The declaration of willingness to donate organs and tissues is regulated by Law no. 91 of 1 April 1999 and by the Ministerial Decree of 8 April 2000. Article 4 of Law no. 91/99 introduces the principle of silent consent, according to which every adult citizen is asked to declare their will on the donation of their organs and tissues, after being informed that the failure to declare their will is considered as consent to the donation. However, this principle is not yet in force. Declarations of will for organ and tissue donation can be made at the following location:
- Public Relations Office, Licensed Operator: Dr. Rocco Iacovella – head office Via A. Fabi Frosinone from Monday to Friday from 8.30 am to 1.00 pm;
Donate organs and tissues
For the time being, the expression of the will is regulated by art. 23 of the same law (transitional provisions) which introduces the principle of explicit consent or dissent. All citizens are given the opportunity (not the obligation) to express their will regarding the donation of their organs. Through the declaration of will each individual citizen has the opportunity to express himself freely, ensuring that, in the event of death, his will is not violated by the decisions of others, whether it is a declaration in favor of donation or unfavorable (you can also decide to leave in writing that you do not want to become a donor). Currently, the methods for expressing the will are as follows:
- the compilation of the blue card of the Ministry of Health that must be kept together with personal documents. It is possible to complete the declaration of will online and print your card on the 2008 Information Campaign website;
- the registration of their will with the local health authority or the family doctor;
- a written statement that the citizen carries with them with their documents. In this regard, the ministerial decree of 8 April 2000 established that any written note containing name, surname, date of birth, declaration of will (positive or negative), date and signature, is considered valid for the purposes of the declaration;
- the holographic act of AIDO or one of the other sector associations.
When your will is registered with the ASL, the data is entered into an archive of the National Transplant Center that is connected with the Interregional Centers. In the event of a possible donation in a subject whose death is ascertained, resuscitation doctors verify whether the latter has the declaration with him or has recorded the will in the computer archive.
If a citizen does not express their will, at present the law provides for the possibility for family members (not separated spouse, cohabiting more uxorio, adult children and parents) to oppose the withdrawal during the period of ascertainment of death. Therefore, it is also good to talk to your family members, since, in the absence of a declaration, they are consulted by the doctors about the will expressed in life by the relative. For minors, it is always the parents who decide. If one of the two is against, the withdrawal cannot be made. The citizen can change the declaration of will at any time. The last statement made in the manner provided will always be considered valid.
In summary, in the event of death, three cases can occur:
- the citizen has expressed in life the positive will to the donation, in this case the family members cannot object: donation yes;
- the citizen has expressed a negative will to donate, in this case there is no organ harvesting: no donation;
- the citizen has not expressed himself, in this case the withdrawal is allowed if the family members do not object: donation yes/no
Bone marrow and umbilical cord blood donation
Anyone interested in donating bone marrow should contact the health facilities that participate in the national bone marrow donation program, which will send the data of potential donors to the National Bone Marrow Donor Registry (IBMDR).
As for cord blood, on the other hand, couples will be able to give their consent to donation during prenatal visits. Subsequently, they will take part in an informative interview where they will be explained the methods of donation and anamnestic data (information regarding pathological and physiological, personal and hereditary antecedents) will be collected, essential to establish the suitability or not of the potential donor.
Donor protection
The donor and the recipient are the two leading figures in the world of transplants and as such must be protected. The basic condition to protect the recipient is that the organ that will be transplanted is healthy. On the other hand, the fundamental right of the donor is the protection of his will. This implies that if he has expressed the choice to donate organs after death no one can object. In addition, it must be clear that the withdrawal will only be carried out after death has been ascertained.
Death Assessment
All stages of death assessment using neurological criteria are strictly sanctioned by law and are carried out by a panel of expert doctors (anaesthetist, neurophysiologist, forensic doctor) who are summoned by the Health Directorate of the hospital, regardless of any consent to the removal of organs. In the event that the subject, whose death is being ascertained by neurological criteria, presents the clinical conditions to become a potential organ and tissue donor, the doctor coordinating the collection checks whether the subject’s living expression is present in the national computer system or if he/she has any express will document with him/her.
We often hear about brain death, clinical death or cardiac death, in reality there is only one death, but there are different methods of assessment: according to cardiac, neurological or necropsy criteria.
Law no. 578 of 29 December 1993, regulations for the assessment and certification of death, establishes that death is identified with the irreversible cessation of all brain functions. This condition can occur following a stoppage of blood circulation (flat electrocardiogram for not less than 20 minutes) or due to a serious injury that has irreparably damaged the brain. In the latter case, doctors perform accurate clinical and instrumental assessments to establish the simultaneous presence of the following conditions:
- state of unconsciousness;
- absence of reflections from the trunk;
- absence of spontaneous breathing;
- brain electrical silence
Observation period
Article 4 of Ministerial Decree no. 582 of 22 August 1994 states that, for everyone and independently of the transplant, the duration of the observation for the purpose of ascertaining death must be not less than:
- 6 hours for adults and children over the age of five;
- 12 hours for children between the ages of one and five;
- 24 hours in children under one year of age
Coma and vegetative state
A coma is a pathological condition characterized by loss of consciousness, spontaneous motility, and sensitivity. A patient can go into a coma due to various causes such as, mainly: intoxication or poisoning, alteration of metabolism, cancer, trauma or brain injury. The reversible coma can last from a few days to a few weeks, the shorter the duration of the coma and the less brain damage the patient will suffer.
The vegetative state is a condition that can evolve from a coma and is characterized by the resumption of wakefulness, however without a state of consciousness. In neither case, coma or vegetative state, organs or tissues are harvested.
With regard to the collection of bone marrow, which takes place in vivo, for the purposes of transplantation, the protection of the donor is guaranteed by the suitability of the collection centres.
