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Humboldt Kolleg Humboldt Kolleg
Limits and Interfaces in ScienceLimits and Interfaces in ScienceHumboldt Kolleg Humboldt Kolleg
Limits and Interfaces in ScienceLimits and Interfaces in Science
The Future of Heart The Future of Heart
Transplantation in BrazilTransplantation in BrazilThe Future of Heart The Future of Heart
Transplantation in BrazilTransplantation in Brazil
Noedir A. G. StolfNoedir A. G. Stolf
[email protected]@incor.usp.br
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORKHISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORKC
arre
l
Car
rel
1905
1905
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
1940
1940
1905
1905
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORKHISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORK
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v Sh
umw
ay
Shum
way
1940
1940
1905
1905
1960
1960
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORKHISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORK
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
Mar
ques
Mar
ques
Shum
way
Shum
way
1940
1940
1905
1905
1960
1960
1962
1962
III Congresso Sul Americano de Cardiologia XXIII Congresso Brasileiro de Cardiologia
TRANSPLANTE ISOTÓPICO DO CORAÇÃO DE CÃES
Euclydes F. Marques, Noedir A.G. Stolf, Seigo Tsuzuki, Samuel R.Marek, Irimar P. Posso, Pedro C. Piantino e Euriclides J. Zerbini.
III Congresso Sul Americano de Cardiologia XXIII Congresso Brasileiro de Cardiologia
TRANSPLANTE ISOTÓPICO DO CORAÇÃO DE CÃES
Euclydes F. Marques, Noedir A.G. Stolf, Seigo Tsuzuki, Samuel R.Marek, Irimar P. Posso, Pedro C. Piantino e Euriclides J. Zerbini.
III Congresso Sul Americano de Cardiologia XXIII Congresso Brasileiro de Cardiologia
TRANSPLANTE ISOTÓPICO DO CORAÇÃO DE CÃES
Euclydes F. Marques, Noedir A.G. Stolf, Seigo Tsuzuki, Samuel R.Marek, Irimar P. Posso, Pedro C. Piantino e Euriclides J. Zerbini.
Os autores relatam os ensinamentos resultantes de 30 transplantes isotó-picos de coração em cães, obtendo-se 20casos de sobrevivência de um mínimode 2horas e um máximo de 26horas. São discutidos os fatores que Inflem noêxito do transplante. Os problemas a serem resolvidos em tal experimentaçãorelacionam-se à técnica cirúrgica, preservação do hospedeiro durante o trans-Plante, preservação do coração durante o transplante e recuperação do coração.Assim são discutidos as diferentes técnicas de transplante, no que tange a viade acesso, tipo de suturas, prevenção de embolia gasosa, problemas de drena-gem de veias cavas. Apresentam-se as diferentes maneiras com que se conser-vou vivo o hospedeiro durante a troca do coração. Foi utilizada sempre a circu-lação extracorpóreacom oxigenadores de Zuhdi, Kay-Cross e ainda um modeloexperimental original da oficina “Coração Pulmão-Artificial” do Hospital das Clíni-
III Congresso Sul Americano de Cardiologia XXIII Congresso Brasileiro de Cardiologia
TRANSPLANTE ISOTÓPICO DO CORAÇÃO DE CÃES
Euclydes F. Marques, Noedir A.G. Stolf, Seigo Tsuzuki, Samuel R.Marek, Irimar P. Posso, Pedro C. Piantino e Euriclides J. Zerbini.
Os autores relatam os ensinamentos resultantes de 30 transplantes isotó-picos de coração em cães, obtendo-se 20casos de sobrevivência de um mínimode 2horas e um máximo de 26horas. São discutidos os fatores que Inflem noêxito do transplante. Os problemas a serem resolvidos em tal experimentaçãorelacionam-se à técnica cirúrgica, preservação do hospedeiro durante o trans-Plante, preservação do coração durante o transplante e recuperação do coração.Assim são discutidos as diferentes técnicas de transplante, no que tange a viade acesso, tipo de suturas, prevenção de embolia gasosa, problemas de drena-gem de veias cavas. Apresentam-se as diferentes maneiras com que se conser-vou vivo o hospedeiro durante a troca do coração. Foi utilizada sempre a circu-lação extracorpóreacom oxigenadores de Zuhdi, Kay-Cross e ainda um modeloexperimental original da oficina “Coração Pulmão-Artificial” do Hospital das Clíni-
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORKHISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – LABORATORY LABORATORY
WORKWORK
23 de Janeiro de 196423 de Janeiro de 1964
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
Mar
ques
Mar
ques
Shum
way
Shum
way
1940
1940
1905
1905
1960
1960
1962
1962
1964
1964
Har
dy
Har
dy
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – CLINICAL CLINICAL
APPLICATIONAPPLICATIONHISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – CLINICAL CLINICAL
APPLICATIONAPPLICATION
1964
1964
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
Har
dy
Har
dy
Mar
ques
Mar
ques
Shum
way
Shum
way
1940
1940
1905
1905 19
6719
67B
arna
rd
Bar
nard
1960
1960
1962
1962
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – CLINICAL CLINICAL
DEVELOPMENTDEVELOPMENT HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – CLINICAL CLINICAL
DEVELOPMENTDEVELOPMENT
1964
1964
1967
1967
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
Har
dy
Har
dy
Mar
ques
Mar
ques
Shum
way
Shum
way
Bar
nard
Bar
nard
1940
1940
1905
1905
1968
1968
Zerb
ini
Zerb
ini
1960
1960
1962
1962
HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – HISTORICAL TRANSP. HISTORICAL TRANSP.
PERIOD..PERIOD..HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – HISTORICAL TRANSP. HISTORICAL TRANSP.
PERIOD..PERIOD..
1964
1964
1967
1967
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
Har
dy
Har
dy
Mar
ques
Mar
ques
Shum
way
Shum
way
Bar
nard
Bar
nard
1940
1940
1905
1905
1968
1968
Zerb
ini
Zerb
ini
1960
1960
1962
1962
1984
1984
Nes
ralla
Nes
ralla
Era pós-ciclosporinaEra pós-ciclosporinaHISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION – HISTORY OF HEART TRANSPLANTATION –HISTORY OF HEART TRANSPLANTATION –
1964
1964
1967
1967
Car
rel
Car
rel
Dem
ikho
v
Dem
ikho
v
Har
dy
Har
dy
Mar
ques
Mar
ques
Shum
way
Shum
way
Bar
nard
Bar
nard
1940
1940
1905
1905
1968
1968
Zerb
ini
Zerb
ini
1960
1960
1962
1962
1984
1984
Nes
ralla
Nes
ralla
1985
1985
.Inco
r
.Inco
r
HISTORY OF HEART TRANSPLANTATIONHISTORY OF HEART TRANSPLANTATIONHISTORY OF HEART TRANSPLANTATIONHISTORY OF HEART TRANSPLANTATION
INTERNACIONAL REGITRY ISHLTINTERNACIONAL REGITRY ISHLT INTERNACIONAL REGITRY ISHLTINTERNACIONAL REGITRY ISHLT
ISHLT Taylor DO. - J Heart Lung Transplant 2005;24: 945-98Taylor DO. - J Heart Lung Transplant 2005;24: 945-98
189 317669
1185
2160
2718
31573383
40314196 4219 4389 4435 4358 4251 4157
38183547 3402 3340 3252 3135
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Nº
Tra
ns
pla
nts
189 317669
1185
2160
2718
31573383
40314196 4219 4389 4435 4358 4251 4157
38183547 3402 3340 3252 3135
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Nº
Tra
ns
pla
nts
20052005
years
110
64
19
119
61
16
128
64
9
147
71
14
175
93
24
206
105
19
196
92
30
139
60
16
136
46
15
200
74
29
100
75
23
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Brasil São Paulo InCor
Heart TransplantHeart TransplantHeart TransplantHeart Transplant
Sources: SES/SP – CTX & ABTOSources: SES/SP – CTX & ABTOSources: SES/SP – CTX & ABTOSources: SES/SP – CTX & ABTO
Number of Transplants Number of Transplants
ABTO RegistryABTO Registry – – 20092009
69 Registered ( 25 69 Registered ( 25 Active )Active )
• 1,1 HTX / million 1,1 HTX / million InhabitantInhabitant
ABTO RegistryABTO Registry – – 20092009
69 Registered ( 25 69 Registered ( 25 Active )Active )
• 1,1 HTX / million 1,1 HTX / million InhabitantInhabitant
Heart Transplants Heart Transplants Heart Transplants Heart Transplants
Indication – Brazil Indication – Brazil
From 1984 to 1999 – 835 Transplants From 1984 to 1999 – 835 Transplants
Chagas 13%Chagas 13%Chagas 13%Chagas 13%
Idiopathic 56%Idiopathic 56%Idiopathic 56%Idiopathic 56%
Ischemic 22%Ischemic 22%Ischemic 22%Ischemic 22%
Congenital 2%Congenital 2%Congenital 2%Congenital 2%
Valvar 3%Valvar 3%Valvar 3%Valvar 3%
Other 4%Other 4%Other 4%Other 4%
Ann Thorac Surg 2001; 71:1853Ann Thorac Surg 2001; 71:1853Ann Thorac Surg 2001; 71:1853Ann Thorac Surg 2001; 71:1853
Heart Transplants Heart Transplants Heart Transplants Heart Transplants
Indication – Brazil Indication – Brazil
From Jan 1995 to Dec 2004 – 482 From Jan 1995 to Dec 2004 – 482 Transplants Transplants
Brazilian Registry of Transplants – ABTO (2007)Brazilian Registry of Transplants – ABTO (2007)Brazilian Registry of Transplants – ABTO (2007)Brazilian Registry of Transplants – ABTO (2007)
ICM 24 %
Chagas 23 %
DCM 39 %
Other10 %
Valvar 3 %
Congenital 1 %
Heart Transplantation Heart Transplantation
Heart Institute University of Sao Paulo Medical SchoolHeart Institute University of Sao Paulo Medical School
Heart Transplantation Heart Transplantation
Heart Institute University of Sao Paulo Medical SchoolHeart Institute University of Sao Paulo Medical School
3
9
13
17
910
12
2018
22
17
14
21
1816
24
19
15
20
31
27
35
22
19
36
24
0
5
10
15
20
25
30
35
40
3
9
13
17
910
12
2018
22
17
14
21
1816
24
19
15
20
31
27
35
22
19
36
24
0
5
10
15
20
25
30
35
40
Year
N°
Tra
nspl
ants
N°
Tra
nspl
ants
InCor – 1985 a 2009InCor – 1985 a 2009
472472 TransplantsTransplants
InCor – 1985 a 2009InCor – 1985 a 2009
472472 TransplantsTransplants
Chagas Disease Chagas Disease Chagas Disease Chagas Disease
INDICATION – HEART INST -USP INDICATION – HEART INST -USP INDICATION – HEART INST -USP INDICATION – HEART INST -USP
472 Transplants (Adult-406) 472 Transplants (Adult-406) From 1985 to 2009 From 1985 to 2009
ICM 24,1%
Chagas 16,9%
DCM 44,8%
Other5,0%
Valvar 4,7%
Congenital 14,07%
Heart Institute of the University of São Paulo- InCorHeart Institute of the University of São Paulo- InCor
%%
Follow-up (years)Follow-up (years)
00
2020
4040
6060
8080
100100
00 11 22 33 44 55 66 77 88 99 1010 1111 1212
Bocchi EA e Fiorelli AI -J Heart Lung Transplant. 2001 Jun;20(6):637-45.Bocchi EA e Fiorelli AI -J Heart Lung Transplant. 2001 Jun;20(6):637-45.
HEART TRANSPLANTATION – SURVIVAL – COMPARATIVEHEART TRANSPLANTATION – SURVIVAL – COMPARATIVE
ISHLTISHLTn = 835n = 835
Br*Br*
Chagas’-14,7%Chagas’-14,7%
Idiopathic-51%Idiopathic-51%
Ischemic-24,6%Ischemic-24,6%Waitting List-ChagasWaitting List-Chagas
Waitting List- Non ChagasWaitting List- Non Chagas’
I Guideline Brazilian Society of CardiologyI Guideline Brazilian Society of CardiologyHeart Transplantation (I GHT)Heart Transplantation (I GHT)
I Guideline Brazilian Society of CardiologyI Guideline Brazilian Society of CardiologyHeart Transplantation (I GHT)Heart Transplantation (I GHT)
p < 0,0277p < 0,0277p < 0,0277p < 0,0277
Follow up (Years)Follow up (Years)Follow up (Years)Follow up (Years)
Perc
en
tag
e (
%)
Perc
en
tag
e (
%)
Perc
en
tag
e (
%)
Perc
en
tag
e (
%)
Survival after HTXSurvival after HTX
Ann Thorac Surg 2001; 71:1853Ann Thorac Surg 2001; 71:1853Ann Thorac Surg 2001; 71:1853Ann Thorac Surg 2001; 71:1853
Quality of Life Quality of Life
%%
00
2020
4040
6060
8080
100100
Physical activity Physical activity
Symptoms Symptoms Sleep Sleep Food Food Sexual activity Sexual
activity
Pre-Op.Pre-Op. 12 Months12 Months6 Months6 Months
HEART TRANSPLANTATION –HEART TRANSPLANTATION – RESULTS RESULTSHEART TRANSPLANTATION –HEART TRANSPLANTATION – RESULTS RESULTS
Borghetti-Maio et al. - J Heart Lung Transpl 1994; 13: 271-5Borghetti-Maio et al. - J Heart Lung Transpl 1994; 13: 271-5
HEART TRANSPLANTATION – HEART TRANSPLANTATION – QUALITY OF LIFEQUALITY OF LIFE HEART TRANSPLANTATION – HEART TRANSPLANTATION – QUALITY OF LIFEQUALITY OF LIFE
Contraindications Contraindications – MedicalMedical
– Psychosocial Psychosocial
Shortage of donorsShortage of donors– Mortality in waiting listMortality in waiting list
Present ImmunosuppressionPresent Immunosuppression– Lack of Specificity Lack of Specificity
– Toxicity Toxicity
Contraindications Contraindications – MedicalMedical
– Psychosocial Psychosocial
Shortage of donorsShortage of donors– Mortality in waiting listMortality in waiting list
Present ImmunosuppressionPresent Immunosuppression– Lack of Specificity Lack of Specificity
– Toxicity Toxicity
HEART TRANSPLANTATION – HEART TRANSPLANTATION – LIMITATIONSLIMITATIONS HEART TRANSPLANTATION – HEART TRANSPLANTATION – LIMITATIONSLIMITATIONS
HEART TRANSPLANTATION – HEART TRANSPLANTATION – CONTRAINDICATIONSCONTRAINDICATIONS HEART TRANSPLANTATION – HEART TRANSPLANTATION – CONTRAINDICATIONSCONTRAINDICATIONS
Transplants14,4%
Transplants14,4%
Patient Refusal 2,6%
Patient Refusal 2,6%
Conventional Surgery 3,1%Conventional Surgery 3,1%Psychological
6,0%Psychological
6,0%
Heart- Institute Heart- Institute 380 Cases referred380 Cases referred
1991 a 19931991 a 1993
Heart- Institute Heart- Institute 380 Cases referred380 Cases referred
1991 a 19931991 a 1993
Freitas HFG et al. – Arq Bras Cardiol 62:233-237, 1994.Freitas HFG et al. – Arq Bras Cardiol 62:233-237, 1994.
Social11,3%Social11,3%
Improves Clinical 18,1%
Improves Clinical 18,1%
Cardiomyoplasty 2,3%
Cardiomyoplasty 2,3%
Medical7,8%
Medical7,8%
• Age: 16 - 68a (43,5±11,4a)• Men: 79,7%• Women: 20,3%
• Age: 16 - 68a (43,5±11,4a)• Men: 79,7%• Women: 20,3%
Freitas HFG et al. – Arq Bras Cardiol 62:233-237, 1994.Freitas HFG et al. – Arq Bras Cardiol 62:233-237, 1994.
HEART TRANSPLANTATION – HEART TRANSPLANTATION – CONTRAINDICATIONSCONTRAINDICATIONS HEART TRANSPLANTATION – HEART TRANSPLANTATION – CONTRAINDICATIONSCONTRAINDICATIONS
Transplants14,4%
Transplants14,4%
Patient Refusal 2,6%
Patient Refusal 2,6%
Conventional Surgery 3,1%Conventional Surgery 3,1%Psychological
6,0%Psychological
6,0%
Heart- Institute Heart- Institute 380 Cases 380 Cases 1991 a 19931991 a 1993
Heart- Institute Heart- Institute 380 Cases 380 Cases 1991 a 19931991 a 1993
Social11,3%Social11,3%
Improves Clinical 18,1%
Improves Clinical 18,1%
Cardiomyoplasty 2,3%
Cardiomyoplasty 2,3%
Medical7,8%
Medical7,8%
• Age: 16 - 68a (43,5±11,4a)• Men: 79,7%• Women: 20,3%
• Age: 16 - 68a (43,5±11,4a)• Men: 79,7%• Women: 20,3%
Freitas HFG et al. – Arq Bras Cardiol 62:233-237, 1994.Freitas HFG et al. – Arq Bras Cardiol 62:233-237, 1994.
5%5%
HEART TRANSPLANTATION – HEART TRANSPLANTATION – CONTRAINDICATIONSCONTRAINDICATIONS HEART TRANSPLANTATION – HEART TRANSPLANTATION – CONTRAINDICATIONSCONTRAINDICATIONS
Transplants14,4%
Transplants14,4%
Patient Refusal 2,6%
Patient Refusal 2,6%
Conventional Surgery 3,1%Conventional Surgery 3,1%Psychological
6,0%Psychological
6,0%
Heart- Institute Heart- Institute 380 Cases 380 Cases 1991 a 19931991 a 1993
Heart- Institute Heart- Institute 380 Cases 380 Cases 1991 a 19931991 a 1993
Social11,3%Social11,3%
Improves Clinical 18,1%
Improves Clinical 18,1%
Cardiomyoplasty 2,3%
Cardiomyoplasty 2,3%
Medical7,8%
Medical7,8%
• Age: 16 - 68a (43,5±11,4a)• Men: 79,7%• Women: 20,3%
• Age: 16 - 68a (43,5±11,4a)• Men: 79,7%• Women: 20,3%
HEART INSTITUTE – WAITING LIST (INCOR)HEART INSTITUTE – WAITING LIST (INCOR)
%%
00
2020
4040
6060
8080
100100
0000 6666 12121212 18181818 24242424 30303030 36363636
Perspective of TxPerspective of Tx Survival in listSurvival in list
Months of follow - upMonths of follow - up
HEART TRANSPLANTATION – HEART TRANSPLANTATION – LIMITATIONS - DONORSLIMITATIONS - DONORS HEART TRANSPLANTATION – HEART TRANSPLANTATION – LIMITATIONS - DONORSLIMITATIONS - DONORS
HEART TRANSPLANTATIONHEART TRANSPLANTATION
100100%%
00
2020
4040
6060
8080
Survival in listSurvival in list Natural historyNatural history
Months of follow - upMonths of follow - up00 1212 2424 3636 4848
MARGINAL DONORSMARGINAL DONORS
1. Donors with hemodynamic instability
Monitoring Aggressive Treatment
2. Donors with localized infection
No systemic infection
3. Elder Donors
4. Donors with cardiopathy
Takagaki et a. - J Heart Lung Transpl 1996;15:527.
1. Donors with hemodynamic instability
Monitoring Aggressive Treatment
2. Donors with localized infection
No systemic infection
3. Elder Donors
4. Donors with cardiopathy
Takagaki et a. - J Heart Lung Transpl 1996;15:527.
HEART TRANSPLANTATION – HEART TRANSPLANTATION – LIMITATIONS - DONORSLIMITATIONS - DONORS HEART TRANSPLANTATION – HEART TRANSPLANTATION – LIMITATIONS - DONORSLIMITATIONS - DONORS
HEART TRANSPLANTATION – HEART TRANSPLANTATION – BRIDGE TO TRANSPLANTATIONBRIDGE TO TRANSPLANTATION HEART TRANSPLANTATION – HEART TRANSPLANTATION – BRIDGE TO TRANSPLANTATIONBRIDGE TO TRANSPLANTATION
Artificial ventricle (InCor) Artificial ventricle (InCor) Artificial ventricle (InCor) Artificial ventricle (InCor)
HEART TRANSPLANTATION – HEART TRANSPLANTATION – BRIDGE TO TRANSPLANTATIONBRIDGE TO TRANSPLANTATION HEART TRANSPLANTATION – HEART TRANSPLANTATION – BRIDGE TO TRANSPLANTATIONBRIDGE TO TRANSPLANTATION
Heart Transplantation in BrazilHeart Transplantation in Brazil
Present StatusPresent Status Heart Transplantation in BrazilHeart Transplantation in Brazil
Present StatusPresent Status
1.1. Small number of Small number of
transplants/yeartransplants/year
2.2. Centers with small number of Centers with small number of
casescases
3.3. Areas without Transplant Areas without Transplant
CentersCenters
4.4. Shortage of donorsShortage of donors
5.5. Donors in worse conditionDonors in worse condition
6.6. Recipients in worse conditionRecipients in worse condition
7.7. High mortality in waiting listHigh mortality in waiting list
8.8. Higher early mortality of TxHigher early mortality of Tx
1.1. Small number of Small number of
transplants/yeartransplants/year
2.2. Centers with small number of Centers with small number of
casescases
3.3. Areas without Transplant Areas without Transplant
CentersCenters
4.4. Shortage of donorsShortage of donors
5.5. Donors in worse conditionDonors in worse condition
6.6. Recipients in worse conditionRecipients in worse condition
7.7. High mortality in waiting listHigh mortality in waiting list
8.8. Higher early mortality of TxHigher early mortality of Tx
Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies
I.I. Increase the nr of transplants Increase the nr of transplants
Improve the payment for the procedureImprove the payment for the procedure
Support to present centers Support to present centers
Encourage creation of new centersEncourage creation of new centers
Payment for mechanical circulatory Payment for mechanical circulatory
supportsupport
I.I. Increase the nr of transplants Increase the nr of transplants
Improve the payment for the procedureImprove the payment for the procedure
Support to present centers Support to present centers
Encourage creation of new centersEncourage creation of new centers
Payment for mechanical circulatory Payment for mechanical circulatory
supportsupport
Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies
II.II. Increase the nr of donors Increase the nr of donors
Improve organ procurement systemImprove organ procurement system
Early communication of potential Early communication of potential
donorsdonors
Better treatment of donorsBetter treatment of donors
Increase the use of marginal donorsIncrease the use of marginal donors
II.II. Increase the nr of donors Increase the nr of donors
Improve organ procurement systemImprove organ procurement system
Early communication of potential Early communication of potential
donorsdonors
Better treatment of donorsBetter treatment of donors
Increase the use of marginal donorsIncrease the use of marginal donors
Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies
III.III. Improve nr and quality of recipients Improve nr and quality of recipients
Early referral Early referral
Clinics of Heart failureClinics of Heart failure
Payment / use of mechanical circulatory Payment / use of mechanical circulatory
supportsupport
III.III. Improve nr and quality of recipients Improve nr and quality of recipients
Early referral Early referral
Clinics of Heart failureClinics of Heart failure
Payment / use of mechanical circulatory Payment / use of mechanical circulatory
supportsupport
Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies Heart Transplantation in BrazilHeart Transplantation in Brazil
Strategies Strategies
IV.IV. Improve results Improve results
All from I- IIIAll from I- III
Better donorsBetter donors
Better recipientsBetter recipients
IV.IV. Improve results Improve results
All from I- IIIAll from I- III
Better donorsBetter donors
Better recipientsBetter recipients
Thank you for your attention Thank you for your attention Thank you for your attention Thank you for your attention