2023, the year of the transplant boom: heart transplants increased by 46%

2023, the year of the transplant boom: heart transplants increased by 46%

For donations and transplants of organs, tissues and cells, 2023 was unprecedented: in the year just concluded, the activity of the Italian transplant network achieved the best results ever achieved in the history of our country in practically all indicators. The data were presented by the Minister of Health Orazio Schillaci and by the director of the National Transplant Center Massimo Cardillo at the opening of the General States of the Transplant Network, which brings together over 400 operators from all over Italy in Rome until Friday.

Record number of interventions

For the first time, organ donations exceeded the two thousand mark, standing at 2,042 (+11.6%), while transplants have largely surpassed the wall, never before crossed, of four thousand operations in a year: in 2023, 4,462 were carried out 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.

The increase in withdrawals brought the national donation rate to 28.2 donors per million people (pmp), well above the historic maximum of 24.6 recorded in 2022. With this result, Italy has separated itself from France and it 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 pmp donors . The rates in Sardinia, Piedmont and Marche are also excellent, while the southern regions unfortunately remain behind.

Which transplants have been performed

As regards transplants, the growth in interventions affected all specialties: in 2023, 2,245 kidney transplants were carried out (+10.4%), 1,696 liver (+14.7%), 186 lung transplants (+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.

Donors: the work of the Regions

Such a sensational result was in fact possible thanks to two growth factors strongly cultivated in recent years by the CNT. The first is the significant increase in reports of potential donors in the intensive care units of the over 200 collection sites active throughout the country. In 2023, there were 3,082 donors reported, 15.8% more than the 2,661 of the previous year.

The growth in reports was stimulated by a greater commitment by the regions in the application of the measures contained in the National Donations Plan, promoted over the last five years by the CNT with the aim of a more organized and efficient donation system, capable of fueling the transplant activity and respond to the needs of a waiting list which, although decreasing, still includes around 8 thousand patients.

The commitment of the operators

Naturally, the basis of this success is above all the exceptional commitment of the intensive care and donation coordination operators, and that of the surgical teams of the approximately 100 transplant programs present throughout Italy. This work 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.

Donations “with a firm heart”

The second growth factor in business volumes is to be found in the CNT’s strong investment in the donation program after 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 438 transplants in 2023 thanks to organs taken from DCD.

The DCD heart sampling program also began last May, an activity so far only present in Great Britain and Spain where, however (as in the rest of the world) the cardiac arrest time required to confirm death is 5 minutes against the 20 foreseen by Italian law.

As many as 6 centers nationwide (starting from Padua, the first) have so far carried out 13 DCD heart sampling and transplants. The successful use of cardiac organs that collectively cope with more than 40 minutes of “warm ischemia” is currently a world record. Such a significant result is due to the increased ability of professionals in the use of organ perfusion technologies (a sector that is experiencing important development) and to the training and organizational work carried out in the area to structure healthcare teams capable of efficiently managing this type of highly complex withdrawals.

But cases of patient refusal in intensive care are rising

The only indicators that have remained substantially unchanged are those relating to the rates of opposition to the levy. In resuscitations, the percentage of those who refuse the donation has risen slightly (30.5%, +0.7%) above all due to the ever-increasing incidence of those who have already registered their no while alive: in 2023, on the occasion of card renewals of electronic identities (CIE), 2.4 million consents were collected (68.5%) but also 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 in the short term most of the donations reported in resuscitations will have behind them a consensus and opposition already collected and therefore no longer obtainable by healthcare professionals. 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: an essential opportunity to strengthen the message in favor of donating to all Italian citizens.

Tissue and marrow, cases of donation on the rise

The record increase in donations also had an enormous impact on tissue activity: we had 14,912 samples (+21%) and 24,949 transplants (+16.7%), with strong increases in both corneas and musculoskeletal tissue . 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 also continues to consolidate, 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: 29,396 18-25 year olds were newly recruited, which brought the list of possible active donors to almost half a million (496,754).

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