Brazilian national transplantation system: discussing health and autonomy

Abstract

It must be admitted that some subjects are still taboo in Brazilian society. With a moral tradition strongly attached to Christian values, to which the idea of corporeal intangibility can be associated, to speak, in Brazil, of the ethical-juridical limits of personal autonomy in regard to the uses of the human body is quite an arduous task, especially if one intends to thoroughly explore the topic of organ and tissue transplantation. In spite of possessing the largest public transplantation program in the world - the National Transplant System, which is totally structured on donations - the country has not been able to solve the problem of the dearth of organs. There has been an increase in demand, with a considerable number of people waiting years on the transplant lists. Besides the problem of scarcity, there is a lack of precision in defining death criteria and restrictions to individual autonomy on donation decisions, so that it is essential to discuss the basis in which this system is established. It must be stressed that achieving a form of valid consensus in a society - such as ours - that deems itself as democratic, open and plural, presupposes a debate founded on the public use of reason and on the imperative principle according to which the best argument should always prevail. Therefore, by (re)thinking the question from an eminently intersubjective-ethical perspective, it becomes possible to identify flaws, merits and to formulate new proposals to try to reach the main objectives of an ethical organ transplantation system: to curtail the deficit between graft supply and demand, to make transplantation procedures safer, universally accessible, as well as valuing the autonomous choices of the involved individuals.