Fausto's heart



Faustão – who didn't think he used the SUS – was on the list, which also makes use of technical criteria and clinical evaluations, according to known norms and ethical principles

SUS is at the heart of Faustão. In the very difficult period of the covid-19 pandemic, SUS was in prayers and fights for the vaccine. And it was also on the shirt of the glorious Bahia Esporte Clube, on that unforgettable night of July 22, 2020, at the Pituaçu Stadium, when the team beat the equally glorious Clube Náutico Capibaribe, from Recife, in Salvador.

The score of that game for the Copa do Nordeste does not matter as much as the great goal scored by the Bahian tricolor that Wednesday: after four months without entering the lawns, the shield of Bahia was half covered by the design of a face mask, symbolizing the opposition from the Bahian club to the scientific denialism that, in that context, divided the country. But another symbol, that of the SUS, which also provoked the anger of the powerful at the time, was printed on the Bahia t-shirt. It might have been at heart level, but there was the mask. So, the SUS symbol was moved to the lower part of the front.

Since then, my Corinthian heart has tried to find a little place to also host the Bahia Esporte Clube, in recognition of what was more than a nice and solidary gesture. Stamping the SUS symbol helped to give visibility to our universal health system and the professionals who give life to it on a daily basis. The same professionals who renewed Faustão's life.

SUS is in the heart of citizen Fausto Silva, 73 years old, well-known TV presenter (by the way, a Santos fan, the “glorious alvinegro praiano”, as the club’s anthem says), because Faustão presented worsening of a cardiac insufficiency which had been evolving for more than two years. On August 5, 2023, the journalist was admitted to the Albert Einstein Hospital, in São Paulo, and the successful transplant operation took place 22 later.

As soon as the news was released, social networks pulsated.

Although the medical communiqués and the Transplant Center of the State of São Paulo informed about the serious conditions of the patient, and his position on the list of patients waiting for an organ, “the blood of many people boiled” and they were posted hurried and uninformed comments that contributed to giving rise to misconceptions about what the Transplant Center is and how it works. Phrases like “being rich must be very good”, or “never doubt the purchasing power of a billionaire” are terrible, as they devalue the work of hundreds of health professionals, not only in São Paulo, but throughout Brazil, reaching their dignity and placing them, unfairly and unduly, under suspicion.

Even though the known difficulties in accessing exams, surgeries, medicines and other health services offered by the SUS, in its own or partner network, motivate such suspicions, the dissemination of these comments causes a lot of harm to those who are still on the list waiting for an organ. It's a type of outburst that doesn't help, because the insinuations are unjustified. They are not based on facts and originate from a lack of knowledge about how the SUS transplant system operates, whose transparency is recognized by all those involved in the waiting list for an organ. Access to all information is possible at any time, to any interested party.

The donation is anonymous. Those who donate have no control over the fate of the donated organ, nor do they know who it is intended for. Who receives, does not know who donated. Those who investigate can obtain information and identify who is who in each process, by their own means. But not officially, as the list control system (it is not a simple “queue”, as sometimes reported…) follows normative and ethical principles. The norms refer to blood typing, weight and height compatibility, genetic compatibility and criteria related to the medical assessment of the severity of each patient.

Bearing in mind the consequences and disastrous consequences of ignorance and prejudice – which contribute to the reduction of donations, a permanent confrontation of those who have responsibilities in the management of the SUS, in this area – quickly experts and the Ministry of Health itself came to publicize positions officials from institutions and entities involved in what is recognized as the largest organ transplant system in the world.

Em SUS: scorched earth, article I published on the site the earth is round, in November 2019, I pointed out that the SUS is responsible for “three quarters of urgent and emergency care” and “96% of organ transplants”, with “one lung transplant every three days and one pancreas transplant every ten days and daily, on average, 16 kidney, 6 liver and 1 heart transplants”. The Ministry of Health announced that between August 19 and 26, 11 heart transplants were carried out in the country, seven in the state of São Paulo and that, in the first half of 2023, 206 heart transplants were carried out in Brazil and that, currently, the SUS finances around 88% of these operations.

But few people know about it, hence the surprise with the heart transplant operation in a very well-known person and the fake news of “Faustão skipping the SUS queue”. It is ignored that the list for transplants is unique and applies to both SUS and private network patients, all of whom receive comprehensive, equitable, universal and free care, including preparatory exams, surgery, follow-up and post-transplant medications.

The National Transplant System (SNT) has a nationwide scope, being centrally coordinated by the Ministry of Health, through the General Coordination of the National Transplant System (CGSNT). This body is responsible for regulating, controlling and monitoring the donation and transplant process carried out anywhere in the Brazilian territory, and performs its functions with the objective of developing the donation process, collection and distribution of organs, tissues and hematopoietic stem cells. for therapeutic purposes.

Regarding how this all works, people's main concern, encouraging conversations about the topic on social networks, bars and social spaces, concerns the chronological order of registration, that is, the order of “entry into the list”. Everyone wants to know what this is like, although the majority are absolutely convinced that “this is a mess, those who can afford it cry less, and those who have money are always saved”, among other pearls of common sense.

Few believe that what really counts are technical criteria and clinical evaluations, according to known norms and ethical principles. Most do not conform when informed that the order of “entry on the list” is indeed one of the criteria, but adopted only to break the tie, after considering, in each case, the seriousness of the situation.

An example of the credibility of the Brazilian transplant list, which I regret like so many people, refers to the former player Sócrates, from Corinthians, Fiorentina and the Brazilian team. 12 years ago, in August 2011, his liver disease worsened and, given his clinical condition, he could “advance on the list” to a position that favored him. But neither he nor the doctors who treated him could change that position, according to what was reported at the time. When asked about this possibility, discarded it: “I have nothing against heart, kidney, pancreas, liver or any other transplant. But here's the thing, I have to be on the list. If I'm not on the list, I don't skip the queue. And I'm not on any of those lists."

Sócrates was not on the SUS list, although he was one of those who fought for democracy in the country and for the institutionalization of our universal healthcare system. Faustão, who thought he didn't use the SUS, was on the list.

*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic).

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