Organ donation: daring to talk about death to talk about life

Home Organ donation: daring to talk about death to talk about life
Written by Doug Hampton

Say yes or no to organ donation, but express yourself whatever happens during your lifetime: a reflex to adopt to relieve relatives and health professionals when it comes to transplanting a recipient. Let’s take stock on the occasion of the National Day of Reflection on Organ Donation and Transplantation and Donor Recognition, organized this June 22.

A heart is taken from a deceased person, the same heart is transplanted into a sick person, and it survives, it lives. It’s crazy, completely crazyIt is in these terms that Olivier Coustère, president of the Trans-Forme association, describes the donation and its impact. in 1982, 1994 and 2006.”At the time, I was told that I was lucky to survive, but I wanted to live and even to live well. As a high-level athlete, I therefore created an association to promote the capital role of physical activity with patients alive thanks to the transplant. Today, I can no longer play sports. But I encourage the prescription of this practice of physical activity to all transplant patients.

A fighter’s temperament! “In the past, I was very angry with the inevitability of my fate which I felt was so unfair. Today, I am so grateful to my donors, doctors, researchers. If I had to live my life again, I would choose the same one, without changing anything. And I can say how important it is to speak out about organ donation during your lifetime. It’s always complicated when you haven’t talked about it. You simply have to dare to speak of death in order to speak of life.

How to express yourself?

No doubt listening to it: on our small scale, we are all able to move the lines. And to participate in the increase in the levy to transplant patients waiting for grafts. Note that at 1er January 2023, 10,810 patients were on the waiting list. What steps should you take to make your position known?

  • If you do not wish to donate your organs, you must register in the national refusal register;
  • In the absence of opposition, you are considered as a potential donor. A principle called “presumed consent“, resulting from the Caillavet law of 1976. A solidarity gift knowing “that in their lifetime, a person is more likely to need a transplant than to be a donor“, continues Olivier Coustère. A single donor can save up to 8 lives in the event of total removal (heart, lungs, two kidneys, a liver, a pancreas, an intestine), and improve 50 lives thanks to tissue donations (skin, valves, veins, arteries, tendons, bones and ligaments, and corneas), according to the Biomedicine Agency.

To relieve a difficult choice, it is advisable to entrust your agreement or your opposition to the donation to a loved one, to a person you trust. And ideally write down his wishes on his advance directives.

Every minute counts

Speaking out on living organ donation can save lives. Every minute counts between the declaration of death and a possible transplant. For the heart, a maximum of 3 to 4 hours can elapse between the removal and the transplant, 6 hours for the liver, 6 to 8 hours for the lungs and 24 to 36 hours for a kidney. This race against the clock will clearly influence the quality of the graft and the chances of success of the graft.

Deadlines differ from region to region

The distribution of organs is managed at national level by the Biomedicine Agency. For the kidneys, the distribution of one of the two grafts is first carried out at the regional level. So, “at the CHU de Poitiers, as required by law, the kidney graft is in the vast majority transplanted for patients living in the territory of the former Poitou-Charentes, therefore taken care of in Niort, Saintes, La Rochelle, Poitiers, Angouleme “, underlines Pr Antoine Thierry, nephrologist at the University Hospital of Poitiers. For the other organs, the attributions are made according to a national score established on priority criteria such as age (children are privileged) and commitment. of the patient’s prognosis.

The waiting period will depend in particular on the blood group, the immunological status and the age of the recipient, but also on the region in which you are “, describes Professor Thierry. “Overall, we tend to wait a little less for a kidney transplant in a small or medium-sized CHU than in large cities.

But in France, how much time can pass between registration on the waiting list and the transplant? As the Biomedicine Agency (ABM) points out, “the wait before receiving a organ varies from case to case and can be counted in months or years“.

The consequences of Covid-19

The Covid-19 health crisis has significantly lengthened this waiting time: fewer organs have been removed and then transplanted. In detail, due to this epidemic and its impact on the hospital system, in 2022 alone, “967 people waiting for a transplant died, that is to say between two and three per day“, notes the Biomedicine Agency.

The situation is still not back to normal, but things are improving. According to the latest figures published by the Biomedicine Agency, the number of transplants increased by 4% between 2021 and 2022. In 2022, 7,714 additional patients were registered nationwide, and only 5,494 transplants were performed. carried out.

How then can we explain the obstacles to donations? As Professor Antoine Thierry points out, “the high refusal rate of more than 30% today in France, the lack of expression of wishes, or even the situation of the hospital“can prevent many donations.

And in the field of innovation?

Positive point: specialists in organ harvesting and transplantation are constantly developing techniques to increase the chances of success. In the next 10 to 15 years, we can prepare for various innovations, specified by Pr Thierry:

  • In the operating room,with advances in surgery. Thanks to the robot-assisted, thehe expert surgeon will no longer necessarily be in the operating room“;
  • The development of virtual reality in therapeutic patient education (TPE) and in the training of surgeons“;
  • The spread of artificial intelligence as a personalized medicine tool to predict graft survival“;
  • The development of “new imaging tools (functional MRI) and new blood and urine biomarkers, making it possible to avoid graft biopsy“;
  • The iidentification of new immunosuppressive molecules, even if this remains hypothetical“;
  • The Ggeneralization of teleconsultation” with the deployment “connected tools“.

So many opportunities for innovation to reduce the waiting time of patients registered on the list as much as possible.

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