Causes of Brain Death and Medical Contraindications in Donors from Northwest Rio Grande do Sul (2019-2024)

ABSTRACT

Objective:  To analyze the causes of brain death and the medical conditions that prevent characterizing a potential donor as eligible, from 2019 to 2024 in the state of Rio Grande do Sul.

Methods:  A retrospective, quantitative, descriptive study based on data collected from the Organ Procurement Organization of the 4th region of Rio Grande do Sul, located at Hospital São Vicente de Paulo in the city of Passo Fundo, between August and October of 2025. Data collection involved reviewing of spreadsheets (Microsoft Excel®) from 2019 to 2024, as well as the organization of extracted information into graphs (Google Drive®). Records included both adults and children, excluding cases outside the established study period and contraindications due to family refusal. The variables analyzed were the cause of brain death, sex, and medical contraindications.

Results:  Between 2019 and 2024, approximately 583 brain death protocols were recorded, among which 68 contraindications were documented.

Conclusion:  The most common causes of brain death observed were cerebrovascular accident, traumatic brain injury, and subarachnoid hemorrhage. The main medical contraindications preventing a potential donor from becoming effective were neoplasms, active infections, and positive HIV serology. Additionally, female sex showed higher rates of medical contraindications.

Descriptors
Brain Death; Tissue Donors; Transplant Recipients; Transplantation; Tissue and Organ Procurement

RESUMO

Objetivo:  Analisar as causas de morte encefálica e condições médicas que impossibilitam caracterizar um potencial doador como elegível durante o período de 2019 a 2024 no estado do Rio Grande do Sul.

Métodos:  Estudo retrospectivo quantitativo descritivo criado a partir da coleta e análise de dados provenientes da Organização de Procura de Órgãos da quarta região do Rio Grande do Sul, localizada no Hospital São Vicente de Paulo, na cidade de Passo Fundo, durante os meses de agosto a outubro de 2025. Realizou-se a leitura de planilhas (Microsoft Excel®) referentes aos anos de 2019 a 2024 e a organização de informações extraídas por meio de gráficos (Google Drive®), incluindo-se adultos e crianças e, por sua vez, excluindo-se casos fora do período cronológico estabelecido e contraindicações por recusa familiar. As variáveis analisadas foram a causa de morte encefálica, sexo e contraindicações médicas.

Resultados:  Durante o período de 2019 a 2024, registraram-se cerca de 583 protocolos de morte encefálica abertos, entre os quais havia 68 contraindicações registradas.

Conclusão:  Observaram-se como causas mais comuns de morte encefálica o acidente vascular cerebral, o traumatismo crânioencefálico e a hemorragia subaracnoidea. As principais contraindicações médicas para um potencial doador tornar-se efetivo são neoplasias, infecções ativas e sorologia positiva para HIV, assim como o sexo feminino apresenta maiores índices de contraindicações médicas.

Descritores
Morte Encefálica; Doadores de Tecidos; Transplantados; Transplante; Obtenção de Tecidos e Órgãos

INTRODUCTION

The organ transplantation system is designed to prolong, improve, and save human lives. To this end, it requires the procurement of one or more organs from a living donor or a donor after brain death (BD). Successful transplantation depends not only on the physiological status of both donor and recipient, but also on a system that encompasses synchronous communication, transportation, procurement, preservation, and storage¹.

In Brazil, the Unified Health System (Sistema Único de Saúde — SUS) is the public system responsible for providing organ transplantation at the national level. When comparing data across Brazilian regions, states in the Southern region have the highest transplantation rates, whereas those in the Northern region have the lowest. In this regard, the availability of infrastructure, resources, and qualified professionals directly influences the success of transplantation^1,2.

Brain death is a definitive state characterized by complete and irreversible cessation of cortical and brainstem activity, resulting in permanent loss of organismal function. Causes of BD are generally sudden and acute, with stroke and traumatic brain injury (TBI) being the most prevalent. However, the existence of a patient with BD is not necessarily synonymous with eligibility for organ donation³.

The initial process leading to BD is based on vascular, traumatic, and hypoxic causes, encompassing intracranial origins (hemorrhage, ischemia, edema) and extracranial origins (cardiorespiratory arrest). Increased intracranial pressure precipitates edema and compression of brain structures, as well as venous engorgement and ischemia, ultimately resulting in brain death^4,5.

The most frequent causes of BD are stroke, which may be ischemic or hemorrhagic in nature, TBI, and anoxic encephalopathy following cardiac arrest. Other less frequent etiologies include acute infectious diseases of the central nervous system (CNS), brain tumours and metastases, and clinical conditions that lead to increased intracranial pressure^6-8.

The distinction between persistent vegetative state and BD is of paramount importance for initiating the brain death protocol. Persistent vegetative state involves some degree of neurological recovery, with complete or partial activity of hypothalamic and brainstem functions, together with autonomous maintenance of respiration and circulation, sleep-wake cycles, and a state of consciousness. BD is a condition in which neurological recovery at any level is impossible, resulting in the absence of total brain activity, sleep-wake cycles, and autonomic maintenance of respiration and systemic circulation⁶.

Reversible clinical conditions that may mimic BD and must be ruled out beforehand are hypothermia, intoxication due to illicit substance use, hydroelectrolytic, acid-base and endocrine disorders, as well as inadequate metabolism or indiscriminate use of drugs that exert suppressive action on the central nervous system or neuromuscular blockade — for example, fentanyl (opioid), morphine (opioid), propofol (hypnotic agent), and dexmedetomidine (alpha-2 adrenergic agonist)^6,9,10.

For a potential donor to become an eligible donor, laboratory evaluation and, when possible, imaging assessment are required to rule out infectious and neoplastic causes and to evaluate the function of the organ in question. Therefore, the steps and criteria that comprise donor eligibility classification must be rigorously followed to ensure the recipient's safety, health, and longevity^6,11.

Medical ineligibility of a potential donor is characterized as the second leading cause that precludes the completion of a transplantation, second only to family refusal¹². Examples of absolute contraindications include: infection with HIV, HTLV-I and II, and SARS-CoV-2 (for lung and intestinal transplantation); recent or active history of specific malignant neoplasms; uncontrolled or refractory sepsis; active infections caused by tuberculosis, malaria, mycobacteriosis, prions (suspected or confirmed cases), Chagas disease (for heart and intestinal transplantation), and fungal, viral, and parasitic infections; bacterial infections without antibiotic therapy for 24 hours; and donors with persistently positive blood cultures despite adequate treatment. In cases without a prior diagnosis of transmissible infectious disease, risk factors that may predispose to such conditions must be taken into account, such as individuals with a history of injectable drug use, prostitution, or maternal history of HIV, HBV, and HCV^6,11,13.

It is important to emphasize the publication of Ordinance GM/MS No. 8,041, dated September 25, 2025, which provides updated information regarding eligibility criteria and medical contraindications. Transplant candidates with positive HIV serology are authorized to receive organs from donors who also have positive serology in urgent situations, except for elective kidney transplants, which require a completed free and informed consent form, and antiretroviral therapy must be ensured for the recipient. After donor acceptance, blood samples must be collected for viral load detection and HIV genotyping, enabling adequate post-transplant care. However, sample results should not preclude the transplantation itself. Therefore, the presence of HIV will no longer be an absolute contraindication, but rather a relative one¹³.

Furthermore, seropositivity for hepatitis C virus is no longer an absolute contraindication; based on quantitative Nucleic Acid Test (NAT) collection from the donor, organ donation is possible. Donors testing positive for HBsAg for hepatitis B may have their organs used by transplant candidates who are seronegative or seropositive, except for liver transplantation, in which eligible candidates are those who are seropositive or at imminent risk of death, but with non-reactive HBsAg. After transplantation, it is crucial to ensure targeted treatment for such hepatitis in the recipient¹³.

Initiating the BD protocol is a crucial step toward achieving a successful organ transplantation. It is of utmost importance to correctly establish the diagnosis of BD, classify its cause, and identify potential contraindications. In the state of Rio Grande do Sul (RS), recent studies on this topic are scarce, making it necessary to provide updated data from the state of Rio Grande do Sul, particularly its northwestern area. Therefore, this study aims to address the causes of BD and conditions that preclude characterization of a donor as eligible between 2019 and 2024 in the state of RS.

METHODS

This was a descriptive, quantitative retrospective study based on the collection and analysis of data from the Organ Procurement Organization of the Fourth Region of Rio Grande do Sul (OPO4), located at Hospital São Vicente de Paulo (HSVP), in the city of Passo Fundo. The guiding question was: "What are the main causes of brain death and its medical contraindications between 2019 and 2024 in the northwestern region of Rio Grande do Sul?" The study included deaths resulting from BD in both adults and children between 2019 and 2024; records predating 2019 were excluded, as were cases due to family refusal, to quantitatively and descriptively analyze the number of BD records and the main medical contraindications that preclude donation. By reviewing spreadsheets (Microsoft Excel^®) provided by OPO4, attention was given to information explicitly described regarding the guiding question of this study.

Data collection was performed retrospectively from August to October 2025 and was divided into two phases. The first phase, conducted between August 28 and October 19, involved systematic reading and extraction of information from tables provided by OPO4. The second phase, between October 20 and 31, 2025, consisted of organizing data into spreadsheets (Microsoft Excel^®) and graphs (Google Drive^®), with tables prepared for each year analyzed, including the variables sex, cause of BD, and medical contraindication.

A single researcher was responsible for reading, transcribing, and organizing the information in a standardized manner, which was subsequently analyzed and verified by another member of the research team to minimize transcription errors and ensure data confidentiality. Manual data collection is recognized as a methodological limitation, although independent verification measures were applied to reduce bias and ensure consistency. This study was approved by the Research Ethics Committee under the Certificate of Presentation for Ethical Appraisal (CAAE) No. 94021525.5.0000.5319, in compliance with the guidelines of Resolution No. 466/12.

RESULTS

Between 2019 and 2024, OPO4 registered approximately 583 opened BD protocols. In descending order of the described causes leading to these deaths (Fig. 1), traumatic brain injury (TBI) accounted for 25.9% of the total (n=144); hemorrhagic stroke (HS), 24.8% (n=138); subarachnoid hemorrhage (SAH), 12.6% (n=70); ischemic stroke (IS), 11.7% (n=65); other more specific causes, 6.8% (n=38); infections, 5% (n=28); hypoxic-ischemic encephalopathy, 4.8% (n=27); unspecified stroke, 3.6% (n=20); neoplasms, 3.2% (n=18); and anoxic encephalopathy, 1.6% (n=9).

Figure 1
Causes of brain death in the Fourth Organ Procurement Region of Rio Grande do Sul (2019-2024).

In descending order of each item described (Fig. 1), during the study period, TBI and hemorrhagic stroke were the most common causes of BD, while SAH and ischemic stroke were also prominent etiologies. However, when grouping stroke subtypes (ischemic and hemorrhagic), totalling 203 cases, this pathology emerges as the leading cause of BD in the northwestern region of RS. When classifying causes of BD categorized as "other" (Fig. 2), the following were observed in descending order: unspecified brain injury (22.7%; n=5), brain abscess (13.6%; n=3), cerebral edema (13.6%; n=3), cardiac arrest (CA) (9.1%; n=2), ruptured aneurysm (9.1%; n=2), hydrocephalus (9.1%; n=2), nonconvulsive status epilepticus (9.1%; n=2), post-embolectomy (4.5%; n=1), polytrauma (4.5%; n=1), and intracranial hypertension (4.5%; n=1).

Figure 2
“Other” causes of BD and their prevalence in the OPO belonging to the Fourth Region of RS (2019-2024).

Traumatic brain injury (TBI) encompasses etiologies such as cerebral hematomas, with the subdural type being the most common, as well as gunshot wounds (GSW). The most prevalent infections analyzed in BD protocols are bacterial meningitis, but fungal meningitis, dengue, neurotoxoplasmosis, and HIV encephalitis were also documented. In parallel, neoplasms and cancers commonly present in protocols are reported only as "brain tumor "; consequently, it is not feasible to determine the specific type of brain tumour being described. The small portion that provided such detail documented myelocytic leukemia, medulloblastoma, and meningeal carcinomatosis in writing.

Based on 68 registered contraindications (Fig. 3), in descending order, neoplasms or cancers account for 41.5% (n=22); active infections, 18.9% (n=10); positive serology for HIV, 15.1% (n=8); advanced age, 9.4% (n=5); and sepsis, 9.4% (n=5). The category "neoplasia or cancer" includes: metastases, prostate cancer, breast cancer, acute promyelocytic leukemia, unspecified brain tumours, invasive adenocarcinoma of the rectum, meningeal carcinomatosis, medulloblastoma, and melanoma. Furthermore, the active infections recorded were dengue, bacterial meningitis, tuberculosis, Klebsiella pneumoniae carbapenemase (KPC), COVID-19, and unidentified etiologic agents.

Figure 3
Causes of contraindications for organ donation (2019-2024).

It is observed that the increase in BD during the analyzed period is synchronous with the number of contraindications during 2023 and 2024, while 2021 and 2022 show a reduction in contraindication records despite growth in BD. Furthermore, 2020 was the only year to show a decline in BD, accompanied by a rise in contraindications. Thus, an increase in contraindications was observed in 2023 and 2024 compared to the period from 2019 to 2022 (Fig. 4). Simultaneously, females are more affected by contraindications than males, accounting for 57.4% (n=39) of the total, while males account for 38.2% (n=26). Across all six years investigated, female numbers were never lower than male numbers; however, in 2019 and 2023, both sexes reached the same number of contraindications (Fig. 5).

Figure 4
Quantitative comparison between contraindications for organ donation and brain death (2019-2024).

Figure 5
Contraindications for organ donation by sex (2019-2024).

Among the 583 opened BD protocols in the northwestern region of Rio Grande do Sul, 34 of these documents are missing from the OPO4 data system (Fig. 6). In 2023 and 2024, a significant increase is observed regarding the absence of documents (BD protocols), due to failure to send them to OPO4 by the hospital teams responsible for opening such protocols.

Figure 6
Comparison between brain death records and missing documentation (2019-2024).

DISCUSSION

Annual reports from the Brazilian Transplant Registry (Registro Brasileiro de Transplantes – RBT) for the period from 2019 to 2024 show that the leading cause of BD at the national level is stroke, followed by TBI and anoxia. This fact is consistent with the results of this study, since, just as stroke and TBI are classified as major etiologies, SAH is the third most evident pathology in the northwestern region of Rio Grande do Sul, unlike anoxia. In parallel, the official United States transplant report (2023 Annual Data Report of the US Organ Procurement and Transplantation Network) indicates, in descending order, that anoxia, stroke, and TBI are the most frequent etiologies, while the Spanish transplant organization reveals in its most recent activity report (2024) that stroke, anoxia, and TBI represent the main causes of BD in its territory — showing a certain difference when compared to Brazilian data surveys^14-21.

Regarding medical contraindications, an epidemiological study conducted with the OPO in the state of Sergipe showed that sepsis, neoplasms, and HIV seropositivity were the main contraindications from 2011 to 2014. Likewise, in the state of Paraná, another scientific study, conducted in partnership with state OPOs between 2011 and 2016, demonstrated that sepsis and positive serologies are the predominant contraindications. When analyzing the prevalence of medical contraindications by sex, another epidemiological study conducted in Campo Grande, Mato Grosso do Sul, found that males had the highest number of contraindications in 2019. Comparing these data with the results of the present study, epidemiological differences are evident, given that in this study the most frequent medical contraindication is neoplasms, and females show the highest prevalence of contraindications^1,22,23.

According to the National Cancer Institute (Instituto Nacional de Câncer – INCA), the most recent estimates, published in 2026, reveal that Rio Grande do Sul has one of the highest cancer rates in Brazil, with a crude rate of 485.61 cases per 100,000 inhabitants – above the national average of 322 cases per 100,000 inhabitants. Considering that lifestyle habits have a strong influence on cancer incidence, conditions such as smoking, physical inactivity, population aging, and high consumption of red meat are risk factors for the development of neoplasms²⁴.

The broad medical terminology used to describe the causes of BD led to the creation of the category "others" (Fig. 2), which includes more specific causes of BD recorded in protocols. Understanding that a pathology can be both the origin and the consequence of various etiologies, it is necessary to identify the true reason that generated such death accurately. For example, according to medical literature, SAH can be a product of a ruptured aneurysm, trauma, arteriovenous malformation, or tumour, as well as a precursor to hydrocephalus, intracranial hypertension, and cerebral edema. The description of a cause of BD is subject to the professional responsible for completing the protocol and their level of training in this area^25,26.

It is important to emphasize that when studying BD protocols opened between 2019 and 2024, changes in the terminology used to classify causes are evident. Consequently, broader classifications such as "cerebral hemorrhage", "intracerebral hemorrhage", and "cerebral ischemia" became less frequently used over time, while strokes of unspecified etiology and SAH began to emerge, since the absence of specific data precludes assigning a specific hemorrhagic cause. For these reasons, this retrospective study considered "cerebral hemorrhage" and "intracerebral hemorrhage" as hemorrhagic stroke (H-stroke), as well as "cerebral ischemia" as ischemic stroke (I-stroke).

Furthermore, at the beginning of the COVID-19 pandemic, the Brazilian Ministry of Health (Ministério da Saúde – MS) published Technical Note No. 25/2020, which established that active coronavirus infection positivity was an absolute contraindication to organ donation. Thus, the data collected for 2020 and 2021 showed 5 contraindications, with COVID-19 infection as the main cause. However, in 2023, the MS, together with the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária – ANVISA), issued Technical Note No. 140/2023, establishing that potential donors with detection of active COVID-19 infection may be considered as organ donors, except for lung donation. Consequently, the following years showed no contraindications established solely due to positivity for COVID-19^27,28.

Based on data collected from OPO4 and its analysis, there is an increase in missing documentation within its records (Fig. 6), which made it impossible to identify patient-related information and, consequently, potential causes of BD. The absence of complete information compromises the quality of epidemiological studies and may affect the validity of the results. Therefore, this retrospective study is also affected by such variables.

CONCLUSION

The northwestern region of RS showed that the most common causes of BD in the analyzed period were stroke, followed by TBI and SAH. Furthermore, the main medical contraindications for a potential donor to become an actual donor are neoplasms, active infections, and positive serology for HIV, and females donors had higher rates of medical contraindications.

ACKNOWLEDGEMENT

We thank OPO4 and its staff for their availability and all the assistance throughout the preparation of this article.

DECLARATION OF USE OF ARTIFICIAL INTELLIGENCE TOOLS

The authors declare that no artificial intelligence tools were used in the preparation, writing, data analysis, or review of this manuscript.

FUNDING

Not applicable.

DATA AVAILABILITY STATEMENT

Data will be available upon request.

References

• ¹ Pogodin GF, Souza MC, Pompeo CM, Ferreira MA Júnior, Hildebrand CR, Ivo ML. Caracterização epidemiológica e causas da não doação por potenciais doadores de órgãos em morte encefálica. Rev Enferm UERJ. 2023 dez; 31(1): e72487. https://doi.org/10.12957/reuerj.2023.72487
  » https://doi.org/10.12957/reuerj.2023.72487
• ² Garcia VD, Abbud-Filho M, Felipe C, Pestana JM. An overview of the current status of organ donation and transplantation in Brazil. Transplantation. 2015 aug; 99 (8): 1535-1537. https://doi.org/10.1097/TP.0000000000000670
  » https://doi.org/10.1097/TP.0000000000000670
• ³ Goldman L, Schafer AI. Goldman-Cecil Medicina. 26 ed. Rio de Janeiro: Elsevier; 2022.
• ⁴ Robba C, Iaquaniello C, Citerio G. Death by neurologic criteria: pathophysiology, definition, diagnostic criteria and tests. Minerva Anestesiol. 2019 jul; 85 (7): 774-781. https://doi.org/10.23736/S0375-9393.19.13338-X
  » https://doi.org/10.23736/S0375-9393.19.13338-X
• ⁵ Yoshikawa MH, Rabelo NN, Welling LC, Telles JPM, Figueiredo EG. Brain death and management of the potential donor. Neurol Sci. 2021 jun; 42: 3541-3552. https://doi.org/10.1007/s10072-021-05360-6
  » https://doi.org/10.1007/s10072-021-05360-6
• ⁶ Garcia CD, Garcia VD, Pereira JD. Manual de doação e transplantes: informações práticas sobre todas as etapas do processo de doação de órgãos e transplante. Porto Alegre: Libretos; 2017.
• ⁷ Haussmann A, Yilmaz U. Brain death confirmation. Radiologe. 2020 apr; 60 (Suppl 1): 17-25. https://doi.org/10.1007/s00117-020-00674-6
  » https://doi.org/10.1007/s00117-020-00674-6
• ⁸ Bezerra GD, Clementino KMF, Silva MIC, Domingos JEP, Araújo IS, Vidal ECF, et al. Potenciais doadores de órgãos em morte encefálica: caracterização e identificação de diagnósticos de enfermagem. Cogitare Enferm. 2023; 28: e82345. https://doi.org/10.1590/ce.v28i0.87978
  » https://doi.org/10.1590/ce.v28i0.87978
• ⁹ Conselho Federal de Medicina. Resolução n.º 2.173/2017, de 23 de novembro de 2017. Define os critérios do diagnóstico de morte encefálica. Diário Oficial da União. 2017 dez. 15; p. 274. [acesso em 2025 abr 12]. Disponível em: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=15/12/2017&jornal=515&pagina=274&totalArquivos=280
  » https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=15/12/2017&jornal=515&pagina=274&totalArquivos=280
• ¹⁰ Spinello IM. Brain death determination. J Intensive Care Med. 2015;30(6):326-337. https://doi.org/10.1177/0885066613511053
  » https://doi.org/10.1177/0885066613511053
• ¹¹ Westphal GA, Garcia VD, Souza RL, Franke CA, Vieira KD, Birckholz VRZ, et al. Guidelines for the assessment and acceptance of potential brain-dead organ donors. Rev Bras Ter Intensiva. 2016; 28 (3): 220-255. https://doi.org/10.5935/0103-507X.20160049
  » https://doi.org/10.5935/0103-507X.20160049
• ¹² Correia WLB, Alencar SEM, Coutinho DTR, Gondim MM, Almeida PC, Freitas MC. Potencial doador cadáver: causas da não doação de órgãos. Enferm Foco. 2018; 9 (3): 30-34. https://doi.org/10.21675/2357-707X.2018.v9.n3.1150
  » https://doi.org/10.21675/2357-707X.2018.v9.n3.1150
• ¹³ Ministério da Saúde (BR). Portaria GM/MS n.º 8.041, de 25 de setembro de 2025. Diário Oficial da União. 2025 set 26; p. 1. [acesso em 2025 nov 4]. Disponível em: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?jornal=600&pagina=1&data=26/09/2025&totalArquivos=26
  » https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?jornal=600&pagina=1&data=26/09/2025&totalArquivos=26
• ¹⁴ Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes – 2024 [internet]. São Paulo; 2024. [acesso em 2026 abr 28]. Disponível em: https://site.abto.org.br/conteudo/rbt/
  » https://site.abto.org.br/conteudo/rbt/
• ¹⁵ Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes – 2023 [internet]. São Paulo; 2023. [acesso em 2026 abr 28]. Disponível em: https://site.abto.org.br/conteudo/rbt/
  » https://site.abto.org.br/conteudo/rbt/
• ¹⁶ Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes – 2022 [internet]. São Paulo; 2022. [acesso em 2026 abr 28]. Disponível em: https://site.abto.org.br/conteudo/rbt/
  » https://site.abto.org.br/conteudo/rbt/
• ¹⁷ Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes – 2021 [internet]. São Paulo; 2021. [acesso em 2026 abr 28]. Disponível em: https://site.abto.org.br/conteudo/rbt/
  » https://site.abto.org.br/conteudo/rbt/
• ¹⁸ Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes – 2020 [internet]. São Paulo; 2020. [acesso em 2026 abr 28]. Disponível em: https://site.abto.org.br/conteudo/rbt/
  » https://site.abto.org.br/conteudo/rbt/
• ¹⁹ Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes – 2019 [internet]. São Paulo; 2019. [acesso em 2026 abr 28]. Disponível em: https://site.abto.org.br/conteudo/rbt/
  » https://site.abto.org.br/conteudo/rbt/
• ²⁰ Scientific Registry of Transplant Recipients; Health Resources & Services Administration. OPTN/SRTR 2023 Annual Data Report [internet]. [S.I.]; 2023. [acesso em 2026 abr 28]. Disponível em: https://srtr.hrsa.gov/adr/2023/
  » https://srtr.hrsa.gov/adr/2023/
• ²¹ Organización Nacional de Trasplantes. Actividad de donación y trasplante España 2024. España: ONT; 2025. [acesso em 2026 abr 28]. Disponível em: https://www.ont.es/wp-content/uploads/2025/03/ACTIVIDAD-DE-DONACION-Y-TRASPLANTE-ESPANA-2024.pdf
  » https://www.ont.es/wp-content/uploads/2025/03/ACTIVIDAD-DE-DONACION-Y-TRASPLANTE-ESPANA-2024.pdf
• ²² Barreto BS, Santana RJB, Nogueira EC, Fernandez BO, Brito FPG. Fatores relacionados à não doação de órgãos de potenciais doadores no estado de Sergipe, Brasil. Rev Bras Pesq Saúde. 2016; 18 (3): 40-48. https://doi.org/10.21722/rbps.v18i3.15741
  » https://doi.org/10.21722/rbps.v18i3.15741
• ²³ Gois RSS, Galdino MJQ, Pissinati PSC, Pimentel RRS, Carvalho MDB, Haddad MCFL. Efetividade do processo de doação de órgãos para transplantes. Acta Paul Enferm. 2017; 30 (6): 621-627. https://doi.org/10.1590/1982-0194201700089
  » https://doi.org/10.1590/1982-0194201700089
• ²⁴ Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2026: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2026. [acesso em 2026 jun 2]. Disponível em: https://ninho.inca.gov.br/jspui/handle/123456789/17914
  » https://ninho.inca.gov.br/jspui/handle/123456789/17914
• ²⁵ Imberti R, Picetti E, Rossi S, Capaccio E, Accetta G, Klersy C, et al. Intracranial pressure monitoring in poor-grade patients with aneurysmal subarachnoid hemorrhage treated by coiling. World Neurosurg. 2021 dec; 156: e206-e214. https://doi.org/10.1016/j.wneu.2021.09.018
  » https://doi.org/10.1016/j.wneu.2021.09.018
• ²⁶ Bucheli-Chávez AC, Andrade-Bonilla MI, Jimbo-Bedón A, Mantilla-Cadena RD. Hemorragia subaracnoidea: etiología, epidemiología, diagnóstico y tratamiento: un artículo de revisión. Polo del Conoc. 2024 abr; 9(4): 553-567. https://polodelconocimiento.com/ojs/index.php/es/article/view/6950
  » https://polodelconocimiento.com/ojs/index.php/es/article/view/6950
• ²⁷ Ministério da Saúde (BR). Nota Técnica n.º 25/2020 – CGSNT/DAET/SAES/MS: critérios técnicos para triagem clínica do coronavírus (SARS, MERS, SARS-CoV-2) nos candidatos à doação de órgãos e tecidos e para manejo do paciente em lista de espera e do transplantado. Brasília: MS; 2020. [acesso em 2025 out 27]. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/notas-tecnicas/2020/nota-tecnica-no-25-2020-cgsnt-daet-saes-ms/view
  » https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/notas-tecnicas/2020/nota-tecnica-no-25-2020-cgsnt-daet-saes-ms/view
• ²⁸ Ministério da Saúde; Agência Nacional de Vigilância Sanitária (BR). Nota Técnica n.º 140/2023 – CGSNT/DAET/SAES/MS: gerenciamento do risco sanitário do SARS-CoV-2 para a doação e o transplante de órgãos e tecidos oculares. Brasília: Anvisa; 2023. [acesso em 2025 out 27]. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/sangue-tecidos-celulas-e-orgaos/notas-tecnicas/vigentes/SARSCoV2paradoacaoetransplantedeorgaosetecidosoculares
  » https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/sangue-tecidos-celulas-e-orgaos/notas-tecnicas/vigentes/SARSCoV2paradoacaoetransplantedeorgaosetecidosoculares

*

Corresponding author: [e-mail]

Section editor:

Ilka de Fátima Santana F. Boin https://orcid.org/0000-0002-1165-2149

CONFLICT OF INTEREST

Nothing to declare.

Publication Dates

• Publication in this collection
  02 Oct 2026
• Date of issue
  2026

History

• Received
  01 Apr 2026
• Accepted
  28 July 2026