When cold saves lives

Doctor Antonio Secchi, the coordinator of the transplant unit at San Raffaele Hospital, explains how organs are transported and preserved to The Fridge Foundation. This is when cold and time play an essential role in saving lives.

How are organs transported in Italy? Do you have special refrigerators?
Organs that are suitable for transplant are transported in isothermal containers and portable refrigerators, which have special labels so they can be easily identified. We do not use thermostatic fridges. They are working on prototypes of equipment with portable instruments for the perfusion of the organs.
How are the organs preserved? At what temperature is this done?
The organ is placed in a sterile double bag to create an insulating barrier against the outside and this is put in melting water ice at a temperature of 4° centigrade. This method is known as cold ischaemia, the organs and tissues do not receive a supply of blood or oxygen, and the temperature allows us to stop metabolic and decay processes.
What time scales are involved with cold ischaemia?
The time varies from organ to organ. The heart is the most delicate organ and needs to be transplanted within two, maximum four hours after retrieval. A kidney can have a longer cold ischaemic time, even up to twenty-four hours, although it is advisable to act within twelve to sixteen hours.
What vehicles are used to transport the organs?
We use specially equipped healthcare vehicles, and helicopters for urgent cases.
How are the different units coordinated?
Up to sixty people with a wide range of different skills may be involved in a transplant. Communication needs to be swift and clear because at times like this speed and clarity are of the essence. Our organisation is the result of thirty years’ work and is like a well-oiled machine with constantly updated protocols and plans of action.
Are the assignment of organs and procedures meticulously regulated?
Doctor Nanni Costa, director of the National Transplant Centre, has created a system that acts with maximum transparency. Organ transplantation is the only field of medicine in which all the data is published online and may be accessed by everyone in the country. Organs are assigned to recipients via a national waiting list. This prevents favouritism and allows every action to be clearly coordinated with rigorously controlled organs.
How many transplant surgeries are performed in your hospital?
At San Raffaele we perform about sixty a year. 7,000 people are on the waiting list in Italy and 1,600 transplants are performed every year. Unfortunately the number of donors does not increase, and far too many people are still dying while waiting for an organ. It’s better to dispel any doubts for people, Italian law is very pro civil rights; if brain death is declared, the patient is no longer alive, and nothing should stand in the way of an act of love and generosity like donating an organ.
We can all become donors. All you need to do is register with AIDO, the Italian Association of Organ Donors, and make a voluntary declaration that you wish to become a donor. As well as being an act of love and generosity, it is also a social duty that can give hope and life when a life has gone.
Visit the aido website www.aido.it