Organ procurement and transplantation activity in 2023 and 2024 opinion barometer

Key figures for 2023 (vs. 2022)

• 5,634 organ transplants (+ 2.5%)
• Of which 577 live donor transplants (+ 8.3%)
• 3,132 donors registered (+ 4.9%), 1,512 harvested (+ 3.6%) in brain death condition
• 36.1% opposed (+ 9.4%)
• 823 deceased patients on waiting list (- 22.6%)
• Still more than 21,866 patients awaiting transplantation, including 11,422 on the active list

*"As in previous years, the Agence de la biomédecine would like to thank the hospital teams for their strong mobilization and ability to adapt, enabling the growth of this activity, which is both a medical and logistical feat. For a patient to receive a transplant and continue to live, it requires extraordinary coordination, which succeeds 15 times a day: it starts with approaching the deceased's next of kin, identifying compatible recipient patients, harvesting and transporting each graft to its destination, and finally, transplanting the recipient patients. In the midst of everyday life, convoys like no other carry an organ destined to save a life, sometimes a young child, sometimes an older person. There's no age limit to receiving an organ, just as there's no age limit to donating them: we're all concerned, all donors, all recipients"*Marine Jeantet, Director General of the Agence de la biomédecine.

In detail

Activity continues to grow steadily, in line with the growth curves defined in the 2022-2026 Ministerial Plan for organ and tissue procurement and transplantation. Our efforts and strategy are bearing fruit, particularly in the area of living-donor transplants and Maastricht III transplants.

In 2023, 3,132 potential brain-dead donors were identified, compared with 2,984 the previous year (+4.9%). Of these, 1,512 were harvested for the benefit of patients awaiting transplants. Including Maastricht II (6 donors) and Maastricht III (273 donors) donors, the number of deceased donors harvested increased by 5.7% compared with 2022, with a total of 1,791 deceased donors harvested. Living kidney (557) and liver lobe (20) donors numbered 577.

As a result, 5,634 transplants could be carried out for patients waiting in 2023 (+2.5% or 139 transplants more than in 2022). The fastest-growing activity was living-donor renal transplants, with 43 additional transplants in 2023, representing an increase of 8.3%. Overall renal transplant activity rose by 4.4%, with 148 additional transplants. Liver transplantation activity increased by 3.8%, with 49 additional transplants.

The overall gross objection rate for brain-dead patients has risen significantly, by 9.4% in 2023, with 36.1% of objections, all causes combined (33% in 2022). Geographically, this figure is highly contrasted: in Brittany, Pays de la Loire and Corsica, the opposition rate is below 25%, while it reaches 48.6% in Ile-de-France and exceeds 50% in the French overseas departments and territories.

The average age of deceased donors harvested in 2023 is 57.8, a figure that has remained stable over the past 10 years. 647 donors over 65 were harvested this year (versus 597 last year), as well as 48 pediatric donors, 13 of whom were under 5 years of age. These donations are essential for treating babies or young children waiting for a transplant, for reasons of morphological compatibility. 18 children waiting for a transplant died for lack of a compatible graft in 2023.

The waiting list in January 2024

On January 1, 2024, there were 21,866 patients on the national waiting list for an organ transplant, including 11,422 patients on the active waiting list (i.e. immediately eligible for an organ transplant), all organs combined.

Tissue procurement activity in 2023

The number of deceased donors harvested was 6,948 in 2023, compared with 6,226 in 2022, representing an 11.5% increase in activity.

Compared with 2022, corneal donation activity rose by 12.1%, artery donation by 1.9%, vein donation by 9.9%, skin donation by 8.1%, heart valve donation by 7.2% and bone donation by 2.8% compared with 2022.

| Number of deceased tissue donors in 2023 | |------------------------------------------------------|--------------| | Subjects in a state of encephalic death | 868 | | Donors deceased after cardiac arrest M2 and M3 | 230 | Subjects deceased up to 24 h after death | 5,850 |

Tissue donations are also made from living donors (surgical residues with the patient's explicit consent). The exact number for 2023 is not yet known, but a census is underway. The same applies to the number of tissue transplants for 2023. We'll be announcing these figures on the occasion of the national organ donation day on June 22.

Actions in 2023

Deployment of the fourth ministerial plan for organ and tissue procurement and transplantation continues:

• Territorial correspondents in each regional health agency have now been identified, and have benefited from a dedicated training module and targeted measures to reinforce their action;
• A national referral physician for the development of living kidney donation has begun meeting with transplant teams;
• 2,338 healthcare professionals have been trained, compared with 1,819 in 2022, an increase of 28.5%;
• 35 audits were carried out throughout the year, with a particular focus on facilities showing room for improvement;
• Visible results following specific measures for Ile-de-France, initiated in 2020 to increase procurement activity in this region: +16.1% increase in procurement activity from deceased donors in encephalic death and +21.4% in Maastricht III procurement, resulting in 1,572 transplants, i.e. 51 more than in 2022.
• New funding to match:- 11% increase in annual transplant and organ procurement coordination packages in 2023 compared with 2022;

  • 119 out of 173 CHPOTs benefit from guaranteed funding in 2023;

  • Acquisition of renal and hepatic perfusion machines in 2022 and 2023, for a total of 85 machines financed (€1.4 million);

  • Financing of hypothermic hepatic perfusion (88 hypothermic hepatic perfusions, €448,184).

As part of the reinforcement of its health democracy policy, the Agence de la biomédecine also set up biannual monitoring committees this year, bringing together all stakeholders - patient associations, learned societies, ARS referents, DGS/DGOS correspondents - to share objectives, indicators, effective interventions and results obtained, in a constant drive for transparency and support for relay players.

Three areas of development for 2024

More than ever, organ procurement and transplantation activities face the challenge of continuing to grow, to meet the growing needs of patients on waiting lists, at a time when the hospital sector is experiencing major difficulties.

The Agence de la biomédecine has identified 3 priorities for 2024:

As an exceptional recourse for a growing number of patients, kidney harvesting and transplantation must remain a national priority for all those involved in the healthcare sector. Kidney transplantation using living donors and so-called "Maastricht III" harvesting must continue to become widespread in authorized healthcare establishments, particularly in university hospitals. Greater involvement of university hospital directors and medical committees must enable us to step up activity to save more patients.

Reminder of the 5 innovative measures of the 2022-2026 Transplant Plan

• Ensure the professionalization of hospital procurement coordinators through the use of advanced-practice nurses, increased staffing levels and enhanced auditing and training;
• Develop multi-source harvesting to offset the downward trend in the number of brain-dead patients. In particular, this involves continuing to roll out the Maastricht III protocol, stepping up the practice of living donor procurement and developing pediatric procurement;
• Revising the methods used to finance organ harvesting and transplantation, to make them more attractive. At the same time, for both organ procurement and transplantation, the plan calls for greater transparency in the allocation of funding;
• Create performance indicators to assess the quality of organ procurement and transplant organization, help mobilize hospital management and reward teams that are making progress or maintaining a high level of performance.
• Appoint a "procurement and transplantation" coordinator in each regional health agency (ARS) to oversee the plan at regional level, in line with the specificities of each local context.

Every year, the Agence de la biomédecine conducts a barometer survey[1] to assess French people's perceptions and knowledge of organ and tissue donation.

The main findings

Public opinion remains overwhelmingly in favor of organ and tissue donation, with unwavering support and stable figures from one year to the next:

• 80% of French people are in favor of donating their own organs after death;
• -78% of French people feel that this law is in line with their values;
• 93% think it's important for their loved ones to know their position on organ and tissue donation, but fewer than one in two have mentioned it;
• 24% of French people spontaneously cite the law on presumed consent when asked about the rules governing organ donation (spontaneous awareness), and 75% recognize the right item in a multiple-choice list (assisted awareness) - even though, on the other hand, only 28% of French people feel "well informed";
• Awareness of the green ribbon continues to grow, with 18% of French people recognizing it as a symbol of organ and tissue donation.

Focus DROMResults in the DROMs are significantly lower than in mainland France, although support for donation remains in the majority:

• 69% of residents are in favor of donating their own organs after death;
• 69% of residents feel that this law is in line with their values;
• 90% think it is important for their loved ones to know their position on organ and tissue donation, but fewer than one in three have mentioned it;
• 8% of residents spontaneously cite the law on presumed consent when asked about the rules governing organ donation (spontaneous awareness), but 74% recognize the correct item in a multiple-choice list (assisted awareness), and only 21% feel "well informed".

"To act, all you have to do is say so".

"If 80% of French people are in favor of organ donation, then the rate of opposition should be capped at 20%, not 36%, as we're seeing this year. If this rate remains at such a high level, it's because too few French people have made their position known to their loved ones, who, not knowing the wishes of the deceased, prefer to report opposition. Organ donation is one of the very few opportunities we have to save 4 or 5 lives with just one word: because to act, all we have to do is say so. That's why we must all, without exception, make organ donation one of the routine subjects that we discuss from time to time with those around us - once a year, on June 22, for example, on the French National Organ Donation Day, an unmissable event in the calendar habits of the French."

David Heard, Director of Communications and Public Relations, Agence de la biomédecine.

All too often, misconceptions persist:

Although the Agence de la biomédecine guarantees fairness in the distribution of transplants, only 6 out of 10 French people feel that organ donation benefits all categories of the population equally.

• Only 24% of French people are aware that harvested organs cannot be used for research or science, but are reserved exclusively for sick patients awaiting transplants.
• 1 in 2 French people believe that organ and tissue donation is incompatible with religious funeral rites, despite the fact that organ donation is recognized and authorized by the 3 main monotheistic religions practiced in France, and that organ donation does not prevent funeral arrangements from being carried out in accordance with individual traditions.
• 42% of French people believe that there is an age limit for organ and tissue donors, whereas the rare contraindications to donation are purely medical: anyone who dies in hospital can be a tissue and/or organ donor, depending on the conditions of death.

The Agence de la biomédecine is a national government agency under the authority of the French Ministry of Health and Solidarity. Created by the French Bioethics Act of 2004, its mission is to regulate and promote the donation of organs, tissues and hematopoietic stem cells, as well as medically assisted procreation, human embryology and genetics. The Agence de la biomédecine does everything in its power to ensure that every patient receives the care they need, in compliance with the rules of health safety, ethics and fairness. Its cross-functional role makes this possible.

In terms of organ and tissue procurement and transplantation, the Agence de la biomédecine :

• Ensures that transplanted organs are allocated to patients awaiting transplants, in accordance with medical criteria and the principles of fairness;
• Evaluates the medical activities it oversees;
• Manages the national transplant waiting list and the national refusal register;
• Coordinates organ harvesting and the distribution and allocation of transplants;
• Promotes and develops information on donation, retrieval and transplantation.

[1]

Annual survey conducted by the Agence de la biomédecine among a representative sample of the French population of 1,000 people aged 16 and over. Representativeness is ensured by the quota method applied to the following criteria: gender, age, profession, region and urban area. The survey was conducted by telephone between January 9 and 22, 2024.