As a young patient remains in critical condition following a compromised transplant, forensic details emerge regarding the use of dry ice and non-standard medical equipment.A medical investigation in Naples has uncovered a series of catastrophic logistical failures that led to a failed heart transplant for a two-year-old boy at the Monaldi Hospital.The case, which has drawn national attention, now centres on the "cold chain" protocols used to transport the donor organ from Bolzano to southern Italy.Logistical failures According to investigators from the Naples Prosecutor's Office and the NAS (Health Protection Unit), the donor heart was transported in a standard plastic container rather than a specialised, temperature-regulated medical carrier. The most critical finding involves the cooling method used during the five-hour journey. Preliminary reports suggest that dry ice, which can reach temperatures as low as -80°C, was used instead of the standard saline ice typically required for organ preservation. Because the plastic box lacked internal thermometres or monitoring sensors, the surgical team was reportedly unaware that the cardiac tissue had likely suffered "thermal shock" or freezing damage. Six individuals, including doctors and paramedics involved in the retrieval and transport chain, are currently under investigation for negligent injury. Medical status The young patient, referred to by his family as a "little warrior," has been kept alive for 55 days via ECMO (Extracorporeal Membrane Oxygenation). While this life-support system is a vital bridge, its prolonged use has led to severe secondary complications that now jeopardise any hope of a second transplant. Consultants from the Bambino Gesù Pediatric Hospital in Rome have reviewed the case, describing the child’s current state as "systemically incompatible" with further surgery. Their report highlights a harrowing clinical picture including significant impairment of the lungs, liver and kidneys as well as neurological damage. Mother’s appeal  Despite the grim medical assessment from Rome, the child’s mother, Patrizia Mercolino, continues to advocate for her son’s survival. Speaking on national television, she appealed for international help and even requested the intervention of Pope Leo, stating, "I hope those doctors are wrong and that a new heart can be found soon." The family’s legal representative, Francesco Petruzzi, has criticised the hospital's transparency. According to the family, they were initially told only that the heart "failed to restart" on 23 December, without any mention of the transport irregularities. It was only through subsequent judicial inquiries that the details of the plastic container and the dry ice came to light. National oversight The health ministry and the Campania Region have dispatched inspectors to join the ongoing probe by the Naples and Trento NAS units. The investigation aims to determine at what point the protocol was breached and why the damaged organ was cleared for implantation upon arrival at the Monaldi Hospital. A multidisciplinary team at the Monaldi is scheduled to meet this week for a final evaluation of the child's status. Their decision will determine whether the patient remains a candidate for a re-transplant or if the focus must shift entirely to palliative care.