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Background: Donation after circulatory death (DCD) donation is becoming more and more popular worldwide. However, in this setting of donation, heart graft suffers from the ischemic injury related with the cardiac arrest. In Italy, the declaration of death with cardiac parameters requires the registration of electrocardiograph for twenty minutes resulting in a very prolonged grafts' warm ischemia time. The aim of this study is to present the Italian preliminary experience on heart transplantation (HTx) from controlled DCD (cDCD) donors., Methods: Despite a very long period of warm ischemic time (WIT) expected, in April 2023, a DCD heart program was started in Italy and in May 2023 the first DCD heart transplant was performed. In the present paper, preliminary results of the national program are analyzed., Results: Since May 2023 until December 2024, 40 DCD heart transplants were performed in Italy. Donors' characteristics were the followings: 31 male, nine female, mean age of 46.6±14.7 years. Causes of death were: 19 trauma, eight cerebral bleeding, four post-anoxia coma, nine others. Three donors showed mild coronary artery disease at angiography. Mean WIT was 43.2±10.8 minutes. Thoraco-abdominal normothermic regional perfusion (T-A NRP) was used in all cases. Recipients' characteristics were the followings: 33 males, seven females, mean age 59.1±12.3 years, 16 re-operations (REDO), 18 on an urgent list. Eight (21%) patients required post-transplant extracorporeal membrane oxygenation (ECMO), four (50%) of whom were successfully weaned. Thirty-day mortality was 10%. Median duration of post-transplant mechanical ventilation, intensive care unit stay and hospital stay was 45 hours, six days and 28 days respectively. At discharge, mean ejection fraction (EF) was 57.8%±10% and tricuspid annular plane systolic excursion (TAPSE) 18.2±3.1 mm, without any significant valvular disfunction., Conclusions: Italian preliminary results suggest that DCD heart transplantation can be successful despite a very long WIT and marginal donors' characteristics. A larger experience and data about medium and long-term results are mandatory to better confirm the short-term findings., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (Copyright © 2025 AME Publishing Company. All rights reserved.)

Total hepatectomy and liver transplantation has emerged as a game-changing strategy in the treatment of several liver-confined primary or metastatic tumors, opening the new era of transplant oncology. However, the expansion of indications is going to worsen the chronic scarcity of organs, and new strategies are needed to enlarge the donor pool. A possible source of organs could be developing split liver transplantation (SLT) programs. We propose to refer donors aged 18-50 years unsuitable for pediatric patients and donors aged 50-60 years for split evaluation. This will generate new small left lateral grafts that can be used for RAPID procedures, based on a national waiting list specifically for non-HCC oncologic patients. Centralized imaging review will streamline the donor-recipient matching process and address organizational challenges. Additionally, adopting an ex-situ splitting technique during hypothermic oxygenated machine perfusion could further enhance logistical efficiency and improve graft viability. The proposed protocol (ALERT 50) will therefore promote the development of oncologic indications without affecting the standard waiting list and without competing with urgent or pediatric patients., (Copyright © 2025 American Association for the Study of Liver Diseases.)