Transplantation is an intervention that falls within the essential levels of assistance (LEA), that is, the services that the National Health Service is required to provide free of charge to all citizens and in many cases constitutes, for those who have to undergo it, the " only opportunity to continue or to resume living normally.
The particular complexity of the Transplant System and the many professional figures involved require a solid and articulated network, capable of governing donation and transplantation activities in the area with uniform criteria.
The architecture of this structure is designed on two action plans: the institutional level and the operational level.
The institutions involved in the Transplant Network are the Ministry of Health, the State-Regions Conference, the Departments and the Superior Health Council which use the National Transplant Center as the governing body of the network.
Operational management, or the coordination of donation, removal and transplantation activities, is articulated on three levels: national, regional and local.
- National Transplant Center, which interfaces with the regional centers in charge of donors and ensures the necessary support for the operational management of national programs
- Permanent technical consultationfor transplants, which has the task of establishing the technical-operational guidelines and guidelines for organ harvesting and transplantation activities. It also carries out advisory functions towards the National Transplant Center
Regional Transplant Centers (CRT), which take the name of Interregional Transplant Center (CIRT) if the Regions or Autonomous Provinces of Trento and Bolzano join together to perform some functions attributed to them.
Hospital coordination centers at local health authorities and clinical-assistance centers in the area. Their function is to enhance the development of donations and transplants, examine waiting lists, check that the organ assignment process is done with the utmost transparency taking into account clinical urgencies and allocative priorities, carry out immunological checks and manage the logistics of the donation-transplant process at the local level.
The centers, which manage the organ and tissue donation phase, are emergency departments where most of the potential donors arrive. These are people in a state of brain death, with irreversible brain damage, whose conditions and possibilities for becoming organ and tissue donors are evaluated.
Generally, collection centers are resuscitation, neuroreanimation or neurosurgery facilities. They represent one of the crucial points of the whole Network and their evaluation depends on the development of the transplant system and the possibility of being able to accept the requests of patients on the waiting list.
They are hospitals authorized by the Ministry of Health to take organs and transplant them. Generally, these are complex operating units that become the referents of the path of care of the sick until their clinical stabilization.
Banks of tissues and cells
The law of 1 April 1999 n. 91 provides for the establishment of centers where tissue and cell processing, conservation, storage or distribution can be carried out. They can be non-profit health facilities, sectors of a transfusion service or even units of public hospitals.
In recent years, the Italian transplant network has been showing constant growth, both in terms of donations and transplants.
The results place Italy in a place of absolute prestige on the international scene.
In 2020, the impact of the SARS-CoV-2 pandemic did not spare the transplant network, resulting in a 10.4% decrease in organ harvesting from deceased donors (1236 against 1379 in the previous year). To this figure is added a more consistent decrease in living donations (294, -19.2%), since it is a "programmable surgical activity, this type of transplant has suffered a greater slowdown."
The drop in donations translated into a specular reduction in transplants. 3441 interventions were carried out in 2020, 373 less than in 2019 (-9.8%). Of these, 3,146 were made thanks to the organs of deceased donors (-303%, or -8.8% compared to a year ago.
These data are due to three main factors:
- the commitment and preparation of health workers employed in transplant structures
- an ever greater coordination of donation, removal and transplantation activities
- information initiatives that have led to greater awareness and sensitivity on the problem by the population
The National Transplant Center
Established as a result of the law of 1 April 1999 n.91, which regulates the Provisions regarding the removal and transplantation of organs and tissues, the National Transplant Center (CNT) is a technical body of the Ministry of Health and is based at the Higher Institute of Health.
It is chaired by:
- Director of the Higher Institute of Health with the role of President
- Director General of the Center
- One representative for each of the regional or interregional transplant centers
The CNT is responsible for the national coordination of all the activities of donation, removal and transplantation of organs, tissues and cells.
In particular, the tasks assigned to it are:
- promote the quality, transparency and safety of donation and transplant activities also through constant monitoring of the data transmitted by the regional transplant centers to the transplant information system
- manage the assignment of bodies with absolute transparency and in full compliance with waiting lists
- oversee the training of medical and health personnel and verify the quality and results of transplant facilities
- collaborate with foreign institutions in the sector to coordinate the exchange of organs at an international level
- promote communication actions for a more widespread knowledge of issues related to donation and transplantation