A two-year-old Italian boy, identified as Domenico, has died after complications following a heart transplant in which the donor organ reportedly sustained frost-related tissue damage during transport. The incident has prompted a formal investigation, with six medical professionals placed under investigation, according to reports.
Domenico was born with cardiomyopathy, a condition in which the heart muscle becomes weakened and cannot pump blood effectively. In severe pediatric cases, heart transplantation may be required shortly after birth if medical therapy does not sufficiently support cardiac function.
Due to the severity of his condition, Domenico was placed on the organ transplant list soon after birth and remained under specialized cardiac care while awaiting a suitable donor heart.
The transplant surgery was performed in Monaldi Hospital in Italy on December 23. However, reports indicate that the donor heart had been transported in regular plastic bags placed on dry ice, over 800km (490 miles) from Bolzano to Naples in an unsuitable container without a thermometer to alert the medical team, rather than in a specialized organ preservation container designed to maintain appropriate temperature and prevent freezing injury.
Medical standards for heart transplantation typically require the organ to be preserved in a sterile solution and maintained at controlled cold temperatures (usually 4°C), not frozen during transport. Direct contact with dry ice, which has a temperature of approximately −78.5°C, can cause frostbite-like tissue damage, leading to irreversible cellular injury.
According to media reports, the transplanted heart never began functioning adequately after implantation. The child remained in critical condition on life support following the surgery.
See also: The First Human Heart Transplant: Breakthrough or Media Spectacle?
Since the transplant, Domenico had been dependent on life support systems because the heart did not recover function. Reports state that his mother publicly appealed for assistance, including an appeal to Pope Leo XIV, seeking support in securing another donor organ.
The case drew national attention in Italy, with advocacy efforts highlighting the child’s deteriorating condition and the need for urgent intervention.
Last Wednesday, a panel of medical specialists convened to assess whether Domenico remained a candidate for a second heart transplant. According to reports, prolonged dependence on life support had resulted in multi-organ complications.
The specialists determined that he was not suitable for another transplant, citing damage to his lungs, kidneys, and other organs, which had deteriorated during the extended period of critical illness.
Shortly thereafter, Domenico passed away on Saturday.
Italian authorities have launched a formal investigation into the circumstances surrounding the transport and preservation of the donor heart.
Six medical professionals have reportedly been placed under formal investigation as part of the inquiry. The investigation aims to determine whether established organ preservation and transport protocols were followed.
Italy’s Prime Minister, Giorgia Meloni, stated that a thorough investigation would be conducted to clarify responsibility and ensure accountability.
In heart transplantation, ischemic time (the period the organ remains outside the body without blood supply) and preservation conditions are critical determinants of transplant success.1
Standard protocol involves:
Flushing the organ with preservation solution
Storing it in sterile triple-layer packaging
Maintaining a controlled hypothermic environment (around 4°C)
Avoiding freezing temperatures
Freezing can cause intracellular ice formation, rupture cell membranes, and render cardiac tissue nonviable. Even minor structural damage can prevent the heart from regaining coordinated contractions after transplantation.1
Authorities have not released further clinical details pending the outcome of the investigation.
Reference
Kounatidis, Dimitris, Vassiliki Brozou, Dimitris Anagnostopoulos, Constantinos Pantos, Athanasios Lourbopoulos, and Iordanis Mourouzis. 2023. "Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion" International Journal of Molecular Sciences 24, no. 23: 16693. https://doi.org/10.3390/ijms242316693
