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					                   THE ITALIAN TRANSPLANT SYSTEM

In Italy the network that co-ordinates retrieval and transplant activities is
articulated on four levels: local, regional, inter-regional and national.
Local co-ordination Experienced physicians in the field of donation
transmit data on potential donors to the regional centre, keep in contact
with donors’ families, organise information campaigns in accordance with
the regional centre, follow all the organisational procedures in order to carry
out retrievals and transplants.
Regional co-ordination It is made up by the regional reference centres.
In the regional area, the Regional Transplant Centre manages: organ
donations and relations with ICUs, waiting lists and relations with external
centres, organ and tissues retrievals, transplants, relations with transplant
centres, relations with the Inter-regional centre;
Inter-regional co-ordination Currently three inter-regional organisations
cover the whole national territory. The three organisations are:
AIRT (Inter-regional Transplant Association) covers Piedmont, Valle d’Aosta,
Tuscany, Puglia and Emilia-Romagna and the Autonomous Province of
Bolzano;
NITp (Nord Italia Transplant program) covers Friuli, Liguria, Lombardy,
Marche, Veneto and the Autonomous Province of Trento;
OCST (Southern-Central Organisation for Transplants) covers Abruzzo,
Basilicata, Calabria, Campania, Lazio, Molise, Sardinia, Sicily and Umbria.
The Inter-regional Transplant Centres manage relations with Regional
Centres in their jurisdiction area as concerns reporting on potential donors
and allocations of organs, urgencies, organ given as advance, return of
organs, contacts with other Inter-regional Centres and with the National
Transplant Centre. They also update registries of retrievals carried out over
the national territory, of transplanted organs, of follow-up and organs
exchanged with other co-ordination organisations.
                                Citizens / Patients
                                   local operational units


                                     Regional Centers

                        Retrieval center              Transplant center
                                             CIR

                                             CNT
                              NATIONAL TRANSPLANT COUNCIL

                          REGIONs              HIGHER HEALTH COUNCIL

                                           MINISTRY
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                                         National Transplant Center


T H E N A T I O N A L T R A N S P L A N T C E N T R E (w w w .m in is te r o s a lu te .it/ tr a p ia n ti)
The National Transplant Centre (CNT) is a technical body of the Italian
Ministry of Health, established under Law 91, dated April 1 1999, in order
to promote, coordinate and manage organ and tissue donation and
transplantation in Italy. The Centre, located in the Italian National Institute
of Health (ISS), is chaired by the President of ISS, and is composed by the
General Director, nominated and appointed by the Health Minister, and by
representatives of the Inter-regional or Regional Centre, nominated by
State-Regions Conference. The Center is supported by the Transplant
Standing Technical Council, that prepares the technical-operational
guidelines for carrying out retrieval and transplant activities, giving advisory
opinions to CNT.
The CNT also avails itself of experts from the Biomedical Engeneering and
Immunology Laboratories of the National Institute of Health.
Another task is to highlight strategies to put into practice the law and the all
the activities on the procedure abiding.

Law 91 (art. 8) also establishes in detail the following functions of CNT:
    •   controlling, through information systems, collected data on donations,
        transplants and waiting lists;
    •   setting criteria for preparation of operating protocols, as rules for
        allocation of organs and tissues, currently carried out by regional and
        inter-regional centres;
    •   issuing guidelines on regional and inter-regional centres activities;
    •   allocating organs in urgent situations;
    • establishing homogeneous criteria to evaluate the quality of structures
      involved in transplant activities;
    • promoting and co-ordinating relations with EOEOs (European Organ
      Exchange Organizations);
    • managing National Programmes regulated by shared rules (i.e.
      paediatric and liver urgencies) and programmes not regulated by ad
      hoc guidelines but generally accepted (i.e. pancreas, bowels, HIV, lung,
      kidney and liver)


In addition to these important tasks, the law assigns to CNT the promotion
of information campaigns on organ donation, retrieval and transplantation,


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                               National Transplant Center


the management of the transplant information system (SIT) and an effective
role in the organisation and management of the Italian transplant system.


The principles that support all the activities of the CNT are:

       ATTENTION TO PATIENT’S NEED
       CREATION OF A NETWORK
       SHARING AND CO-DECISION
       EQUITY AND TRANSPARENCY
       DISSEMINATION OF THE INFORMATION


                           MAIN FIELDS OF ACTIVITY
                           MAIN FIELDS OF ACTIVITY


Qualliity and safety
Q u a ty a n d s a fe ty
Quality activity is based most of all on controlling and evaluating quality
programs and in audit activity of liver and kidney transplant centres,
Regional/Interregional Transplant Centres, tissue banks, heart and lung
transplant centres, taking into account the specific guideline.
As regards safety, these are the main field of activity:
   • National HIV programme
   • Drawing-up and adoption of Guidelines concerning donor safety.
   • Experts Task force (Second opinion)
   • Tel Bios Project

R esearch
R esearch

The CNT is involved in several national programmes and coordinates or
participates in national projects or reasearch programmes.
These are the main current projects:
   • Assessment, selection and use of kidney marginal donors
   • Innovative Strategies for Liver Transplant
   • Surveillance of the national transplant kidney programme for the
       difficult patients
   • Mangement of national heart emergencies
   • Biological national repository for safety of transplant network
   • Clinical protocols for surveillance of calulated risk transplants
   • Italian Gate to Europe

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                                     National Transplant Center


    •   Quality in transplants carried out
    •   National certification of Coordinators
    •   Comparative study protocol for the evaluation of artificial substitute in
        liver insufficiency
    •   Protocol on management of bowel and multivisceral transplant
        programme
    •   Document on regional standards for transplant organs centres
        authorizations
    •   Implementation of a regional quality programme on the process of
        organs and tissues retrieval
    •   Donations and transplantation of hematopoietic stem cells:
        epidemiological data collection and evaluation
    •   Clinical application of the PCR diagnostic test to determine the tissue
        from which the cancer has been developed

Projjects and iinternatiionall affaiirs
P ro e c ts a n d n te rn a t o n a a ffa rs

These activities regards relations with national and supernational
organisations in the field of donations and transplantation and participation
in projects.
CNT coordinates or participate as a partner in several EU funded European
projects:

EUROCET         (EUROpean Registry on Organs CElls and Tissues)
COCOON
Alliance-O –
SANCO (European Quality for Tissue Banking)
DOPKI – (under negotiation, supposed to start early 2006)
EUSTITE (under negotiation, supposed to start early 2006)

Informatiion Technollogy
In fo rm a t o n T e c h n o o g y

The Information System (SIT) of the Italian National Transplant Centre has
been settled in 1999 by the Law 91/99 with this goals:
– Registration and collection of living will statements on organ and tissue
   donation delivered by citizens;
– Automatic information collection of data on retrieval and transplant
   activities carried out by all facilities over the national territory;
– Comparison between organ offered and needed


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                                  National Transplant Center


–   Allowing information sharing among all transplant network actors.

Informatiion to ciitiizens
In fo rm a t o n to c t z e n s

CNT coordinates national information campaigns launched through mass
media, with the goal to stress out the importance of organs and tissues
donation. Information is provided to citizens also through the web site of the
Ministry of Health (http://www.ministerosalute.it/trapianti/) and through a
toll-free number for transplantation (800 333 033), where a staff of experts
answers more frequently asked questions, and through a newsletter, “Fatti e
Cifre”(http://www.think2.it/CNT/indice.html), directed to all in-field
personnel, that is published every two weeks.

Legislation

The National Transplant System in Italy is established by Law 91/1999,
which has contributed to to development of the present organizational
model.
In addiction to this law, other legislative and regulatory documents (e.g.
guidelines issued by CNT) compose the frame of regulatory reference for
health care personnel.




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