Adriano Peris1,2, Chiara Lazzeri3, Giovanni Cianchi3, Manuela Bonizzoli3, Stefano Batacchi3, Andrea Franci3, Mario Rugna4, Lucia De Vito4, Pier F Ticali5, Vincenzo Li Marzi6, Maria L Migliaccio3. 1. Unit of Intensive Care and Regional ECMO Referral Center, Emergency Department, Careggi University Hospital, Florence, Italy - aperis@libero.it. 2. Tuscany Authority for Transplantation (Centro Regionale Allocazione Organi e Tessuti CRAOT), Florence, Italy - aperis@libero.it. 3. Unit of Intensive Care and Regional ECMO Referral Center, Emergency Department, Careggi University Hospital, Florence, Italy. 4. Emergency Medical System, Florence, Italy. 5. Department of Emergency Medicine, Careggi University Hospital, Florence, Italy. 6. Department of Urology, Careggi University Hospital, Florence, Italy.
Abstract
BACKGROUND: Donation after circulatory death (DCD) is an emerging way to implement organ procurement for transplantation. In Italy, until June 2016, the only formal DCD program was implemented in Pavia, the so-called "Alba program." METHODS: We describe our one-year experience of the DCD program implemented at the Careggi Teaching Hospital (Florence, Italy) since June 2016. We specifically describe organizational changes induced by the DCD program on our pre-existing Donation After Brain Death (DBD) program and DCD activity. RESULTS: Eighteen activations were recorded (i.e. 18 DCD donors), among whom Seven donors were discarded due to opposition in five patients and failure to meet activation criteria in two (inability to contact relatives). Our population comprises 11 donors among whom eight patients were Maastricht type II donors while three were Maastricht type III donors. 22 kidneys and six livers were retrieved, while 13 kidneys and two liver were transplanted. CONCLUSIONS: A DCD program was feasible and increased procurement of splancnic organs (kidney and liver). Starting a DCD program in a traditionally oriented to DBD poses some organizational and cultural problems. A skilled, experienced ECMO team is necessary to guarantee organ ex vivo perfusion. Another important aspect for the implementation of a DCD program is the collaboration with the emergency system which allows a therapeutic approach of patients with cardiac arrest.
BACKGROUND: Donation after circulatory death (DCD) is an emerging way to implement organ procurement for transplantation. In Italy, until June 2016, the only formal DCD program was implemented in Pavia, the so-called "Alba program." METHODS: We describe our one-year experience of the DCD program implemented at the Careggi Teaching Hospital (Florence, Italy) since June 2016. We specifically describe organizational changes induced by the DCD program on our pre-existing Donation After Brain Death (DBD) program and DCD activity. RESULTS: Eighteen activations were recorded (i.e. 18 DCD donors), among whom Seven donors were discarded due to opposition in five patients and failure to meet activation criteria in two (inability to contact relatives). Our population comprises 11 donors among whom eight patients were Maastricht type II donors while three were Maastricht type III donors. 22 kidneys and six livers were retrieved, while 13 kidneys and two liver were transplanted. CONCLUSIONS: A DCD program was feasible and increased procurement of splancnic organs (kidney and liver). Starting a DCD program in a traditionally oriented to DBD poses some organizational and cultural problems. A skilled, experienced ECMO team is necessary to guarantee organ ex vivo perfusion. Another important aspect for the implementation of a DCD program is the collaboration with the emergency system which allows a therapeutic approach of patients with cardiac arrest.
Authors: Leonardo Caroti; Giuseppe Cestone; Lorenzo Di Maria; Marco Allinovi; Vicenzo Li Marzi; Sergio Serni; Calogero Lino Cirami Journal: Clin Nephrol Case Stud Date: 2021-05-25