Donations and transplants of organs, tissues and cells are growing in Italy. “2023 has been unprecedented: in the year just concluded, the activity of the Italian transplant network achieved in practically all indicators the best results ever achieved in the history of our country”. Thus the National Transplant Center (Cnt), which presented the data today in Rome during the General States of the Transplant Network which until Friday will see over 400 operators from all over Italy in the capital. Also present at the opening of the proceedings was the Minister of Health, Orazio Schillaci.
“For the first time, organ donations exceeded the 2,000 mark, reaching 2,042 (+11.6%), while transplants have largely surpassed the wall, never before crossed, of 4,000 operations in a year: in 2023 they were carried out 4,462 organ transplants, 586 more than in 2022 (+15.1%). In both cases, these are not only the highest absolute figures ever, but also the highest annual growth percentages ever obtained”, specifies the Cnt.
The increase in withdrawals has brought the national donation rate to 28.2 donors per million people (pmp), much higher than the historical maximum of 24.6 recorded in 2022 – continues the CNT report – With this result the Italy has overtaken France and ranks second among the major European countries in terms of number of donors, behind Spain. Supporting the performance are above all the results of three regions: Emilia Romagna with 51.1 PMP donors (+4.7), Veneto with 46.4 (+10.1) and Tuscany with 45.6. The rates in Sardinia, Piedmont and Marche are also excellent, while the southern regions unfortunately remain behind.
The interventions
As regards the type of intervention, the growth in interventions concerned all specialties: in 2023, 2,245 kidney transplants were carried out (+10.4%), 1,696 liver (+14.7%), 186 lung ( +33.8%), 40 pancreas transplants (+5.3%), but above all 370 heart transplants compared to 253 last year (+46.2%). Furthermore, the constant improvement in the outcomes of the interventions is still confirmed. In absolute terms, Lombardy was the region that carried out the highest number of transplants (827), while in relation to the population the record goes to Veneto (140.9 transplants per million inhabitants), followed by Piedmont and Emilia Romagna. In the South, the growth recorded by Puglia is significant, going from 29.7 to 46.9 transplants per million inhabitants in one year.
“Such a sensational result – explain the experts – was in fact possible thanks to two growth factors strongly cultivated in recent years by the National Transplant Center. The first is the significant increase in reports of potential donors in the intensive care units of over 200 sites collections active on the national territory. In 2023, the donors reported were 3,082, 15.8% more than the 2,661 of the previous year”.
The growth in reports – the specialists underline – was stimulated by a greater commitment by the Regions in the application of the measures contained in the National Donations Plan, promoted in the last 5 years by the CNT with the aim of a more organized and efficient donation system, capable of fueling transplant activity and meeting the needs of a waiting list which, although decreasing, still includes around 8 thousand patients. “Naturally – specifies the CNT – at the basis of this success there is above all the exceptional commitment of the operators of intensive care and donation coordination, and that of the surgical teams of the approximately 100 transplant programs present throughout Italy. This work is was also supported by a significant increase in national training activity for network professionals: between in-person courses (almost doubled) and distance learning, around 14 thousand operators were involved in 2023”.
The second growth factor in activity volumes is to be found in the CNT's strong investment in the donation program after confirmation of death with cardiac criteria, the so-called 'donation after cardiac death' (DCD). “Transplants derived from this type of donor have increased exponentially: we went from 100 in 2018 to 221 in 2022 to reach as many as 438 transplants in 2023 thanks to organs taken from DCDs – indicates the CNT – Starting last May the DCD sampling program also of the heart, an activity so far only present in Great Britain and Spain where, however, as in the rest of the world, the cardiac arrest time necessary to certify death is 5 minutes compared to the 20 required by Italian law. As many as 6 centers at a national level (starting from Padua, the first) have so far carried out 13 DCD heart samples and transplants. The successful use of cardiac organs which in total can cope with more than 40 minutes of 'warm ischemia' is currently” according to the experts, “a world record. Such a significant result is due to the increased ability of professionals in the use of organ perfusion technologies (a sector which is experiencing important development), and to the training and organizational work carried out forward in the area to structure healthcare teams capable of efficiently managing this type of highly complex blood samples”.
“The only indicators that have remained substantially unchanged – notes the CNT – are those relating to the rates of opposition to the blood sample. In resuscitations, the percentage of those who refuse the donation has risen slightly (30.5%, +0.7%), especially due to the increasing incidence of those who have already registered their no in life. In 2023, on the occasion of the renewals of electronic identity cards (Cie), 2.4 million consents were collected (68.5%), but also well 1.1 million refusals (31.5%). Considering the current presence in the Transplant Information System of over 18 million registered declarations, it is foreseeable that soon the majority of donations reported in resuscitations will have a consent and a opposition already collected and therefore no longer obtainable from health workers. An important innovation is expected in 2024, that of the activation of the Cie digital portal which will allow citizens to register their declaration directly from home and not only in the registry offices: a “an unmissable opportunity – the specialists point out – to strengthen the message in favor of donation to all Italian citizens”.
“The record increase in donations – reports the CNT – also had an enormous impact on tissue activity: we had 14,912 samples (+21%) and 24,949 transplants (+16.7%), with strong increases both on corneas than on musculoskeletal tissue. A record year also for hematopoietic stem cells: in 2023 in Italy there were 399 bone marrow donations (+21.3%) and 1,023 transplants (+6.5%). The tendency to prefer the collection of cells from peripheral blood is also consolidating, a very minimally invasive method (very similar to a blood donation) which now concerns over 90% of donations. Registrations to the IBMDR donor register were also very good: there were 29,396 the newly recruited 18-25 year olds, who brought the list of possible active donors to almost half a million (496,754)”.
Schillaci
“The extraordinary results achieved in the transplant field” in 2023 “must make us proud and, at the same time, stimulate us to continue with renewed commitment to make the transplant network increasingly efficient and safe as well as to strengthen the culture of donation, essential for offering patients waiting for a transplant a second life or a better life prospect”, stated the Minister of Health Orazio Schillaci who added: “Promoting the culture of donation is a priority objective and I am sure that from these days a significant contribution will come to the reaching this goal.”
“In Italy, in fact – highlighted Schillaci – there are many patients waiting and the need is not yet completely satisfied. This is due to some critical issues that still persist and which we are committed to overcoming: I am thinking, in particular, of the regional differences which exist in the donation rate between North and South and in the rates of opposition to the withdrawal, the only indicators that have remained substantially unchanged”.
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