODS: A prospective cross-sectional study, exploratory, descriptive and quantitative approach. Attended by family members of patients who have been in inpatient units. Nonprobability sampling, defined by the proportional intentionality criterion. with 50 respondents. A form has been used as a tool for data collection. Independence analyzes were performed from the Chi-square statistical tests with significance level (u) of 5% in the SPSS software. RESULTS AND DISCUSSION: The demographic data show a predominance of women, most in the economically active group and had completed primary school or higher. In relation to the religion factor, none was antagonistic to the donation and organ procurement. Respondents showed predominant factors: "helping others" and "personal decision" thus observed that the will is an inherent factor to humano 52% of respondents still think it needs to be written in the identity card whether 01' not in favor of organ donation. Television corresponding to 82% of the media used by the interviewees. There is a clear lack of knowledge of the population of the Metropolitan Hospital to be involved with the theme transplant when 92% did not know of this relation. CONCLUSION: We identified factors that influence the decision to grant family of organs. Such as gender, religion, inpatient unit, serving information, and as the most influence is above all the human facto r. We were able to draw a profile of the covered population. Tt is necessary to disseminate and discuss the issue among the scientific community and the lay population, as only family is allowed to consent to donation organ

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El sistema de salud no redistribuye. Aunque debiera,porque es parte de la política social que se promete como correctivo de los desvíos concentradores de la economía. Pero la equidad no se ha discutido hasta ahora en los trasplantes de órganos, al menos en los sistemas universales como el argentino. Si existen, no encontramos publicaciones que prueben la existencia de inequidad en el proceso donación-trasplante de órganos. Sin embargo, esto se pone a la vista cuando re-elaboran los datos oficiales

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Latin America started its transplant activity early-as soon as the first transplants in the world took place. Its member states have created their laws of donation and transplantation also. The first laws for transplants in the region were created in Brazil in 1963. Subsequently, all states approved its regulatory framework for transplants. Until 2012, Nicaragua was the only country in the region that did not have a transplants law. In October 2013, Nicaragua adopted the "Law on Donation and Transplantation of Organs, Tissues and Cells for Human Beings," which consummates the process that creates the legal framework for donation and transplantation in Latin America, a journey of 50 years' duration, from Brazil's law to Nicaragua's law. This achievement is the fundament for searching an exercise of transplantation in a ground of accessibility, equity, ethics, and transparency as part of comprehensive health care services in the region.

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O transplante de órgãos e tecidos está consolidado mundialmente como recurso terapêutico utilizado para cura de doenças e melhoria da qualidade de vida em indivíduos acometidos por patologias crônicas. A complexidade do transplante de órgãos e tecidos e as estatísticas atuais que apontam para o sucesso da técnica levantam uma série de aspectos bioéticos envolvendo profissionais de diferentes áreas de atuação. A justificativa deste estudo é a recente estruturação de um serviço direcionado para o atendimento especializado e à pacientes cuja terapêutica indicada é o transplante hepático. O estudo objetivou descrever o fluxo de um serviço especializado ao atendimento em transplante hepático em um Hospital Universitário no estado de Santa Catarina, sul do Brasil e discutir os aspectos bioéticos intrínsecos aum serviço especializado no atendimento a esse tipo de transplante. Pesquisa qualitativa, do tipo estudo de caso, realizada em um serviço de transplante hepático. A coleta de dados ocorreu no período de novembro de 2013 a fevereiro de 2014, pela análise documental em prontuários de três pacientes submetidos ao transplante hepático e de fluxos de atendimento de enfermagem, entrevistas semiestruturadas realizadas com 11 profissionais da equipe multiprofissional e observação direta que consistiu em observar o fluxo do atendimento e rotinas do serviço em turnos integrais, após a aprovação pelo Comitê de Ética em Pesquisa, sob o número 454.283. A análise de dados foi realizada pela análise de conteúdo temática. Os resultados foram organizados e apresentados em dois manuscritos, o primeiro intitulado "Serviço especializado em transplante hepático em um hospital universitário: um estudo de caso" que se propõe a descrever o fluxo do serviço especializado no atendimento em transplante hepático, em que os resultados revelaram a atuação de uma equipe multiprofissional de forma coesa, com competência reconhecida por pacientes e demais setores da instituição e carências estruturais no serviço para atendimento de pacientes imunossuprimidos. O segundo, intitulado "Serviço de transplante hepático em um hospital universitário: olhar da bioética social"que discute os aspectos bioéticos intrínsecos de um serviço especializado no atendimento em transplante hepático. O estudo possibilitou melhor compreender a aplicação de uma das políticas públicas mais consolidadas em países desenvolvidos e em desenvolvimento, mas que suscita a todo o momento questões bioéticas que permeiam desde a decisão pela doação de órgãos até os aspectos legais e financeiros da terapêutica. E ainda, evidenciou que há espaço para pesquisas que articulem a política de transplante de órgãos à bioética social pois essa aproximação entre as temáticas acende questionamentos relacionados ao direito ao bem estar da população brasileira considerando a saúde como uma das dimensões que promovem qualidade de vida. Para os profissionais que atuam no serviço, o estudo apresentou e reconheceu os esforços despendidos por todos para tornar esse atendimento uma realidade para a população que é referenciada ao serviço de gastroenterologia deste hospital e assim, não necessita deslocar-se para outras cidades ou estados para obter a terapêutica com o êxito esperado na resolução de doenças

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BACKGROUND: In this article we present an economic evaluation of policies aimed at increasing deceased organ donation in Chile, a developing country that has low donation rates; it had 5.4 donors per million people (pmp) in 2010. METHODS: Expert opinions of leading participants in donation and transplantation were analyzed, resulting in a set of local policies aimed at increasing donation rates. Using previous results of reported cost savings of increasing kidney transplantation in Chile, we estimated the net benefits of these policies, as a function of additional donors. RESULTS: The main problem of the Chilean system seems to be the low capability to identify potential donors and a deficit in intensive care unit (ICU) beds. Among considered policies central to increase donation are the following: increasing human and capital resources dedicated to identifying potential donors, providing ICU beds from private centers, and developing an online information system that facilitates procurement coordination and the evaluation of performance at each hospital. Our results show that there is a linear relationship between cost savings and incremental donors pmp. For example, if these policies are capable of elevating donation rates in Chile by 6 donors pmp net estimated cost savings are approximately US $1.9 million. Likewise, considering the effect on patients' quality of life, savings would amount to around $15.0 million dollars per year. CONCLUSIONS: Our estimates suggest that these policies have a large cost-saving potential. In fact, considering implementation costs, cost reduction is positive after 4 additional donors pmp, and increasing afterward.

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By 2005, human organ trafficking, commercialization, and transplant tourism had become a prominent and pervasive influence on transplantation therapy. The most common source of organs was impoverished people in India, Pakistan, Egypt, and the Philippines, deceased organ donors in Colombia, and executed prisoners in China. In response, in May 2008, The Transplantation Society and the International Society of Nephrology developed the Declaration of Istanbul on Organ Trafficking and Transplant Tourism consisting of a preamble, a set of principles, and a series of proposals. Promulgation of the Declaration of Istanbul and the formation of the Declaration of Istanbul Custodian Group to promote and uphold its principles have demonstrated that concerted, strategic, collaborative, and persistent actions by professionals can deliver tangible changes. Over the past 5 years, the Declaration of Istanbul Custodian Group organized and encouraged cooperation among professional bodies and relevant international, regional, and national governmental organizations, which has produced significant progress in combating organ trafficking and transplant tourism around the world. At a fifth anniversary meeting in Qatar in April 2013, the DICG took note of this progress and set forth in a Communiqué a number of specific activities and resolved to further engage groups from many sectors in working toward the Declaration's objectives.

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A principios del año 2010 se reformó en Chile la antigua ley de donación y trasplante de órganos de 1996, instaurando una nueva forma de hacer donantes a los ciudadanos a través del llamado consentimiento presunto. A partir de lo anterior se analiza este concepto en relación a los pilares fundamentales del consentimiento informado; información, voluntariedad y capacidad, enfocado principalmente en los dos primeros. Respecto al principio de voluntariedad es claramente violado ya que actualmente no es necesario que la persona se manifieste para ser donante, sino que es posicionada automáticamente como tal a no ser que escoja lo contrario. Continuando con el análisis, se puede ver como la autoridad ha dejado de lado el principio de información, no poniendo énfasis en éste, a pesar de que la evidencia indica que es una forma efectiva de convencer a pacientes no donantes. La promulgación de la ley debe ser complementada con entrega de información y educación a los distintos sectores cívicos.

In early 2010, in Chile, the law of organ donation and transplantation from 1996 was amend ended, establishing a new form of organ donation to citizens through the presumed consent. From the above, this concept is analyzed according to the fundamental pillars of informed consent; information, voluntariness and capacity, mainly focused on the first two. Regarding the principle of voluntary it is clearly violated, as it is no longer necessary that the person chooses to be a donor if one does not manifest their willingness to not be one. Continuing with the analysis, it can be seen how the authority has neglected the principle of information, not emphasizing it, even though the evidence indicates that it is an effective way to convert non-donors. The enactment of the law must be supplemented by providing information and education to civic sectors.(AU)om the above, this concept is analyzed according to the fundamental pillars of informed consent; information, voluntariness and capacity, mainly focused on the first two. Regarding the principle of voluntary it is clearly violated, as it is no longer necessary that the person chooses to be a donor if one does not manifest their willingness to not be one. Continuing with the analysis, it can be seen how the authority has neglected the principle of information, not emphasizing it, even though the evidence indicates that it is an effective way to convert non-donors. The enactment of the law must be supplemented by providing information and education to civic sectors.

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