Organ transplants are increasing in France but still not at the pre-Covid level nor up to the needs, according to the 2023 report from the Biomedicine Agency.
Third country in the world for transplants behind Spain and the Netherlands, France carried out more than 5,634 transplants in 2023, most often of the kidney, but also of the liver, or even the heart and lungs.
This is more than in 2022 (+ 2.5%, or 139 additional transplants) and especially than in 2020, a year turned upside down by Covid, noted at a press conference by Marine Jeantet, general director of the Agence de biomedicine, emphasizing that organ donation can “save between three and four people”.
But the pre-Covid level, namely 5,903 transplants in 2019, has still not been caught up.
And the growing needs cannot be entirely met: more than 21,866 patients remain waiting for a transplant, including 11,422 who can be called immediately.
“Transplant activity is increasing in France half as fast as the number of new registrants waiting,” summarized François Kerbaul, director of collection.
Further closing this gap will be “a real collective challenge in 2024”, recognized Marine Jeantet.
Especially since the rate of opposition to organ donation from relatives who died of brain death experienced a “significant increase” over one year (+9.4%), rising to 36.1%.
On the territory, this rate exceeds 50% in the Overseas Territories, is around 49% in Île-de-France, but is less than 25% in Brittany, Pays-de-la-Loire or Corsica.
" Stereotypes "
Difficult to explain the rise in refusals, "multifactorial", according to the agency, which wants to strengthen information, while waiting for a better understanding.
Since 1976, the law has provided that everyone is an organ donor upon death, unless they have expressed their refusal during their lifetime, by registering on the national register of refusals or by informing their loved ones.
Registrations in the register of refusals “remain minimal – around 0.7% of the population –”, but with “a significant increase in those under 35 – before it was mainly over 60 –”, noted Marine Jeantet .
More than 80% in favor, according to an Agency barometer, of donating their organs, "too few French people have expressed their position to their loved ones, who, due to not knowing the wishes of the deceased, prefer to report opposition,” according to David Heard, communications director.
Faced with “received ideas”, the agency wants to “reassure”: “the organs removed are used for therapeutic interventions, not for scientific research;
transplants are allocated based solely on medical criteria; socio-professional category or origin are not taken into account”;
“no monotheistic religion is opposed to organ donation, and it is possible to perform all funeral rites.”
Objective: between 6,700 and 8,300 transplants in 2026
Another obstacle to an increase in transplants: the hospital remains “in pain”, “surgical activity has not returned to the pre-Covid level” due to lack of staff, pointed out Marine Jeantet, referring to choices sometimes “ cornelian” between “a patient waiting for an operation for 3-4 months” and a transplant.
For hospitals, a transplant involves major logistics.
Often, operations are carried out at night, when all the teams can be mobilized and the blocks available.
And, for a transplant from a living donor, mainly a kidney, two blocks must function simultaneously.
The Renaloo patients' association deplored Tuesday, in a press release, "a weakened living donor transplant activity, which relies on the commitment of a small number of teams".
To further mobilize caregivers, beyond specialized teams, the Biomedicine Agency is also focusing on training interns, raising awareness among nurses and caregivers, and even general practitioners.
A financial incentive for harvesting and transplant teams, inspired by Spain, is also being studied, according to Marine Jeantet.
🏥 Harvesting and transplantation, victims of the hospital crisis
➡️ Lack of availability of blocks, competition with other activities, insufficient support from management...
🎯 Quickly, measures to prevent the announced failure of the transplant plan !https://t.co/wR33A57INh
— Renaloo, the voice of kidney patients (@Renaloo) February 13, 2024
The objective remains to reach between 6,700 and 8,300 transplants in France by 2026, under a multi-year plan.
Criticized by the Court of Auditors at the end of January, the Biomedicine Agency highlights its multiple actions to respect this fourth transplant plan.
Its director will be heard on Wednesday in the Senate.