A national registry in which every San Marino citizen could express, during their lifetime, their consent or refusal to organ donation after death. The Grand and General Council (Consiglio Grande e Generale) has opened the way to new regulations on the matter, unanimously approving the Arengo Petition (Istanza d’Arengo) dedicated to the donation of organs, tissues and cells for therapeutic purposes.
The vote in the chamber, however, represents only a starting point. To turn that intention into a genuinely operational system, San Marino will need to connect to specialist transplant networks, sign agreements with Italy, and update the IT systems of the Institute for Social Security (ISS).
It was the Secretary of State for Health, Massimo Andrea Ugolini, who laid out the necessary steps. The transplant system requires a complex apparatus capable of acting within extremely tight timeframes, with highly specialised staff, round-the-clock diagnostic availability, and coordination between donor and recipient. For a country the size of San Marino, the path forward necessarily runs through collaboration with external institutions.
A first building block is already contained in the draft law on end-of-life care, which would allow citizens to include, in their Advance Treatment Directives, their wishes regarding the fate of their body and organs after death. To make donation effective, Ugolini clarified, specific bilateral agreements with the Italian Republic and an update of ISS systems will nonetheless be essential. The Government has therefore expressed a favourable opinion on the Petition, while acknowledging that completing all the necessary agreements and adjustments will take considerable time.
On this issue, the Council found itself united. Emanuele Santi (Rete) recalled how the matter had remained “shut away in drawers for too long,” calling for clear rules that would allow citizens to concretely express their wishes.
Silvia Cecchetti (Psd) also emphasised the opportunity for San Marino citizens to give real, regulated consent to donation, while Denise Bronzetti (Ar) called for swift progress on the necessary adjustments and agreements with Italian healthcare institutions.
Marinella Lorena Chiaruzzi (Pdcs) clarified one of the central points of the proposal: the Petition does not call for establishing a transplant centre on Titano, but rather for allowing every citizen to formally express their wishes, creating a national registry, and building reliable procedures through international cooperation.
Speaking for Libera, Giuseppe Maria Morganti described organ donation as “a tremendous act of love, altruism and generosity,” pointing to integration with the Italian healthcare system as the way forward.
Repubblica Futura, for its part, focused above all on the shift from intention to practice. Maria Katia Savoretti recalled the difficulties encountered so far in the absence of accreditation and bilateral agreements with Italian institutions, while Antonella Mularoni urged a swift regulatory update and San Marino’s inclusion in the transplant network.
In the end, there was no division at the moment of the vote: the Arengo Petition was approved unanimously. The next step will be to translate this political green light into operational procedures, building the national registry and, above all, the network of agreements with Italy needed to ensure that citizens’ expressed wishes can find concrete application.
