{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T19:27:11Z","timestamp":1781292431540,"version":"3.54.1"},"reference-count":42,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the \u201cextreme\u201d application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. Methods: A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. Results: Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney\u2013pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. Conclusions: The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams.<\/jats:p>","DOI":"10.3390\/jcm14155444","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T08:46:55Z","timestamp":1754383615000},"page":"5444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Clinical and Medico-Legal Aspects in the Challenge of Transfusion-Free Organ Transplants: A Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8784-8463","authenticated-orcid":false,"given":"Matteo","family":"Bolcato","sequence":"first","affiliation":[{"name":"Department of Medicine, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovico","family":"Fava","sequence":"additional","affiliation":[{"name":"MESIT Foundation of Social Medicine and Innovation Tecnology, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aryeh","family":"Shander","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Englewood Health, Englewood, NJ 07631, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Zenger","sequence":"additional","affiliation":[{"name":"Center for Health Law and Management, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8768-9263","authenticated-orcid":false,"given":"Kevin M.","family":"Trentino","sequence":"additional","affiliation":[{"name":"Medical School, The University of Western Australia, Perth, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Chisari","sequence":"additional","affiliation":[{"name":"Rodolico\u2014San Marco Hospital, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Agostini","sequence":"additional","affiliation":[{"name":"Transfusion Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9486-9740","authenticated-orcid":false,"given":"Ivo","family":"Beverina","sequence":"additional","affiliation":[{"name":"Transfusion Medicine, ASST Valle Olona, 21052 Busto Arsizio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3755-1434","authenticated-orcid":false,"given":"Giandomenico Luigi","family":"Biancofiore","sequence":"additional","affiliation":[{"name":"Transplant Anesthesia and Critical Care, University Hospital of Pisa, 56121 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"De Angelis","sequence":"additional","affiliation":[{"name":"National Blood Centre, Italian National Institute of Health, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.bpa.2013.01.001","article-title":"Patient blood management--the new frontier","volume":"27","author":"Shander","year":"2013","journal-title":"Best Pract. 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