Organ procurement and transplantation in non-heart beating donors, Type 2 and 3, treated with normothermic regional perfusion

Transplantation serves as the most effective therapy for individuals suffering from end-stage organ failure. However, the progress of this therapy is hindered by the limited availability of suitable organs for transplantation. Aiming to overcome this scarcity, the scientific community has been diligently working to expand the organ pool by considering organs harvested post-circulatory death. The main problem was related to the failure of the circulation and the inevitable ischemia of the organs: the longer the ischemia, the greater the probability that they would not function and in Italy a 20-minute stand-off period is still required to ascertain death. Extracorporeal membrane oxygenation (ECMO) is a medical device and therapy that provides temporary support to vital organs and in recent years it has found an application in a relatively new area - organ procurement in donation after circulatory death (DCD). There are two distinct categories of DCD, controlled (cDCD) and uncontrolled (uDCD). Categories I and II of the Maastricht classification fall under the uncontrolled DCD criteria and the third refers to controlled DCD. In 2008, the "Alba Program: Retrieval of Abdominal and Thoracic Organs from Donation after Circulatory Death (DCD) Donors" was developed at the Fondazione IRCCS Policlinico San Matteo in Pavia.

Transplantation serves as the most effective therapy for individuals suffering from end-stage organ failure. However, the progress of this therapy is hindered by the limited availability of suitable organs for transplantation. Aiming to overcome this scarcity, the scientific community has been diligently working to expand the organ pool by considering organs harvested post-circulatory death. The main problem was related to the failure of the circulation and the inevitable ischemia of the organs: the longer the ischemia, the greater the probability that they would not function and in Italy a 20-minute stand-off period is still required to ascertain death. Extracorporeal membrane oxygenation (ECMO) is a medical device and therapy that provides temporary support to vital organs and in recent years it has found an application in a relatively new area - organ procurement in donation after circulatory death (DCD). There are two distinct categories of DCD, controlled (cDCD) and uncontrolled (uDCD). Categories I and II of the Maastricht classification fall under the uncontrolled DCD criteria and the third refers to controlled DCD. In 2008, the "Alba Program: Retrieval of Abdominal and Thoracic Organs from Donation after Circulatory Death (DCD) Donors" was developed at the Fondazione IRCCS Policlinico San Matteo in Pavia. The aim of this study is to analyze the population of potential donors and understand how we can further increase it in order to meet the high demand of organs. Out of 74 Policlinico San Matteo patients, 69 (93%) were deemed viable donors. Thus, the DCD donation program in Italy has yielded very good results, both in terms of the number of enrolled patients and quality of harvested organs, and therefore should be considered a necessary resource to increase the donor pool in this country. The introduction of innovative protocols based on the combination of organ preservation techniques and the greater integration of cardiac arrest treatment protocols will be the focuses to delve into so that these results can be further improved.