Just for additional note:
* the owner of the lab that realized the tests (PCS Lab Saleme) is the cousin of the former secretary of health from Rio, Dr.Luizinho.
* Anvisa (brazil health regulatory agency) alleges the lab didn't have the kits to realize the blood exams and didn't present the receipts proving their purchases, leading to the suspicion
they didn't do the tests at all and forged the results.
* Since many hospitals outsourced donor organ tests to the 3rd party lab, there is a precedent for more cases of infected organs, so the stored material of 286 donors will be retested by HemoRio, a state health unity.
> Dr.Luizinho.
He was also short listed to take over the Ministry of Health under Bolsonaro’s government.
No. That is just naive pattern-matching against a hot-button issue that you read a lot about on HN. For both this story AND Boeing, the explanation is more complicated than “outsourcing bad!”
Outsourcing isn't a problem, people don't make their own clothes. It's inadequate checks relative to the risk of the component.
Nothing wrong with outsourcing as long as it doesn't allow the user of the third-party operation to escape legal liability for failures and fraud committed by said third party that affect the user's clients.
the same thing happened in the states and France among other countries, it was a global thing
At the bottom of the Wikipedia article I'd linked are references to similar scandals in France as you note, Arkansas, Libya, Italy, and Scotland.
That’s rough cause transplants usually mean immunosuppressants which is precisely what you don’t want for hiv
Why? If you have HIV you need to be on antiretroviral drugs. They keep your viral load to undetectable levels, so your immune system does not need to fight it.
Yep, if HIV progresses to the point of AIDS, suppressing your already-suppressed immune system would be bad. But with today's treatment regimens HIV won't progress anywhere near that point. Which is borderline miraculous, really.
HIV is the virus that makes you develop (or "acquire") AIDS; AIDS is the condition that weakens and kills you. If you pump the breaks as soon as possible, HIV on its own won't have catastrophic health implications, although it's obviously better not to have it at all.
So dumb question, but if you have HIV, does that mean you won't have transplant rejection? Or are there two different mechanisms of immunity here?
(Disclaimer: not a doctor)
AIDS is the immune deficiency-causing virus, and that begins (usually) way after an HIV infection takes place — months, years. So until then, they’d still need to take immunosuppressants.
> AIDS is the immune deficiency-causing virus
AIDS (Acquired Immune Deficiency Syndrome) the illness, whereas a HIV infection (Human Immunodeficiency Virus) is its cause.
to be clear, I believe modern antiretrovirals can prevent the virus from replicating for an entire lifetime. They bring the viral load down to undetectable levels.
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But after AIDS sets in, you don't?
A little bit more context:
Rio de Janeiro is by far the most corrupt Brazilian state. Its hard to explain how bad it is if you are not Brazilian, but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended.
So what usually happens is that someone from the public sector opens up a public bidding for some service to be done by the private sector, and usually who wins is someone who has ties with the local government.
Most of the time whoever wins the bid (usually some shell company) is going to barely offer the service, and share most of the profits with their associates in the local gov.
This is one of such cases: The private lab doing the tests is owned by the cousin of the former state secretary of health Dr.Luizinho. Its very likely that they just did not do the tests at all (yes, that how bad it is)
Just another normal day in Rio de Janeiro.
Interesting perspective on the impact of corruption across different countries. It's striking how two countries with similar levels of corruption can have vastly different outcomes in specific areas. Take Argentina as an example: while it's highly corrupt, organ transplants are remarkably well-organized under a single entity, INCUCAI [1]. You can even see crystal clear stats there.
[1] https://www.argentina.gob.ar/salud/incucai
Corruption is not a single axis, for example college entrance exams and voting in brazil are very trustworthy in my opinion.
Institutions are corrupt, not a whole country. Sure there is some level of infection between institutions but there is still a lot of a single one can do.
Brazil is way more decentralized in that way, especially health care, so health care quality will greatly change depending on your city even.
That said, organ transplants in Brazil are managed by the Federal Government (lists, etc), but the clinics and hospitals will usually be state or city made...
Brazil is pretty good at organ transplants, surprisingly.
Rio de Janeiro is corrupt, but it is far from the most corrupt in relative terms. Contrary to popular perception is not even one of the most violent.
> but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended
Sounds similar to Illinois
Similarly to the Mongolian government, except that only major cases are targeted, and instead of the actual culprits, people who were just doing their jobs under them end up in prison. Case closed.
I usually direct people to watch the movies Elite Squad 1 and 2. They're entertaining and pretty much explain why Rio is so violent and so corrupt and how both things feed off each other.
I'd like to note that Brazil is not at all unique in being corrupt or even in the methods used. For example, watch HBO's The Wire and you'll find the police and politicians playing the exact same numbers game. It seems to be inherent to democracy, a side effect of reelection.
The films do a wondeful job depicting the poverty of Brazil, and the way it attracts people to organized crime. It attracts so many of them, they form a nation unto themselves. Complete with their own army, territory, laws, tribunals... It gets to the point it's a silent secession.
> Its hard to explain how bad it is if you are not Brazilian
It's hard to explain to most Brazilians too.
People go there expecting the worst. I don't think I've met anyone that wasn't still surprised.
Huh, as a South African, now I'm quite intrigued to visit it.
How free do people feel to speak up against corruption? Like could they go public on Twitter/X and call out the issues they see? Or would they face legal retribution or physical violence?
It really depends. Locally, factions like criminal associations and retired cops mafias (militias), who always have city councelors and mayors in their pockets, may retaliate if someone with an audience is being too annoying (see Marielle Franco's case).
Nationally, not all politicians enjoy any protection from the supreme court against critiscism, only the best connected ones and the supreme court itself. Recently, a former YouTuber who lost all his social accounts and had to self-exile to the US for some disrespectful comments against the supreme court was sentenced to 1.5 years in jail for calling the newest supreme court judge a "fatty".
Except for the supreme court itself, the average Brazilian can voice their concerns and speak up against corruption with very low chances of repercussions if they don't display wholly anti-democratic discourse, like wishing the military to execute a coup.
Freedom of expression is guaranteed in Brazil. In general people feel free to speak and that hasn't changed.
What has become a crime is the spread of misinformation in the form of fake news. For the most part these are still legislated fairly IMHO. But the precedent feels a bit dangerous
See the recent spat between the Brazilian supreme court and Twitter for your answer there
Its just bizarre to me how simple this is to avoid.
Its one of the most common place tests in the world.
Yes, incredible. When HIV/AIDS emerged, dentists were among the first professionals to adopt protective measures.
I don't have more details than what's mentioned in the article, but situations like this can sometimes reflect a deeper issue within the underlying professional and organizational structures, almost as if they're "calcifying", not just negligence, but a symptom of how things are functioning beneath the surface. On the other hand, it might simply be a case of individual malpractice, though I think the latter will be rare in the context of transplants.
Rio isn't exactly known for its solid institutions or sanitary excellence.
Isn't the window period large enough for the HIV test that it could slip through that way, i.e. you get infected on Friday, die and organs get harvested/get tested on Monday (or possibly longer) but you have not been infected long enough for the test to detect it? I had to sign a waiver acknowledging this possibility when I had some dental procedure last year.
Sounds reasonable, but why would they have you sign that before having a dental procedure?
Is it in case one of the doctors or nurses infects you?
It is but the test isn’t fully considered accurate for the first 30 days (45-90 days to be conclusive). That’s a long window of time for the virus to spread.
Organ transplants are "ooh, shiny" headline grabbing medicine. Better healthcare to try to keep your original equipment is boring and gets dismissed as "just lucky." It's hard to prove a connection between x, y z and not needing a transplant.
Any criticism or critique of this paradigm gets hated on without anyone really listening or wondering what might motivate someone to be not crazy about our "we are borg" trends in medical care.
Everyone I've ever talked to dealing with conditions that often end in transplant knows and shares that they're big-deal, serious-business, forever-life-altering treatments that are ultimate last resorts. But for some things we simply don't have any alternatives.
And for some of those - for instance one of the super-obvious ones is alchoholism-induced cirrhosis - "don't drink so much that you kill your liver" is VERY discussed, not just considered "lucky." You might even get yourself disqualified from a transplant if you can't get it under control. Everyone would MUCH rather you not need it.
Where are you seeing "get a transplant" pushed as a shiny panacea? They aren't even new anymore... lots of newer-shinies out there.
>>> Any criticism or critique of this paradigm gets hated on without anyone really listening
I'm having a hard time following this. Could you perhaps reference some examples to illustrate what you mean here?
Sure, reducing the conditions that lead people to need transplants is a great idea, and should be done more. But I don't see how that's relevant to this discussion.
I wonder what HIV tests cost.
Also, if I were dying of organ failure, getting (treatable) HIV to get a transplant might be a good deal. This is not 1988. HIV is treatable today.
Note: There are 3 kinds of illness: curable, treatable, and terminal.
Curable illnesses can (generally) be cured.
Treatable illnesses will be with the patient for the rest of their life, but are treatable so the patient does not have to die from them.
Terminal illnesses kill the patient.
What happens if someone contracts HIV and dies over the next 2 weeks before the virus is detectable in tests. Would it propagate even in a dead body? Using an organ from this donor would cause HIV either ways and so is honestly a risk factor for US donors as well.
Maybe people with HIV just shouldn't donate blood or organs...
It's possible they didn't know they were infected.
Oh my god, why didn't anyone think of that!
Do you think people are doing it intentionally?
For those who watch medical shows, this is somewhat reminiscent of a case of several patients who contracted rabies through organ transplants - a story that was portrayed in Scrubs season 5 episode 20, "My Lunch".
> laboratory responsible for conducting tests on donated organs had been suspended after the organs from two donors were transplanted into six people
So they missed the same thing twice, presumably at around the same time.
> and all stored organs from donors are being tested back to December 2023 when the lab was hired
I had the impression that there was a very short time limit, like maybe as long as a couple days. Is this just wrong, or does it only apply to same things?