[Need, Opportunity, and Accessibility: Application of the NOA method to analyze the effectiveness of the organ transplant system in BrazilNecesidad, oportunidad y accesibilidad: aplicación del método NOA para analizar la eficacia del sistema de trasplante de órganos en Brasil].

Abstract

Objective: To apply the NOA method, which integrates the dimensions of need, opportunity, and accessibility, to evaluate the effectiveness of kidney, liver, pancreas, heart, and lung transplants in Brazil.

Methods: This retrospective cohort study used data from the Brazilian Transplant Registry regarding transplant need (the sum of the number of patients on waiting lists in 2022 and the total number of patients added to the lists in 2023). Opportunity considered the number of transplants from living and deceased donors in Brazil; for the latter, a correction factor derived from data from the Global Observatory on Donation and Transplantation was applied. Accessibility represented the sum of the number of organ transplants from deceased and living donors. A percentage score was generated to measure transplant performance relative to supply in relation to demand. Utilization and completed transplant rates were also estimated.

Results: Performance ranged from 10% for kidney transplants, reflecting the mismatch between the waiting list and available grafts, to 64% for heart transplants. The South region had the highest utilization rate, while the North showed low organ availability, technical difficulties, and limited installed capacity.

Conclusion: The NOA method is an effective tool for measuring the performance of the donation and transplant system, identifying bottlenecks to guide public policies. In Brazil, it is urgent to implement strategies aimed at reducing regional disparities, strengthening technical capacity, and expanding equity and efficiency in access to transplantation.