Giuseppe Arena, Chief Nursing Officer
Giuseppe Arena is the chief nursing officer at ISMETT. He coordinates over 400 people, but in 1999 he was a young 24-year-old nurse. Having previously worked in Cologno Monzese and Palermo, in joined ISMETT and was went to the United States with 14 other nurses. Their destination was UPMC Presbyterian Hospital in Pittsburgh, where organ transplantation had a long and important tradition. That life-changing experience lasted one year. “Everybody should have the opportunity to experience such a great professional and personal growth. We acquired new theoretical and practical knowledge. Training lasted all day and each of us was assigned to a different unit. I was sent to the ICU.”
Giuseppe and the other Italian nurses returned to Palermo with several UPMC nurses to continue their training. “From May to July, we worked hard to set up the first ISMETT facility: 4 ICU beds and 16 inpatients beds. Even though we were a small and young center, people trusted us because they saw the American know-how and expertise, and also witnessed our enthusiasm.” At that time, ISMETT was a special place: English and Italian were interwoven, the young staff felt they were part of an important project that offered everybody a chance to improve professionally, and where the transfer of know-how was considered of primary importance.
Giuseppe was on duty in the ICU the day before the first liver transplant: “Everybody was excited. We all felt the responsibility. In the U.S. we had basically observed, now we were in charge and there was no room for mistakes.” The relationship with Pittsburgh remains of key importance even today that ISMETT has grown: “When in doubt we request a second opinion from our colleagues in Pittsburgh, even though now our relationship has become equal, and sometimes they ask our support.”
Salvo Gruttadauria, Director, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation
Salvo Gruttadauria remembers very well the first liver transplant performed in Sicily: “I was a member of the team that performed the organ procurement in Catania and the transplant in Palermo. I was in the OR for close to 23 hours.” At that time, Salvo was 29 and he was the first fellow hired at ISMETT: “After specializing in General Surgery, I was selected for a sort of ‘super-postgraduate program’ similar to an American fellowship.” He had to leave his hometown in Sicily and move to Bologna first, then in Nebraska, and finally in Pittsburgh, in order to take part in the liver transplants. “All Sicilian surgeons knew very well they had to move to other Italian regions or abroad, if they wanted to work in the field of transplants. That transplant performed twenty years ago was a game changer for physicians but also for patients, since it reversed the trend of the journeys of hope.”
Salvo remembers it was a very long and very hot day. Even in the OR the temperature was high, maybe because the air conditioning system wasn’t working very well, and also because everybody knew they had a very big responsibility. “Today, a liver transplant lasts six hours on average. It’s a fairly standard procedure that in 70% of cases doesn’t require blood transfusions. But, at the time, they lasted much longer and, like any new procedure, it posed more risks and difficulties. Luckily, everything went for the best.”
Today Dr. Gruttadauria is the director of the Department for the Abdominal Transplantation, where many Sicilians, like him, work. ISMETT has obtained extremely positive outcomes in liver transplants, but there’s still room for improvement, namely the number of available organs. “Sicily is still struggling to reach an adequate number of donations, even if in theory it could become self-sufficient. While waiting for things to change, we continue to work and improve our techniques for marginal donors, performing living donor transplants.” The events that took place during the last twenty years, seen from this part of the world, have something to teach all of us. Dr. Gruttadauria sees it like this: “If you choose the right model to follow, the impossible becomes possible.”
Pietro Conti, Supervisor, Maintenance and Systems
“It was very hot that day in Palermo: 42-43 °C. The refrigerating system cooling the operating rooms wasn’t strong enough for those temperatures. They were overheating and weren’t cooling enough. An increase in the OR temperature would have meant putting the patient at a higher risk of developing an infection. When the procedure started, I went on the roof with a technician from Civico Hospital to pour cold water on those machines. We spent the entire night on that roof, pouring water over them.”
Pietro Conti today is the Supervisor for the Maintenance and Systems at ISMETT, but in July 1999 he was a maintenance technician hired just a month before. He was responsible for all systems: from the complex electromedical equipment to the OR beds.
“A couple of times I had to go in the OR during the surgery, crawl under the bed on which the patient was lying, and unlock the mechanism to raise and lower it.”
Pioneering times: “There was only a few of us at the time and we had to take care of everything. All problem had to be solved. Time was not an issue. Once I worked for 72 consecutive hours. Transplants lasted 14 hours, and I had to remain at the hospital for their entire duration. Sometimes, as one transplant finally ended, another one started immediately after. But there was only one technician: me.”
Pietro remembers the enthusiasm of being part of a team: “I lived in Palermo and I knew that health care in Sicily wasn’t working as it should have. The idea of being part of a center of excellence, where lives were saved, and meritocracy mattered, filled me with enthusiasm.”