Advances in Liver Transplantation in Brazil: Challenges and Opportunities under Ordinance GM/MS No. 1,262

The article examines the impact of Ordinance GM/MS No. 1,262, published in September 2023, which links financial incentives to measurable outcomes in liver transplant programs in Brazil. The initiative, which considers the number of transplants performed and 30-day and 1-year survival rates, is viewed as progress toward greater accountability and improved patient care. However, the author highlights significant flaws in the current classification system that may undermine the principles of equity, universality, and decentralization of the Unified Health System [Sistema Único de Saúde (SUS)]. The payment model in use is outdated, does not cover the actual costs of transplants, and ends up using financial incentives to fill budgetary gaps rather than reward excellence in outcomes. Furthermore, the emphasis on the absolute volume of transplants disadvantages centers in smaller and less populated regions, making it harder for them to compete with large centers in more populous states. This exacerbates regional inequalities and encourages the centralization of transplant operations, contravening the SUS’s principle of decentralization. The author proposes adjustments to the system, such as updating the base payment to reflect actual costs, enabling all centers to operate with financial stability. It is also suggested that financial incentives reward excellence in outcomes and that the scoring system assigns greater weight to one-year survival rates, creating a fairer and results-oriented model. Proportional measures based on population size and redistributive funding for lower-ranked centers are recommended to promote equity and stability in transplant access. Ordinance GM/MS No. 1,262 is recognized as an initial milestone, but adjustments are needed to align quality and efficiency with the fundamental principles of the SUS, ensuring that all patients receive high-quality care, regardless of where they are treated.