Transplantes de córneas no estado do Rio Grande do Norte: possibilidades e desafios

Abstract

INTRODUCTION: This study addresses the barriers and challenges related to corneal transplants in the state of Rio Grande do Norte, Brazil. Corneal transplantation is the most frequently performed transplant procedure in Brazil, essential for restoring vision and improving patients' quality of life. However, there is a mismatch between the supply and demand for ocular tissues in the state, resulting in long waiting lists and significant impacts on patients' lives. OBJECTIVE: The main objective was to characterize corneal transplantation in Rio Grande do Norte (RN), analyzing the demographic profile of recipients, the types of corneas used, the service providers involved, and the reasons for not performing the procedure. Additionally, the study aimed to evaluate the waiting time until the transplant was performed. METHODS: This is an epidemiological, quantitative, cross-sectional, and descriptive study based on secondary data extracted from the National Transplant System (SNT), covering the period from January to July 2024. The study population consisted of patients residing in the state of Rio Grande do Norte who were registered on the SNT active waiting list during this period. Descriptive analyses were conducted using absolute and relative frequencies, as well as measures of central tendency. The difference in waiting time between groups was analyzed using the mean with a 95% confidence interval (CI). RESULTS: Of the 295 patients analyzed, only 133 (45.1%) underwent corneal transplantation during the study period. The average waiting time was 814.7 days, exceeding two years. Most recipients were female (56.6%), self-identified as mixed-race (62.6%), and residents of the interior regions of the state (61.7%). The main reasons for not undergoing the transplant were lack of clinical conditions (21.6%), patient refusal (19.7%), and voluntary withdrawal from the transplant list (13.6%). The Onofre Lopes University Hospital (HUOL) accounted for 43.9% of the procedures, and 85% of the transplants were performed through the Brazilian Unified Health System (SUS). Waiting time was significantly shorter when the transplant was performed in the private sector compared to procedures carried out within the SUS. CONCLUSIONS: The study reveals a scenario of imbalance between the supply and demand for corneas in Rio Grande do Norte, characterized by long waiting times, concentration of procedures in a few centers, and disparities in access. It also highlights the central role of the SUS in providing these transplants, although waiting times are shorter in the private sector. These findings indicate the need to improve management processes, expand the network of transplant services, strengthen donation campaigns, and optimize tissue procurement and transplant procedures.