First multi-organ harvest from a heart-dead donor performed in Sardinia

It was performed on Friday 11 October, in the SS. Annunziata Hospital in Sassari, the First multi-organ collection in Sardinia from a donor with a controlled heart failure.

The procedure, which involved the liver and kidney sampling intended for patients waiting in Rome and Padua was successfully completed on the basis of the national heart-stopping donation program of the CNT – Istituto Superiore di Sanità – already adopted in several Regions of our country and started this year also in our Region by the Regional Transplant Center with the support of the Regional Health Department.

“New promising prospects are opening up for our island in the transplant sector: this procedure allows us to increase the number of potential donors, helping to satisfy the demand of Sardinian patients waiting for a transplant on our island, and at the same time strengthening the national exchange network”. Thus the health councillor, Armando Bartolazzi, promoter of the resolution that recently gave the green light to the establishment of the operational protocol on the Stopped-Heart Organ Donation Program (DCD). "Stopped-heart donation is an innovative technique, already present in the most advanced settings in our country and which now places our region among the national points of reference in the sector. Sardinia has long had a consolidated background in the transplant field, which has allowed us to identify ARNAS Broztzu and the Sassari University Hospital Trust as the two points of reference for the introduction of a new, highly complex technique that, just a few months after the approval of the regional executive, is already a reality".

It was the regional resolution 29/1 of last August 7th to introduce for the first time in Sardinia the Heart failure organ donation and procurement program, with the establishment of a specific technical support table at the General Directorate of Health.

The heart-stopping donation is a program of organ donation from deceased donor which is carried out by subjects deceased due to cardiocirculatory arrest and subjected to death certification using cardiological criteria (Donor after Circulatory Death – DCD), unlike donors who have died of brain damage, a program that has been regularly carried out for years in our Region, in which death certification is carried out using neurological criteria (Donor after Brain Death – DBD).

A peculiar aspect of heart-stopped donation is given by the death certificate with cardiological criteria which can happen in Italy only after twenty minutes of cardiac arrest recorded by electrocardiogram, therefore, to avoid that the organs may be affected by the so-called systolic warm ischemia (that is, the phase in which the circulation is stopped and the organs are in place, but not perfused by blood circulation, neither physiological nor artificial, nor supported by cardiopulmonary resuscitation maneuvers), it is necessary to implement specific techniques and strict respect for deadlines, which presupposes a high level of professionalism and perfect synergy between the various operators.

The work that was carried out during the donation at the AOU of Sassari was particularly challenging, as it was a highly complex clinical-surgical process, which required a very high level of collaboration between different structures and disciplines managed by the Local Coordination and, through the Regional Operations Centre, by the Regional Transplant Centre.

“The regional heart-stopping program” explains Dr. Lorenzo D'Antonio, Regional Transplant Coordinator, “will allow a significant increase in the availability of organs in Sardinia, particularly livers and kidneys, which will allow a greater number of transplants to be performed with a consequent reduction in waiting times for patients on the list suffering from very serious organ failure”.

“We are committed,” he continued. Of Anthony "to continue on this path, with the aim of making our regional donation and transplant system increasingly efficient and effective, aware that to obtain concrete and important results it is necessary to provide our dedicated structures with adequate resources that are essential to be able to carry out such complex and articulated work. The heart-stopping donation that took place in Sassari "concluded Of Anthony"it was the result of a wonderful team effort, an example of great commitment and sharing, for which I would like to thank in particular Dr. Giuseppe Feltrin, Director of the National Transplant Center, Dr. Paola Murgia and Dr. Leonardo Bianciardi, respectively Local Coordinator and Director of Intensive Care at the AOU of Sassari, but also all the individual professionals who actively participated in the process".

“We have marked a historic moment for the healthcare of our region and for our company - states the general director of the Aou of Sassari, Anthony Lorenzo Spano. “A special thanks goes to the donor and his family who made this donation possible, which will save the lives of other patients on the waiting list. Kidneys, liver and corneas were removed from a 65-year-old patient who had expressed his desire to donate when renewing his identity card”

In addition to Dr. Bianciardi and the Dr. Paola Murgia, the General Management of the AOU of Sassari extended its thanks to the Ecmo specialists with the Dr. Stefania Milia intensive care physician, cardiac surgeons and perfusionists led by Michele Portuguese, to the cardiac anesthetists led by the doctor Andrea Balata, to the operating room nurses, to the team of the Urological Clinic directed by Professor Max Madonia, to the specialists of the analysis laboratory directed by Angela Bitti, to Professor Microbiology and Virology Salvatore Rubino, at the Transfusion Center directed by Dr. Peter Missing, at the Radiology department directed by Professor Salvatore Masala, to the ophthalmologists of the Clinic directed by Professor Antonio Pinna and to the Pathological Anatomy directed by Professor Antonio Cossu.