On National Organ Donation Day, pediatric transplant procedures in Brazil are being hindered by the lack of donors. A report from Folha de S.Paulo points out that family refusal is one of the main obstacles faced by medical teams.
According to data from the Ministry of Health, between January and July 2026, the country performed 278 pediatric organ transplants. The low availability of pediatric donors makes the waiting period extremely challenging for children needing a new organ.
The difficulty in finding organs for children is aggravated by the need for the donor's size and weight to be compatible with the recipient. Eduardo Antunes da Fonseca, director of the liver transplant department at Sírio-Libanês Hospital, reported that only about 2% of notifications of deceased donors are from children.
In this context, Felipe Oliveira Costa, a 7-year-old boy, had to resort to living donation. After developing cirrhosis and liver failure due to a medication reaction, he was placed on the waiting list for a liver transplant. Since no compatible organ was found, his father, Abimael Maurício Oliveira Silva, opted to donate part of his own liver, undergoing medical preparation and weight loss for the procedure.
Fonseca told Folha that since no organ appeared, they spoke with the father, who offered to donate part of his liver to his son, as he could die waiting for the transplant. Living donation is permitted for healthy and legally capable adult individuals, provided the act does not compromise the donor's health. It is possible to donate a kidney, part of the liver, bone marrow, or lungs, subject to medical evaluation.
Brazil operates a single waiting system for transplants through the Unified Health System (SUS). Each patient's priority is not based solely on the date of entry into the queue; clinical and technical criteria, donor-recipient compatibility, and, in the case of children, organ sizing relative to the patient's body, are considered factors.
The country has 829 accredited health units to perform organ transplants. In 2025, 70 of these units conducted pediatric transplants. That year, 589 pediatric transplants were recorded, distributed among 61 heart, 211 liver, two lung, and 315 kidney transplants. Comparing with the period from January to July 2026, there were 278 procedures, consisting of 24 cardiac, 114 hepatic, and 140 renal ones.
According to the Ministry of Health, more than half of pediatric transplants, specifically 53%, use organs from donors aged between 11 and 17 years. Organ donation from children requires the authorization of both parents, if alive, or the legal guardian. In 2025, the Brazilian Association of Organ Transplantation (ABTO) registered that potential donor families refused donation in 45% of cases, a situation considered particularly sensitive by specialists when the donor is a child.
Discussion on pediatric brain deaths
Fonseca explained that many pediatric brain deaths result from drowning or accidents that cause cardiopulmonary arrest. At this moment, the family may be in great distress when approached about the possibility of donation. A large part of these deaths occurs due to drowning or accident, leading to cardiopulmonary arrest, and the family's response is usually negative during the approach.
José Sampaio, surgeon responsible for the Liver Transplant Service at Pequeno Príncipe Hospital, highlights that among adults, lack of knowledge about the potential donor's prior wishes is a recurring factor. For this reason, he advocates that families discuss this topic in advance. Sampaio suggested implementing awareness campaigns to encourage families to debate the individual decision.