More than 15,000 patients were waiting for a kidney transplant on January 1, 2019, while only 3,567 could have been performed in the previous year. A number of transplants down 5.7%. Worrying for France Transplant, which has just published a report in order to understand the reasons for this shortage. The association sent a questionnaire to doctors in kidney transplant services.
First of all, these specialists point to the “insufficient number of organs collected”. Several explanations for this. First of all, the numerous refusals of direct debits from families even if, by law, any deceased person is deemed to be a donor unless he has expressly indicated otherwise. This principle of presumed consent is however not applied according to the president of France Transplant, the deputy LREM and professor of medicine Jean-Louis Touraine.
Too many refusals
“85% of people are in favor of organ donation, which should generate a 15% refusal to donate. However, it is 30 to 50% depending on the region, "regrets the professor, who believes that we could increase" levies by a third, as in Spain ". Why such disparities? "In certain regions, the opinion of relatives is taken more into account than the opinion of the deceased." He does not hesitate to quote bad students, like Ile-de-France, while Bourgogne Franche-Comté, Brittany and Pays de la Loire are virtuous. To remedy this, France Transplant proposes to undertake "a major study on the current causes of opposition to organ donation" ... "and to better train the teams that speak to families," adds Jean-Louis Touraine.
Among other obstacles, doctors cite the lack of nephrologists, but also the “non-optimal” search for voluntary living donors, in the family and friendly circle. "This is a real lead," according to the president of France Transplant, especially since "these grafts cause fewer complications and are of better quality" than those taken from the deceased.
Victim of his own success
At the same time, the number of kidney transplant candidates is increasing. This is linked to the increase in the number of diabetics with chronic renal failure. "Confronted with the choice between the various methods of treatment of end-stage renal disease, most patients choose this therapy first," says the report.
Without forgetting that it is necessary to transplant again patients whose first graft has only worked for a few years or a few decades. In the end, while in 2013, according to figures from the biomedicine agency, there were a total of 4.7 candidates for a kidney, this figure rose to 5.5 in 2018.
Conclusion of the report: "Kidney transplantation is a victim of its success" and "it will be necessary to double the current activity then reach the figure of 10,000 kidney transplants per year within a decade. Good news: the Greffe de vie foundation has calculated that these transplants could generate a saving of 8.4 billion euros over 14 years because in the end, they are "much less expensive" than dialysis in the center.