The Role of National Experts in Organ Allocation. Italian Experience

Introduction Organs and tissues donor suitability assessment is designed to minimize the risk of transmitting disease from donor to recipient. It is also evident that it is not possible to list all the conditions that can have a risk of transmission. For this reason, it is indispensable to foresee, however, that in cases not expressly and explicitly provided in the guidelines, it is possible to consult an expert in specific topic. The objective of the analysis is to provide a snapshot of the role of National Experts (NE) in the donor risk assessment. Methods From 2010 to 2015, the NE activity was evaluated about donor risk assessment and recipient follow-up by at December 2015 was evaluated. The analysis is based on the data provided by the Transplant Information System (SIT) and National Operative Transplant Center (CNTO). In Italy, five experts are involving in the organ allocation process in the following topics: oncology, infection disease, hematological and immunological disorders and legal medicine issues. Results During the period evaluated on 6777 donors used in total, 49% of the cases (3329 donors) were asked for a NE. In particular, 59% and 30% were infectious and oncologic NEs, respectively. In the cases involved, the NE assigned a standard risk in 47%, increased risk in 33%, accepted risk 10% and high risk in 12%. The 5-year follow-up of liver and heart survival is 70-75% and for kidney about 85%, percentages in line with the survival of organs for which no second opinion was required. Conclusions In view of the chronic deficiency of organ donors and the increase of recipient number in waiting lists, the use of the National Experts provides a clarification and a reasonable risk/benefit ratio for the use of organs from donor that may have a potentially increased or high risk.