• Adriano Peris, Chiara Lazzeri, Giovanni Cianchi, Manuela Bonizzoli, Stefano Batacchi, Andrea Franci, Mario Rugna, Lucia De Vito, Pier F Ticali, Vincenzo Li Marzi, and Maria L Migliaccio.
• Unit of Intensive Care and Regional ECMO Referral Center, Emergency Department, Careggi University Hospital, Florence, Italy - aperis@libero.it.
• Minerva Anestesiol. 2018 Dec 1; 84 (12): 1387-1392.

BackgroundDonation 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."MethodsWe 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.ResultsEighteen 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.ConclusionsA 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.

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