Attitudes and Knowledge of Professionals Regarding the Utilization of Kidneys from Expanded Criteria Donors in Brazil: Perspectives and Recommendations

Objectives: To investigate how the attitudes and knowledge levels of transplant professionals affect the utilization of kidneys from expanded criteria donors (ECD) in Brazil and to identify managerial actions that could improve their use in clinical practice. Methods: This qualitative study involved semi-structured interviews with 25 key professionals from Brazil’s organ donation and transplantation system, including transplant coordinators, medical teams, and representatives of the National Transplant System (Sistema Nacional de Transplantes). Thematic analysis was employed to extract insights into professional behaviors, decision-making processes, and opportunities for operational improvement related to the use of ECD kidneys. Results: The underutilization of ECD kidneys is linked to limited access to accurate information, inconsistent clinical practices, and risk perceptions not supported by empirical evidence. Participants emphasized the lack of standardized guidelines and variability in team decisions. Based on the findings, the study proposes actionable recommendations, including improving the transparency and accessibility of data on transplant outcomes, investing in professional training, standardizing evaluation protocols for ECD kidneys, and fostering better communication and alignment among transplant teams. Conclusion: The study presents practical contributions by identifying managerial actions to improve organ utilization and enhance transplant system efficiency in Brazil. It also contributes theoretically by applying a management perspective to a highly technical health system challenge. Addressing the identified barriers may increase the acceptance and use of ECD kidneys, expand the donor pool, reduce organ discard, and ultimately save more lives.