[Organ procurement in France: new challenges]. / Prélèvement d'organes en France : état des lieux et perspectives.

France has reached a pretty good level of activity, comparable to southern European countries: in 2011, 4945 transplantations (TX) have been performed among them, 2976 (60%) kidney TX, 1164 (24%) liver TX, 398 (8%) heart TX and 312 (6.3%) lung TX. However, the progression has slowed down since 2008 like in many countries. The potential of donors is mainly represented by the donor after brain-death (DBD) (90%), living donor (LD) for kidneys transplantation participates for only 10% of the overall kidney TX, and donor after cardiac death (DCD) activity, just started in 2006, for 2.2%. Current challenges to maximize the existing activity of DBD rely upon the implementation of program aimed to monitor deceased organ donation potential, a comprehensive approach of the regional disparities covering the steps of the detection of the potential donor, the rate of organ procurement and the refusal rate to organ donation. The profile of the donors has changed due to substantial epidemiologic shifts and a growing shortage of organs. The resource of expanded criteria donor (ECD) is widely used, mainly defined by a criteria of age. This policy is acceptable and successful under specific allocation scheme based on a donor-recipient matching. Before the TX needs of the population have been adequately met, the opportunities for improvement should be the development of DCD and LD activities, in addition to DBD activity. The extension to the DCD of the 3rd category of Maastricht is currently devised as a possible option for the future. The development of perfusion machine, available for kidney preservation and soon for the other organs is a new technical challenge that might increase the donor pool to previously discarded grafts. This superior and cost-effective method evaluated for ECD kidney preservation has also a potential of resuscitation and prediction of post-transplant outcome. To give a new launch to the TX activity as it was done in 2000, the Agency together with the professionals, has elaborated a "new action plan" for the next few years, which has been acted on April 2012 by the Minister of health.

The French organ transplant data system.

The Agence de la Biomédecine is a state agency dealing with Public Health issues related, among others, to organ, tissue and cell transplantation in France. The Agence maintains a national information system used to coordinate and administer organ procurement and transplant activities and to perform the evaluation of organ transplantation activities. This paper describes the core uses and functional requirements of Cristal, the donor, recipient and allocation software of the information system and its evolution in the new system.

A survey on patients admitted in severe coma: implications for brain death identification and organ donation.

OBJECTIVE: To identify factors to improve the identification of brain dead patients in intensive care units (ICUs). DESIGN AND SETTING: Prospective study conducted in 79 ICUs in 54 hospitals. PATIENTS: All hospitalized patients with a Glasgow Coma Scale (GCS) score less than 8. MEASUREMENTS AND RESULTS: During the study period hospital staff completed a form for each patient with a GCS less than 8. Hospital information units provided us with statistics from the discharge forms. The characteristics of the hospitals were also recorded. We included a total of 792 patients with a GCS less than 8; 120 of these patients were diagnosed as being clinically brain dead (15.1%). These patients accounted for 11.8% of the comatose patients in ICUs, 11.7% of the deaths occurring in ICUs, and 3.3% of the deaths that occurred in the hospital during the study period. Two multivariate linear regressions were performed to predict the number of clinically brain dead patients in the ICUs. The regression analyses included causes of death or causes of coma, and hospital characteristics. The presence of a coordination team and the number of transplant coordinators were positively associated with the number of brain dead patients in both models. The number of patients carried to the ICU by a mobile emergency unit was also positively associated in the model with causes of coma. CONCLUSIONS: Increasing the number of hospital coordinators and collaboration with mobile emergency units should lead to the identification of more brain dead patients among comatose patients in ICUs.