Waiting for a corneal transplant almost doubles since 2019 – 05/22/2023 – Health

The waiting list to receive a corneal transplant in Brazil has basically doubled since 2019: it jumped from around 12,000 patients on the waiting list during that year to more than 24,000, a number recorded in March 2023. The data was presented during an event at the Brazilian Council of Ophthalmology (CBO) with information from the National Transplant System (SNT).

The time span includes 2020, the period of greatest drop in procedures and the first year of the Covid-19 pandemic. With the cooling of the health crisis, the rate of surgeries per year even rose again, but it is still below what was previously recorded.

The cornea is a transparent layer that surrounds the eye. It protects the organ, as well as being necessary for proper vision. When a complication affects this ocular tissue, a transplant may be necessary in order to prevent the progression to more serious problems, such as blindness.

In Brazil, access to corneal transplantation is centralized in a single list. That is, regardless of whether the service is carried out in the public or private network, the list is the same. The problem is that, in recent years, this wait has grown a lot.

“The queues increased and the waiting time approximately doubled”, summarized Frederico Pena, treasurer director of the CBO.

The delay in having a transplant varies depending on the state. Ceará has the shortest estimated waiting time: the patient waits about a month for the surgery. On the other hand, if the person is in Pará, he must have about two years and two months to carry out the operation, the worst index in Brazil.

One of the factors that may explain the scenario of extensive delay is the Covid-19 pandemic. In 2020, the first year of the health emergency, there were 4,374 corneal transplants in the country’s public network. The number is basically half of what was seen between 2012 and 2019, when Brazil had an average of 8,388 procedures per year.

In 2021 and 2022, the number of transplants returned to a more common level, with more than 7,000 surgeries each year. Even so, Wilma Lelis, CBO’s first secretary, says that “despite the passing of the pandemic and the resumption of these transplants, we have not reached an ideal number, there is a large queue of patients waiting”.

She says that the difficulty in performing transplants in patients is felt by the medical community. “Behind the scenes, doctors observe, in their services, the growth in the number of people waiting for the transplant.”

regional differences

In addition to waiting data, the event brought a CBO survey based on public information on transplants performed in the SUS. One of the pieces of information includes regional differences.

Most surgeries are performed in the Southeast region: between 2012 and 2022, they were almost 47% of the total. Meanwhile, the North region was responsible for only 5% of operations.

The Southeast also concentrates most of the ocular tissue banks: there are 52 across the country, 17 of which are in this region. Meanwhile, the North of the country only concentrates four of these institutions. It is also there that the only three Brazilian states that do not have these banks are located: Acre, Amapá and Roraima.

These reference centers are responsible for capturing and properly preserving corneas and other ocular tissues. Therefore, they are an important part of the gear that involves surgeries. “Transplants occur in greater numbers in states where there is greater corneal uptake”, says Pena.

He explains that there may even be the availability of teams able to perform the transplants, but if there is not an efficient system for capturing corneas in that location, the number of transplants will be affected.

Thus, the greater number of ocular tissue banks in certain locations can generate unequal scenarios between regions.

An example cited by Pena are people who travel to São Paulo in order to perform a corneal transplant, since the state has a greater fundraising capacity: there are nine tissue banks in the state, the largest number in the entire country, and about six months of waiting, one of the shortest intervals in Brazil.