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Santi Cosmo e Damiano

Santi Cosmo e Damiano. Erano entrambi medici, nati in Arabia nel III secolo d.c. L’iconografia eccelsiastica li rende protagonisti del tentativo di trapiantare la gamba di un moro a un cristiano. 1831 Mary Shelley Publishes Frankenstein

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Santi Cosmo e Damiano

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  1. Santi Cosmo e Damiano Erano entrambi medici, nati in Arabia nel III secolo d.c. L’iconografia eccelsiastica li rende protagonisti del tentativo di trapiantare la gamba di un moro a un cristiano

  2. 1831 Mary Shelley Publishes Frankenstein …describes a morally and physically superior creature constructed with parts from graveyards; this creature turns to violence only when his fictional creator rejects him. This is the first positive and negative depiction in literature of the use of organs and parts from dead people.

  3. 1902, the French surgeon Alexis Carrel, Nobel Prize for medicine in 1912, develops the technique of vascular anastomosis for the suture of blood vessels.

  4. Joseph Murray and the medical team at Boston's Peter Bent Brigham Hospital perform the first long-term successful organ (kidney) transplant, Dec 23 1954.Richard Herrick received a kidney from his identical twin.

  5. T.E. Starzl performed in Denver, Co, USA the first successful liver transplant procedure 1963

  6. Christiaan Barnard performed the first human heart transplant, in Cape TownSouth Africa Dec. 3, 1967

  7. TRASPLANTS IN THE WORD KIDNEY 447.182 PANCREAS 19.695 KIDNEY-PANCREAS 8.823 LIVER 112.299 LRLT 3.291 HEART 49.829 CUORE-LUNG 2.266 LUNG 8.842 BONE MARROW 82.780 UNOS 2004

  8. LONGEST SURVIVAL WITH WORKING TRANSPLANT KIDNEY 35 anni LIVER 28 anni BONE MARROW 29 anni HEART 23 anni PANCREAS 15 anni KIDNEY-PANCREAS 16 anni HEART-LUNG 13 anni LUNG 13 anni UNOS 2004

  9. DEFINITION OF DEATH THE DEATH OF AN INDIVIDUAL IS IDENTIFIED BY THE IRREVERSIBLE CESSATION OF ALL THE ENCEPHALIC FUNCTIONS (CORTEX AND TRUNK) (art. 1 Legge 23/12/93 n. 578)

  10. POTENTIAL DONOR • PRIMARY BRAIN PATHOLOGIES WITH POSSIBLE FATAL OUTCOME • Cerebro-vascular accidents • Cranioencephalic traumas • Post-anoxia cerebral damages Intensive Care

  11. DEATH DIAGNOSIS • CONVOCATION OF THE MEDICAL COLLEGE • (Art. 5 D.M. 409/1977) • Forensic expert/ pathologist or a doctor commisioned by Direzione Sanitaria • Anesthesist / Intensive Care expert • EEG expert neurologist/ neurosurgeon

  12. DEATH DIAGNOSIS • INSTRUMENT CHECKS • (D.M. 22/8/94 n. 582) • 30’ EEG is required every 2 h for 3 times • ( absence of electric activity, spontaneous or induced) • X-ray brain angiography ( abcence of flux)

  13. DEATH DIAGNOSIS • OBSERVATION TIME • (D.M. 22/8/94 n. 582) • Adults and children > 5 anni 6 hours • Chidren 1 - 5 years 12 hours • Children < 1 year 24 hours

  14. ACTUAL DONOR • TWO PREREQUISITE CONDITIONS • Not opposition/ consent of the family • Overall and specific organ suitability

  15. REALTIONSHIP WITH THE FAMILY • THE PROPOSAL FOR DONATION • IS MADE AFTER THE • COMMUNICATION OF DEATH • The family cannot interfere in the course of death verification • The will of the deceased and the will of the family must be made clear • The talk must explain clearly the timing and procedure of consent or opposition

  16. RELATIONSHIP WITH THE FAMILY The Intensive Care expert must safeguard the relationship with the family as much as possible, supply all the information as clearly as possible and explain the possibility of donation without influencing the family discretionary power.

  17. THE NEW TRANSPLANT LAW (Legge n.91, 1-3-99) • ANONIMITY • The donor’s and the recipient’s personal data must remain anonymous • The harvest must be performed with the due respect for the deceased

  18. THE NEW TRANSPLANT LAW (Legge n.91, 1-3-99) • PENALTIEA FOR TRAFFICKERS • Arrest and heavy fines for organ traffickers. Disqualification from the medical profession for the doctors

  19. ORGANIZATIONAL ASPECTS (donor-recipient) Suitability of the donor: • Tests for the evaluation of organ functionality • Serology ( transmissible diseases) • Instrument exams (exclusion of tumors in the donor) • Specialistic counselling • Possible biopsies for the organ evaluation (liver, marginal kidneys) Managment of the recipient ( call, transport)

  20. Transplants in Italy • CNT (Roma) • NITp • AIRT • OCST • SICILIA

  21. TRANSPLANT OPERATIVE SCHEDULE Repert about donor from I.C. to NITp Alert of transplant center Selection and call of the recipient Transport activation: harvest team and recipient Harvest and conservation of the organs Transplant (within ~10 hours from report) LIver 12 h Kidney 36 h Pancreas 20 h Heart 6h

  22. Donation & Transplantation Process Potential Donor Detection Brain Death Confirmation Society Legal Confirmation Brain Death Org. Proc. Experts Transplant Family Consent Organ Storage Transplant Teams Legal Consent Organ Removal Donor Evaluation Donor Management Organizational Aspects

  23. Video Conferenza Safety-Quality Network T.I. internet Interregional Reference Centers Regional Reference Centers National Transplant Center Istituto Superiore di Sanità Experts ( couselling during harvesting procedure)

  24. *Dati preliminari al 31 luglio 2009 Confronto Donatori Utilizzati PMP 2008 vs 2009* Anno 2008 19,2 Anno 2009* 20,5 + 6,77% FONTE DATI: Dati Reports CIR

  25. *Dati preliminari al 31 luglio 2009 Confronto Numero Donatori Utilizzati 2008 vs 2009* Anno 2008 1094 Anno 2009* 1222 +11,7%** **Il maggiore aumento % riscontrato sul numero assoluto delle donazioni rispetto all’incremento % del PMP è dovuto all’adozione della nuova popolazione

  26. *Dati preliminari al 31 luglio 2009 Attività donazione per regione – Anno 2009* % Opposizioni alla donazione FONTE DATI: Dati Reports CIR

  27. Donatori % opposizione – Anni 2002/2008 473 558 601 575 574 683 749 FONTE DATI: Dati Reports CIR

  28. Incremento percentuale delle opposizioni ultimo triennio + 11,2 %

  29. Incremento percentuale trapianti eseguiti ultimo triennio - 8,2 %

  30. Incremento percentuale pazienti iscritti in lista ultimo triennio + 8,9 %

  31. *Dati SIT 17 Febbraio 2009 Liste di Attesa al 31 Dicembre 2008* Incluse tutte le combinazioni Rene Fegato Cuore Tempo medio di attesa dei pazienti in lista 3,11 anni 2,04 anni 2,19 anni 1,53 % 6,18 % 9,72% % mortalità in lista FONTE DATI: Dati Sistema Informativo Trapianti

  32. *Dati definitivi al 31 Dicembre 2008 Trapianto di FEGATO – Attività per centro trapianti Incluse tutte le combinazioni 2008* 100 75 50 25 FONTE DATI: DatiReports CIR

  33. OLTx Università degli Studi di Udine Clinica chirurgica

  34. Centro Nazionale Trapianti Sopravvivenza dei pazienti trapiantati Sopravvivenza % 100 p = 0,0001 80 74 % 60 40 20 0 0 1 2 3 4 5 Anni

  35. Centro Nazionale Trapianti Sopravvivenza dei pazienti entrati in lista d’attesa e non trapiantati Sopravvivenza % p = 0,0001 31,2 % Mesi

  36. SOPRAVVIVENZA TRAPIANTI DI FEGATO Udine vs registro Europeo Udine ELTR 1 anno80% 79% 5 anni70% 69%

  37. CONDIZIONI DEL PAZIENTE TRAPIANTATO DI FEGATO A 5 ANNI Scadente 9,2 % Eccellente 90,8 %

  38. Organ procurement

  39. Organ procurement

  40. Organ procurement

  41. ELTR 12/2005 Liver Transplantation in Europe Indications in 33845 Cirrhosis 01/1988 - 12/2005 Primary Biliary : 3761 11% Others : 439 1% Unknown causes : 2689 8% Virus related : 13973 41% Secondary Biliary : 378 1% > 60% HCV Autoimmune : 1462 4% Alcoholic : 11143 33%

  42. Primary Indications of Liver Transplantation in 14359 Virus related Cirrhosis in Europe 01/1988 - 06/2006 Virus BCD : 117 Other virus : 102 1% Virus BC : 590 1% 4% Virus B : 3469 Virus BD : 974 24% 7% Virus C : 9107 63%

  43. ELTR 12/2005 Liver Transplantation in Europe Indications in 7318 Hepato-Biliary Cancers 01/1988 - 12/2005 Metastases : 403 6% Carcinoma biliary tract : 209 3% Cholangiocellular carcinoma : 227 3% Others : 508 7% Hepatocellular carcinoma : 5971 82%

  44. ELTR 12/2005 Indications of Liver Transplantation in 1779 Other liver diseases in Europe 01/1988 - 12/2005 Polycystic diseases : 424 24% Budd Chiari : 567 32% Benign liver tumors : 211 12% Other liver diseases (unspecified): 523 29% Parasitic diseases : 54 3%

  45. Emergency • Fulminating Hepatitis • PNF within 10 days since OLTx • Hepatectomy for trauma with complete loss of function • Acute deficiency in Wilson’s disease • HAT within 15 days since OLTx UNOS Priority Criteria

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