Domenico Caliendo was two and a half years old when he was transplanted with a heart damaged during transport from Bolzano to Naples, which had been incorrectly preserved with dry ice. After almost two months of hospitalization, the child died on February 21st. A story that unfortunately we all know and which has shocked and outraged the whole of Italy.
This affair, which has become a symbol of a healthcare system that has failed in such a delicate moment, has triggered a regional investigation. And after the General Directorate for Health Protection delivered an alarming dossier, the president of the Campania Region, Roberto Fico, ordered a series of urgent measures on the AORN “Ospedali dei Colli”, the Monaldi hospital in Naples.
The critical issues encountered go well beyond the episode of December 23, 2025, the day of the transplant: outdated organ transport and preservation protocols, preservation devices available but not used, staff with inadequate training, a “severely deteriorated” internal climate even before the tragedy, and significant delays in communications to the health authorities.
The combination of these elements, according to the investigation, constitutes a pre-existing systemic organizational problem. A picture that Fico himself defined as “extremely worrying”.
Stop pediatric transplants, at least for now
The most immediate measure is the suspension of the pediatric heart transplant program at Monaldi. The resumption will not be authorized until all the necessary safety conditions have been verified: a hospitalization area and an operating room dedicated exclusively to pediatric cardiac surgery, cardiac surgeons with proven experience in the pediatric field, updated protocols compliant with the most recent scientific evidence, adequate training of staff and real integration between the units involved.
In the meantime, patients on the waiting list are assisted through an agreement with the Bambino Gesù Pediatric Hospital in Rome.
Another significant decision concerns the Regional Transplant Center (CRT): until now housed within the AORN dei Colli, it will be transferred directly to the offices of the Campania Region in Palazzo Santa Lucia. The objective is to strengthen public control over the entire transplant network, taking coordination away from the management of the hospital and bringing it back under the direct supervision of the regional bodies responsible for healthcare planning.
Fico also ordered the reactivation of the regional Health Inspection Service, provided for by regional law no. 20 of 2015, with the mandate to conduct an extraordinary inspection at Monaldi, which will also make use of external professionals. The objective is to understand whether the conditions that made Domenico’s death possible were known or knowable, and whether the necessary measures were adopted. The inspection structure will also evaluate management and disciplinary responsibilities.
More broadly, in the 2026 Annual Inspection Activity Plan, an overall audit of the entire transplant network in Campania is envisaged: protocols, resources, information flows, security systems, center by center.
In Fico’s words there is also space for human pain:
I want to reiterate my deepest sympathy to little Domenico’s family. This very painful event has turned their lives upside down and affected an entire community. And it requires us to intervene with the utmost determination, seriousness and sense of responsibility so that such events never happen again.
Domenico will not be able to return. But what happened can – and must – prevent it from happening again.
