Kidney Transplant Coverage in Brazil in 2024: Regional Contrasts and Challenges in Equitable Access

Kidney transplantation is one of the main therapeutic strategies for end-stage chronic kidney disease, widely recognized for improving survival and quality of life. In Brazil, the Unified Health System (SUS) has established one of the largest public transplant programs in the world, with universal coverage and state funding. However, the demand for transplants exceeds the available supply, posing a persistent challenge to the healthcare system.

Differences in the distribution of transplant centers and hospital infrastructure across regions directly affect access to the waiting list and the performance of transplantation, deepening regional inequalities in the country. Even within a well-established public system, this insufficiency of supply remains a central barrier to equitable access.

The gap between the need for and availability of transplants becomes even more critical when analyzed from a regional perspective. Structural disparities generate significant contrasts among states and regions, highlighting the importance of analyzing the mismatch between kidney transplant demand and supply to support public policies that promote greater equity and effectiveness in the treatment of end-stage chronic kidney disease.

This is an observational, descriptive, ecological study using secondary data from the Brazilian Transplant Registry (RBT, 2024). Estimated needs and performed kidney transplants in Brazil were analyzed, considering the country, regions, and states as units of analysis. Coverage was calculated as the ratio between transplants performed and estimated need, expressed as a percentage, allowing the identification of disparities between supply and demand.

 During the analyzed period, an estimated 13,675 kidney transplants were needed in Brazil, of which only 6,287 were performed, corresponding to a national coverage of 45.9%. Regional analysis revealed profound inequalities.
The South region showed the highest average coverage (74.4%), with Rio Grande do Sul standing out (82.8%), followed by Paraná (76.1%) and Santa Catarina (60.3%). In the Southeast, which had the largest absolute number of transplants, average coverage was 62.8%. São Paulo performed 1,873 transplants out of 2,758 indications (67.9%), followed by Minas Gerais (60.5%), Rio de Janeiro (57%), and Espírito Santo (41.5%).
In the Northeast, average coverage was 33.1%, with considerable intra-regional heterogeneity. Pernambuco reached 65% (372/572) and Ceará 45.1%, while Sergipe (1.5%), Alagoas (7.3%), and Paraíba (8.4%) exhibited severe deficits.
The Center-West region had an average coverage of 28.4%, with the Federal District achieving 64.8%, whereas Mato Grosso did not perform any transplants despite 230 patients in need. The North region presented the most critical scenario, with an average coverage of 14.5%. Only Amazonas showed significant performance (39.3%), while Amapá, Rondônia, Roraima, and Tocantins performed no transplants, leaving over 290 patients without access.
In total, five federative units did not perform any transplants during the period, demonstrating population exclusion and a substantial gap between demand and supply.

 The analysis highlights significant regional disparities between the demand for and supply of kidney transplants. The South and Southeast show relatively satisfactory coverage, while the North, Northeast, and Center-West face severe structural limitations, with some states performing no transplants at all during the period. These inequalities reflect historical and structural challenges within the healthcare system and underscore the urgent need for public policies that promote decentralization of the transplant network, strengthening of hospital infrastructure, workforce training, and revision of allocation criteria, ensuring equitable access to kidney transplantation in Brazil.