Figure 1

Telemedicine network architecture with all involved centers. The accredited cardiologist of the area where the donation takes place, will send, via internet stress echo digitized images to the central core Echo Lab, Pisa (IFC, CNR). Digitized eight-frame cine-loop quad screen echocardiograms are transmitted to the central core Echo Lab laptop computer-receiving station. One core-lab cardiologist is available by telephone or e-mail during the procedure. The Echo Lab is responsible for the "second opinion" of digitally transferred images. One of three cardiologists will interpret the tele-echocardiograms and will make "second-opinion" decisions, and is responsible for the final ("go-not go") green light to donation. When done, the second opinion report is finally sent to the transplant coordination center, and if the marginal heart is eligible for transplant, is proposed to the cardiac surgeon for transplant.