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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 dAosta,
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.
CNT
NATIONAL TRANSPLANT COUNCIL
CIRCIR
Regional CentersRegional Centers
local operationallocal operational unitsunits
RetrievalRetrieval centercenter TransplantTransplant centercenter
MINISTRYMINISTRY
REGIONsREGIONs HIGHER HEALTH COUNCILHIGHER HEALTH COUNCIL
CitizensCitizens // PatientsPatients
2
2
National Transplant Center
TTHHEE NNAATTIIOONNAALL TTRRAANNSSPPLLAANNTT CCEENNTTRREE ((wwwwww..mmiinniisstteerroossaalluuttee..iitt//ttrraappiiaannttii))
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,
3
3
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 PATIENTS NEED
CREATION OF A NETWORK
SHARING AND CO-DECISION
EQUITY AND TRANSPARENCY
DISSEMINATION OF THE INFORMATION
MMMAAAIIINNN FFFIIIEEELLLDDDSSS OOOFFF AAACCCTTTIIIVVVIIITTTYYY
QQQuuuaaallliiitttyyy aaannnddd sssaaafffeeetttyyy
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
RRReeessseeeaaarrrccchhh
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
4
4
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
PPPrrrooojjjeeeccctttsss aaannnddd iiinnnttteeerrrnnnaaatttiiiooonnnaaalll aaaffffffaaaiiirrrsss
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)
IIInnnfffooorrrmmmaaatttiiiooonnn TTTeeeccchhhnnnooolllooogggyyy
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
5
5
National Transplant Center
 Allowing information sharing among all transplant network actors.
IIInnnfffooorrrmmmaaatttiiiooonnn tttooo ccciiitttiiizzzeeennnsss
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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Cnt presentazione

  • 1. 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 dAosta, 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. CNT NATIONAL TRANSPLANT COUNCIL CIRCIR Regional CentersRegional Centers local operationallocal operational unitsunits RetrievalRetrieval centercenter TransplantTransplant centercenter MINISTRYMINISTRY REGIONsREGIONs HIGHER HEALTH COUNCILHIGHER HEALTH COUNCIL CitizensCitizens // PatientsPatients
  • 2. 2 2 National Transplant Center TTHHEE NNAATTIIOONNAALL TTRRAANNSSPPLLAANNTT CCEENNTTRREE ((wwwwww..mmiinniisstteerroossaalluuttee..iitt//ttrraappiiaannttii)) 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,
  • 3. 3 3 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 PATIENTS NEED CREATION OF A NETWORK SHARING AND CO-DECISION EQUITY AND TRANSPARENCY DISSEMINATION OF THE INFORMATION MMMAAAIIINNN FFFIIIEEELLLDDDSSS OOOFFF AAACCCTTTIIIVVVIIITTTYYY QQQuuuaaallliiitttyyy aaannnddd sssaaafffeeetttyyy 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 RRReeessseeeaaarrrccchhh 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
  • 4. 4 4 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 PPPrrrooojjjeeeccctttsss aaannnddd iiinnnttteeerrrnnnaaatttiiiooonnnaaalll aaaffffffaaaiiirrrsss 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) IIInnnfffooorrrmmmaaatttiiiooonnn TTTeeeccchhhnnnooolllooogggyyy 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
  • 5. 5 5 National Transplant Center Allowing information sharing among all transplant network actors. IIInnnfffooorrrmmmaaatttiiiooonnn tttooo ccciiitttiiizzzeeennnsss 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.