IRCCS ISMETT, in Palermo, recently performed its first kidney transplants with organs procured from donors without a heartbeat. The two procedures were done last week thanks to a donation from the region of Piedmont, in the north of Italy. The recipients of the organs were two Sicilian patients with chronic renal failure and on dialysis.
From a technical perspective, the procedure is possible thanks to perfusion of the organ. After the procurement, the kidneys are reperfused with a specific device under controlled oxygenation, pressure, and temperature conditions. In this case, the extracorporeal organ perfusion technique allowed transport of the organs by plane from Piedmont to Sicily, while they were being perfused with a portable device. “Thanks to the current available procedures, before and after procurement,” said Dr. Salvatore Gruttadauria, Director of the Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and Dr. Salvatore Piazza, Director of ISMETT’s Kidney Transplant Program, “the quality of organs from donors without a heartbeat is the same as that of organs procured from donors with a heartbeat. The two transplant recipients are in good conditions, and are both recovering well.”
ISMETT is the first center south of Rome to perform this kind of procedure. Sicily is the fifth region in Italy, after Lombardy, Piedmont, Tuscany, and Emilia Romagna to participate in the non-heart-beating donation program of the Centro Nazionale dei Trapianti (CNT). In Italy, this type of donation is regulated by the same standards regulating brain-dead donors with a heartbeat, whose death is confirmed by neurological criteria (six hours of observation by a specific commission to determine brain death). After the death is determined, the organ procurement from a donor without a heartbeat for transplant purposes is very complex, especially from an organizational perspective, from the regional emergency system to the medical team and healthcare operators involved in the procedures.
“The use of organs from donors without a heartbeat, and organ reconditioning,”, “is the new frontier of transplantation,” explains Dr. Angelo Luca, Director of IRCCS ISMETT. “ISMETT has been focusing on this over recent years. We performed, in 2015, and for the first time in Europe, a bilateral lung transplant with organs reconditioned by extracorporeal perfusion, and in 2016 we performed two liver transplants with reconditioned organs. In order to improve the current organ reconditioning techniques, the clinical program works alongside preclinical research groups, in collaboration with the Bioreactor Group of the McGowan Institute for Regenerative Medicine, in Pittsburgh, and UPMC (University of Pittsburgh Medical Center). We aim at increasing the use of organs that otherwise would be rejected, thus increasing the number of possible transplants, and reducing waitlist mortality rates.”