Kidney Donation after circulatory death: The Veneto Region experience in Italy

Donation after circulatory death (DCD) is a promising strategy for increasing organ supply worldwide. The Italian current legislative framework has represented a major barrier to the implementation of such program, given the 20-minute no-touch period required for donor death declaration. In this study, we describe DCD reporting activity in Veneto, number of procurements and kidney transplants performed from DCD donors since the beginning of its application, in 2017. We considered donor characteristics (DCD Maastricht category, age, sex) and number of kidney grafts retrieved and transplanted for each donor. All the procured kidney grafts underwent ex situ hypothermic perfusion and pre-implantation kidney biopsy according to Karpinski-Remuzzi score. Perfusion parameters were monitored in order to predict functional recovery after transplantation and the histological evaluation focused on evaluating the extension of the ischemic injury. In the Veneto experience, histological data and hypothermic perfusion have proven to be very useful tools to make a decision concerning whether a kidney is suitable for transplantation. Considering logistical, clinical, ethical and technical issues related to DCD donor program in Italy, many resources had to be dedicated in Veneto to build adequate technical expertise and to develop dedicated care pathways. The Veneto Region Transplant Coordination has encouraged and supported the development of DCD activity, increasing kidney transplantation from DCD donors.