OBJECTIVES:: To propose new immunosuppression drugs incorporation for the Brazilian public healthcare system. METHODS:: Systematic evidence synthesis and Brazilian transplantation registries-based base-cases Kaplan-Myer survival and economic assessments were presented in specialized national congresses open public Delphi sessions to build professional Clinical and Therapeutic Protocols (PCDT) by consensus. Five consensus transplantation PCDTs with SUS’ perspective budget impact and sensitivity analysis were submitted to the Health Ministry SUS Technology Incorporation National Commission (CONITEC) plenary and voted. PCDTs were publicized in CONITEC Internet and Diário Oficial da Uniãoofficial periodic, and underwent widespread dissemination through mailings for Public Consultation. Public contributions were added to PCDTs to subsidize Health Ministry policy making. RESULTS:: The São Paulo State Health Secretariat coordinated the synthesis and economic assessments made by 115 over 10 years experienced transplantation specialists and health technology evaluators. Heart, lung, liver, pancreas and hematopoietic cells transplantation PCDTs with tacrolimus, sirolimus and everolimus alternative immunosuppression can significantly prevent 27,8%, 28,1%, 7,2%, 11,1% and 4,3% graft loss or graft versus host disease and death, respectively, for conventional cyclosporine-based refractory transplanted patients’ rescue during the first year post-transplantation, saving substantial healthcare resources used. Ten years follow-up demonstrated partial benefits sustained. Analysis demonstrated +US$689,655.17, +US$501,567.40, -US$377,802.51, +US$221.289,42 and +US$ 50.734,08 budget impact, respectively, resulted in overall US$1,085,443.55 for 2146 transplantees’ rescue. The 05 PCDTs were favorably voted by CONITEC plenary members, 155 public contributions were added by patients and stakeholders, and the Brazilian Health Ministry decided to adopt SUS reimbursement listing. CONCLUSIONS:: Democratic participation gave PCDTs real-world adjustments, SUS innovation and compliance.