Fatores associados à taxa de doações efetivas de órgãos sólidos por morte encefálica: uma análise espacial nas Unidades Federativas do Brasil (2012-2017)^♦

Abstract

This study analyzes the factors associated with the effective solid organ donation rate (heart, lungs, kidneys, liver, and pancreas) due to brain death in the Brazilian Federative Units (UF) from 2012 to 2017. For this purpose, Exploratory Spatial Data Analysis and the Spatial Durbin model with panel data were used. The conditioning factors used were divided into sociodemographic and health management. The existence of large regional disparities in the donation process among these areas was evidenced, with spatial clusters of high-high type in the southern region of the country. The results showed that population density positively affected these donations in the unit of analysis. This same signal was obtained when considering the impact of the variables lagged density, lagged schooling, and the effects of spatial spillovers. The lagged population aging rate negatively affected these donations in the unit of analysis, in addition to having indirect and total negative results on the donation rate in neighboring units. When considering the ethnic composition, through the proportion of non-whites, it was observed that the higher this proportion in each UF, the lower donation rate in that same unit, confirmed by the direct effect. The sign of this lagged explanatory factor and the indirect effect was negative. The emergency breathing rate proved to be important for the growth of the donation rate in the analyzed areas. The lag in the rate of beds in the Intensive Care Unit (UTI) had a negative effect on donations and the spillover effects (indirect and total effects) followed the same impact direction. The rate of organ transplantation teams negatively affected these donations in the unit of analysis; however, the effect of neighbors was positive, with a positive relationship in the indirect effect and a negative relationship in the direct one. The rate of deaths from neurological causes in each UF positively affected its donations, but this factor in neighboring units negatively affected the dependent variable, in addition to the direction of the direct effect being positive and the indirect effect being negative. The dummies referring to public policies that created the Organ Procurement Organizations (OPO’s) and the Intra-Hospital Commissions for the Donation of Organs and Tissues for Transplantation (CIHDOTT’s) showed positive total effects, indicating their importance in this process. It was concluded that the geographic and temporal behavior of solid organ donations in the federative units were explained by the sociodemographic and management conditions discussed. Effective decisions by the managers of this system, based on evidence, are necessary to improve the structural and dynamic performance of the donation process, especially in relation to regional differences in the supply of organs in the country.

Keywords
Economics-health; Offer-organs; Regional disparities-health; Spatial econometrics