Faustão, Health, and the Waiting List That Is the Same for Everyone
Treatment may vary, but the rules of priority do not change.
Editor’s note: Fausto Silva, popularly known as “Faustão,” is one of Brazil’s most famous television hosts, who for decades led Sunday TV shows watched by millions.The news of Fausto Silva’s liver transplant and kidney retransplant, after a previous heart transplant, reignited the controversy over transparency and fairness in access to organs for transplantation in Brazil. Public reactions revealed a mix of feelings: skepticism, personal stories of success and dissatisfaction with the system, calls for accountability and investigation, disbelief, and sarcasm. The critical tone prevailed over favorable expressions.
Faustão’s national fame and wealth naturally amplify scrutiny. In a country of marked socioeconomic inequalities, where the Unified Health System (SUS) serves millions with limited resources, suspicions of privileges in organ allocation become almost inevitable. The National Transplant System follows national laws and regulations but is regionalized according to SUS hierarchization, which generates structural variations and different perceptions in public opinion.
In an unequal country like Brazil, it is natural that a transplant for someone rich and famous arouses mistrust, even if the waiting list follows technical rules.
The public perception of injustice arises, in part, from a lack of understanding of the nuances of treatment, but finds support in a factual inequity — inequity related to unequal access to health care and resources, and not to any alteration in organ distribution rules, which remain technical and legal.
The main driving force behind suspicions is the belief in favoritism on the waiting list, something that, in the allocation process, does not occur.
Nevertheless, his financial condition and visibility guarantee access to the best specialists, advanced diagnostics, and more effective maintenance treatments, which influence clinical preparation but do not alter position or grant priority on the transplant list.
This contrasts with the reality of SUS, where diagnostic delays and limited care are common due to budgetary and organizational constraints.
Excellent pre-transplant care — optimized nutrition, dialysis, physical therapy, use of and adherence to the best medications — can improve or optimize the patient’s clinical condition, increasing eligibility for the transplant waiting list. In sum, socioeconomic status influences access to the list, but once included, the distribution of organs is independent of this factor. In the transplant system, everyone on the list follows the same priority rules. But, just like in a race, some arrive at the starting line in better shape — thanks to more complete medical care. This does not change the order of arrival, but influences who manages to complete the race.
In transplantation, the waiting list is the same for everyone, but those with access to better treatment arrive in better condition to wait — a difference linked to the ability to maintain health until the procedure and not to interference in the choice of who will receive the organ.
Multiple transplants are rare because they require highly specialized teams and health infrastructure that does not exist everywhere. In Faustão’s case, access to this type of treatment is also linked to the resources that his financial condition allows, which reflects structural inequalities in the Brazilian health system and not any manipulation of the waiting list.
The point is that, although he receives better health care, this occurs within legality and does not change the order of organ distribution. For those unfamiliar with the system, the difference between deciding who receives the organ — that is, the waiting list and distribution — and preparing the patient for transplantation is confusing and raises doubts.
The order of who receives an organ is defined by medical criteria on the waiting list. Extra resources influence preparation, not priority.
Thus, public perception echoes a real inequity — people know that someone rich and famous can receive better health care, but this extra care does not alter the rules or the order of distribution.
When this nuance is not understood, especially in high-profile cases, the effect is corrosive to the altruistic foundation of organ donation. Distrust can lead to refusal to donate. In Brazil, this phenomenon is known: the states with the highest refusal rates coincide with those with the lowest confidence in the effectiveness of the health system.
Differences in preparation do not mean priority on the list, but when this is not understood, trust in the system falls and donations decrease.
The negative repercussion of Faustão’s transplants, fueled by the perception that the system is biased, invites reflection on how communication could have been better handled. The legislation is clear, the system is consolidated, and the Brazilian Association of Organ Transplantation (ABTO) publishes quarterly reports with data on donations, waiting lists, and transplants. Even so, the reaction of public opinion demonstrates room for improvements in communication.
One reflection would be, in cases of great media exposure, to create a pre-transplant communication protocol in which the medical team would explain, in generic terms, the clinical conditions and priority criteria. Given the patient’s notoriety, this could draw attention and facilitate understanding of the case, reducing mistrust. Evidently, this practice involves ethical issues and can only occur with the express authorization of the patient and their family. Based on this disclosure, ABTO or SUS could promote explanatory campaigns about multiple transplants and prioritization criteria. Such an approach could humanize the process and reduce suspicion, reconciling confidentiality with public interest.
Transparency, when voluntary and planned, can prevent distortions and preserve public trust in the transplant system.
The narrative of privilege has been overshadowing the real medical need of a beloved public figure who marked Sunday afternoons for millions of Brazilians. This perception is understandable in the face of social inequalities, but it does not reflect the technical functioning of organ distribution in the country. Faustão faces a serious and rare combination of diseases and deserves compassion and empathy. A multifaceted approach — with voluntary disclosure previously agreed upon in high-profile cases — could bring public perception closer to medical reality. After all, public trust is not a peripheral detail: it is an essential pillar for the sustainability of the transplant system.
This essay was originally published in Portuguese on August 09, 2025. You can read the original version here:
