The loss of a loved one is one of the most painful experiences a family can face, as they are confronted with the difficult decision of whether or not to authorize organ donation after brain death has been confirmed, in order to save the lives of strangers on the waiting list. In Brazil, the average rate of family members refusing organ donation hovers around 45 percent – a figure that varies between states and even between hospitals within the same city, highlighting that refusal depends not only on the people but also on institutional factors.

According to Cristiano Franke, president of the Brazilian Association of Intensive Care Medicine (AMIB), many patients inform their families of their wish to donate organs, and many families would also like to honor that wish. However, he notes, in many cases a lack of support for family members and poor communication within hospitals – both public and private – is one of the main obstacles to successful organ donations.

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“Families often do not receive all the necessary information in a timely manner and through an appropriate protocol to make the best decision. And medical teams often are not prepared to handle difficult conversations, using overly technical and inaccessible terms, or adopting approaches considered cold and businesslike in inappropriate settings,” said Franke.

As a result, the association, in partnership with the Ministry of Health, trained 2,534 healthcare professionals from September 2025 through August 2026 to assist in the organ donation and transplantation process. To date, the program has exceeded its initial target of 2,000 trained participants by 25 percent.

The goal of the courses developed and offered by the association is to increase the number of professionals prepared to carry out this process, including the improvement of communication to reduce families’ resistance to authorizing the removal of organs from relatives diagnosed with brain death.

The training also aims to provide expertise on the various stages leading up to a donation, covering the identification of potential donors, the determination of brain death, and the clinical management of the potential donor, thereby making the process safer, Franke added.

“Reaching over 2,500 trained professionals shows that we are succeeding in bringing technical knowledge to those on the front lines of a process that demands a great deal of responsibility. A diagnosis of brain death must follow strict criteria, as must the care of the potential donor and the dialogue with the family,” he stated.

Among the difficulties family members face in agreeing to authorize transplants are understanding or accepting the diagnosis of brain death, religious beliefs, fear of compromising the body’s integrity, mistrust of the process, and lack of knowledge regarding the wishes the family member expressed while alive – or even the perception that healthcare professionals were more interested in the organs than in the patient or their family members.

“Families are also concerned about bodily disfigurement, and we thoroughly explain how the procedure and the restoration of the body are carried out, which will leave no visible disfigurements during funeral rites such as the wake. They raise this issue very clearly, and we also need to explain it thoroughly and clearly,” he noted.

According to the association, among the participants trained through August are 933 physicians, 473 of whom received training focused on determining brain death. The remaining participants – who include physicians, nurses, psychologists, social workers, nursing technicians, physical therapists, administrators, pharmacists, dentists, biologists, as well as a nutritionist and an educator – received instruction on donation and transplant management and the use of communication in critical situations.

As of August, 73 courses had been held across 23 modules and involving activities in 25 Brazilian states. Eight more training sessions are still planned before the project concludes.

Transplants in Brazil

In 2025, 15,940 potential donors were registered across Brazil. Of this total, 4,335 became actual donors. Among the families interviewed, 4,200 did not authorize donation – the equivalent to 45 percent of the interviews conducted. In the same year, Brazil reached 20.3 actual donors per million people, compared to 19.2 in 2024.

In the search for new treatments and even a cure for hepatitis B, two Brazilian public universities have joined forces with international institutions.

The consortium is led by the Johns Hopkins University School of Medicine in the United States and comprises researchers from Brazil, India, Senegal, and Uganda. Brazil is represented by the Cassiano Antônio Moraes University Hospital of the Federal University of Espírito Santo (Hucam-Ufes) and the University of São Paulo (USP).

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The global study will examine, at the cellular level, both the behavior of the virus in patients from different countries and the immune responses of infected individuals. People co-infected with hepatitis B and HIV will also be included in the analysis.

“There is no cure for hepatitis B. That is the major global goal,” says Tânia Reuter, a professor at Hucam-Ufes and a leading expert on the subject. “The primary goal is to eliminate viral hepatites - in our case, to eliminate hepatitis B as a public health problem by 2030,” she emphasizes.

Research

Reuter explains that the researchers will monitor 600 patients with hepatitis B, including those co-infected with HIV, for about four and a half years. There will be 150 patients from each country, 75 of whom will be analyzed by her team.

The study aims to identify why the disease progresses differently in each patient, which genetic characteristics may protect people from faster progression, and which viral subparticles may serve as predictors of a cure or treatment response.

“I want to discover targets that can help in the management and cure of hepatitis B,” the researcher explains. “[Whatever we find] could serve as a target for drug development, whether for immunostimulants, immunomodulators, or other treatments,” she notes.

Reuter began recruiting patients in July and has enrolled 40 participants so far. She plans to reach the full group of 75 participants by the end of this year. The study is scheduled to run until mid-2027.

“The hepatitis B virus is one of the leading causes of primary liver cancer, or hepatocellular carcinoma. We’re working here to slow the progression of cirrhosis and liver cancer,” Reuter explains.

Hepatitis B

Hepatitis B is a silent viral disease that attacks the liver. There is still no cure, and the disease can progress to cirrhosis, liver cancer, and death. According to the World Health Organization (WHO), approximately 240 million people were living with chronic hepatitis B infection as of 2024.

In Brazil alone, the Ministry of Health reported 276,600 confirmed cases from 2000 to 2022.

Hepatitis B can be transmitted through sexual contact and exposure to contaminated blood, including during pregnancy or childbirth, when the virus can be transmitted from mother to baby. According to the Brazilian Society of Clinical Medicine, the hepatitis B virus is 100 times more contagious than HIV.

The WHO’s global goal is to eliminate HIV, viral hepatitis, and sexually transmitted infections (STIs) as public health threats by 2030. According to a report released by the organization in July this year, annual viral hepatitis infections have fallen by 32 percent globally since 2015, reflecting increased childhood vaccination coverage, which reached 84 percent in 2024.