Challenges for Expansion of Thoracic Transplant Clinical Pharmacy in Brazil: Comparison with U.S. Accredited Centers and Call for Action

PURPOSE Clinical pharmacists' involvement in the care of transplant recipients has become a requirement in the accreditation process of transplant centers. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programs nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centers in Brazil and compared them with accredited U. S. programs. METHODS An electronic questionnaire was distributed to all heart and lung transplant centers registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. The survey consisted of 16 questions on presence, full-time equivalents (FTEs), practice-setting and training of clinical pharmacists at each center. Survey findings were compared to available published data from accredited U.S. centers. RESULTS From 39 centers invited, 22 (16 heart and 6 lung) responded, representing 88.6% (n=420) of thoracic transplants performed nationally in 2018. Ten centers (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translates into 144 (35.2%) transplant recipients without any direct pharmaceutical care. In centers with pharmacists (n=12), none had a full-time professional dedicated to their programs. When compared to U.S. centers, there was a significantly lower expression of several aspects of transplant clinical pharmacist activities among Brazilian centers (Figure 1). Importantly, pharmacist FTE in Brazil was less than half of that observed in the U.S. CONCLUSION Marked differences exist in Brazilian centers in comparison to the U.S. Our findings point to an unmet need related to clinical pharmacist activity within thoracic transplant programs, especially in developing countries, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.