The Italian Programma Alba for organ donation after circulatory death

A donation after cardiac Aims & ScopeCurrent A donation after cardiac/circulatory death (DCD), i.e. non-heart-beating donation (NHBD) programme named "Programma Alba" (Sunrise Programme) started in Pavia (Italy) in 2007. As in many countries, the main aim was to shorten the organ transplantation waiting lists. Initial targets were kidney and liver donations. Compared to other European countries and the US, the Italian DCD programme has taken more time to get established. Several reasons have apparently discouraged Italian physicians to set up such a transplantation programme, as unawareness of DCD organ viability, risk of diversion from heart beating donor programmes, ethical issues and the need to regulate medical requirements according to Italian legislation. Determination of death after irreversible cardiac arrest requires a 20-minute flat electrocardiogram, according to the law. This no-touch period is much longer than that established in legislations worldwide and organ viability after such a long no-touch period has been a major concern for many Italian transplant doctors over the years. Recent data allow up to 40-minutes warm ischemia time for preservation of organ viability. This has encouraged us to establish a DCD programme in Italy as well. Currently, three patients are out of dialysis with DCD kidneys. This paper analyzes all issues of DCD in detail from death definition and ascertainment according to Italian legislation to financial, technical and human resources needed to begin and establish such a transplantation programme in an Italian hospital.