Past, present, and future of donation after circulatory death in Italy

How to Preserve Liver Grafts From Circulatory Death With Long Warm Ischemia? A Retrospective Italian Cohort Study With Normothermic Regional Perfusion and Hypothermic Oxygenated Perfusion

“…3,6 The encouraging results of the first Italian series have promoted the wider use of this protocol and encouraged other Italian centers to implement a DCD liver transplant program despite the high overall donor risk. [10][11][12][13] Based on the exceptionally long donor warm ischemia time in Italy, there is a general reluctance to use such DCD livers for transplantation due to the expected high risk of graft failure. The use of in situ or ex situ MP technology may help to improve graft function and assess liver viability to support the decision making whether to utilize such livers or not.…”

“…3,6 The encouraging results of the first Italian series have promoted the wider use of this protocol and encouraged other Italian centers to implement a DCD liver transplant program despite the high overall donor risk. 10-13…”

Is donation after circulatory determination of death feasible for pediatric patients in italy?

“…At the moment, NRP cannot be divided by DCD in Italy. 16 This technique has proved to be a beneficial strategy to restore cellular metabolism and allows organ function evaluation 17 but it is a significant economic and organizational effort to be taken into account to organize a future pDCD program.…”

“…Waiting for 20 minutes of the absence of cardiac rhythm compromises the quality of organs and forces the Italian system to use the normothermic regional perfusion (NRP) on patients complicating all scenarios. At the moment, NRP cannot be divided by DCD in Italy 16 . This technique has proved to be a beneficial strategy to restore cellular metabolism and allows organ function evaluation 17 but it is a significant economic and organizational effort to be taken into account to organize a future pDCD program.…”

Novel Organ Perfusion and Preservation Strategies in Transplantation – Where Are We Going in the United Kingdom?

“…This study was presented at the American Transplant Congress in 2017, and reported significantly lower levels of DGF in cDCD kidneys following NRP when compared to DBD kidneys (9%vs.19%, p<0.05) 35 . In Italy, where declaration of circulatory death is based on absence of electrical activity and requires a minimum no-touch period of at least 20 minutes, 36 a series of 10 kidneys from cDCD donors using NRP and oxygenated-HMP reported a DGF rate of 30% and no PNF 37 .…”