Deceased-donor kidney transplantation in Brazil, 2014-2024: temporal patterns, regional heterogeneity, and donation-context indicators.

Background: Deceased-donor kidney transplantation is a component of the Brazilian transplant system and takes place within a deceased-donation environment that in-cludes donor identification, notification, family approach and authorization, organ allocation, and logistics. This study described temporal, macroregional, and federative unit-level variation in deceased-donor kidney transplantation in Brazil from 2014 to 2024, together with hospitalization-based indicators and contextual indicators of the deceased-donation environment. Methods: This nationwide descriptive time-series study used publicly available secondary data from the Hospital Information System of the Unified Health System (SIH/SUS), the Brazilian Transplant Registry (RBT/ABTO), and the Brazilian National Transplant System (SNT). Indicators includ-ed the number of transplants, transplant rates per million population, kidney transplant waiting list stock, mean length of hospital stay, in-hospital mortality, potential donor notifications, and family interview and refusal proportions. The three databases were analyzed separately and in parallel, without linkage. Results: The annual number of deceased-donor kidney transplants increased over the study period. The kidney trans-plant waiting list stock also increased. Mean length of hospital stay decreased, and in-hospital mortality decreased over time. Marked macroregional and federative unit-level heterogeneity was observed in transplant activity, hospitalization-based indica-tors, and contextual indicators of the deceased-donation environment. Conclusions: Deceased-donor kidney transplantation increased in Brazil between 2014 and 2024, although regional disparities persisted. These findings support monitoring strategies that incorporate contextual indicators alongside measures of transplant activity. Be-cause this was a descriptive study based on secondary data from distinct sources, the findings should not be interpreted as evidence of causal relationships.