Organization of a high-volume kidney transplant program--the "assembly line" approach

This report describes the organization of a high-volume Brazilian kidney transplant program. With use of an "assembly line" approach, 2,461 kidney transplantations were performed between 1999 and 2004, fulfilling government expectations without compromising the care of the patients. The annual number of kidney transplants increased from 428 to 656 per year. In our Organ Procurement Organization (with 7 million inhabitants), brain death notifications increased from 196 to 461, but less than 25% became actual donors. There are 3,200 patients on the waiting list and recipient selection is based of human leukocyte antigen matching (25 new listings per week). More than 700 first appointments for living donation occur every year. A significant number of recipients are of black race and have been receiving dialysis for long periods of time. The majority of patients are followed locally (100-120 appointments per day). Transplant outcomes among living-donor recipients are comparable to those of large registries, but inferior outcomes have been observed among recipients of deceased-donor organs. However, consistent improvement has been seen in more recent years. The present report also discusses issues related to local regulations and solutions to improve efficiency and outcomes.