First heart transplant in Sicily from non-beating heart donor

Milestone procedure possible thanks to collaboration between ARNAS Civico Di Cristina Benfratelli, CRT, and ISMETT.

For the first time in Sicily, a heart transplant successfully performed using a non-beating heart donor. This DCD (Donation after Circulatory Death) controlled transplant is a procedure currently performed in only a few highly-specialized centers in Italy.

The donor, admitted to the ICU of ARNAS Civico Di Cristina Benfratelli in Palermo, managed by director Vincenzo Mazzarese, had suffered irreversible brain damage. According to the protocols for this type of donation, the patient was placed on extracorporeal membrane oxygenation (ECMO) at ISMETT prior to the organ procurement. A heart transplant from a non-beating donor is one of the most complex and delicate procedures in the field of transplantation. A cardiac arrest involves a period of ischemia during which the heart is deprived of oxygen, increasing the risk of irreversible damages. ECMO support during organ procurement is essential, and requires highly specialized skills, coordination between medical teams, and an exceptionally advanced level of clinical management. At ISMETT, the transplant recipient has already been discharged in good clinical conditions.  “This achievement,” jointly stated the general managers of the two hospitals, “was made possible by the generosity of the donor’s family, allowing another person to survive. This complex procedure was accomplished possible thanks to the professionalism of our teams and to the synergy between our two hospitals.”

The activities were coordinated by the Regional Transplant Center (CRT) of Sicily. “This procedure is a significant scientific milestone made possible by the generosity of the donor’s family, to whom we extend our heartfelt thanks,” said Giorgio Battaglia, Regional Coordinator of CRT Sicily. “Our gratitude also goes to all donors, who every day enable us to save other lives and are the cornerstone of this system. It is crucial to continue investing in the culture of donation, a shared objective that our teams have tirelessly pursued over the years through education and awareness efforts about organ and tissue donation.” “Previously,” explained Antonino Scafidi, Director of UOC CRTO at ARNAS Civico Di Cristina Benfratelli, “in our region this type of DCD controlled transplant had involved the procurement of other organs, such as kidneys or liver, but not the heart. Today we can offer new hope to many patients on the waiting list.” 

From an anesthesiology perspective, managing the patient requires advanced and continuous monitoring, with particular focus on the reperfusion and hemodynamic stability. “The success of the surgery and the patient’s discharge are the result of an extraordinary collaboration among highly qualified professionals,” commented Dr. Gaetano Burgio, Chief of Anesthesia and OR Unit at ISMETT. “The seamless integration between the teams from ARNAS Civico and ISMETT enabled us to undertake this innovative and delicate procedure, confirming the added value of the synergy between our hospitals.”

 “This is a remarkable achievement for Sicily,” stated Michele Pilato, Director of ISMETT’s Heart Center, “that demonstrates our region is capable of delivering organizational processes and health care standards at the level of the best national and international centers.”  Due to its extreme complexity this procedure was considered unfeasible until very recently. The first transplant of this kind in Italy was performed in Padua in 2023. “This was a complex operation,” explained Sergio Sciacca, head of the Heart Transplant Program at ISMETT, “made possible by a multidisciplinary team of surgeons, cardiologists, anesthesiologists, perfusionists, nurses, psychologists, and physical therapists, using the most advanced technologies. With a heart transplant from a DCD donor, the heart’s non-beating condition is maintained for at least 20 minutes [Ed. Note: a timeframe established by Italian regulations to certify circulatory death]. During this period, the organ receives no oxygen or blood, a condition that can significantly compromise its function.”