How is the Agence de la biomédecine giving new impetus to living-donor kidney transplants?

In March 2022, the French Ministry of Solidarity and Health and the Agence de la biomédecine adopted a ministerial action plan for organ and tissue procurement and transplantation for the period 2022-2026. The plan was drawn up with input from all the stakeholders concerned: institutional partners, learned societies, healthcare professionals and user associations.

One of the main thrusts is to develop multi-source harvesting, in order to increase access to transplants and reduce waiting times. In particular, this involves stepping up the practice of living-donor transplants. By the end of 2022, living donor kidney transplants will account for 15% of all kidney transplants. The plan sets a target of 20% by 2026. To date, this rate varies from one hospital to another. In fact, 7 teams have already reached the plan's target, while 22 teams are below it.

The Agence de la biomédecine is working in three areas to boost living-donor kidney transplant activity and meet patients' needs:

• Drawing up national rules of good practice for living kidney donation and transplantation, to support healthcare professionals and inform citizens and institutions.
• Appointment of a national "living donor" referral physician: actions aimed at low-activity centers, proposals for corrective measures to be taken by healthcare establishments, and support for the latter.
• Launching a cross-donation initiative: setting up a dedicated working group, providing more information, distributing a regular newsletter to teams, and reactivating our agreement with Switzerland, in order to increase the number of patient pairs registered.

New recommendations concerning living kidney donation will be published by the end of the year. The last ones were published in 2009. Many healthcare professionals, patients and representatives of learned societies (SFT, SFNDT, SFHI, SFAR) have contributed to this project, in working groups (80 people) and reading groups.

This tool will help to harmonize practices by keeping pace with regulatory and scientific developments.

Among the highlights of these recommendations

• A broadening of the selection criteria for potential donors, with acceptance of certain comorbidities such as overweight and the risk of type 2 diabetes, for example, for those whose risk would be measured, and advanced age. Risk-taking remains measured in relation to shorter life expectancy. Age is also a factor in determining the acceptable glomerular filtration rate (GFR) threshold for assessing renal function, since this is physiologically reduced with age.
• Genetic aspects make their entry as an aid to clinical practice, in order to specify the risk of recurrence in the recipient in the event of undetermined renal disease, and to screen for renal risk in a related donor candidate.
• Psychological aspects are included in the new recommendations, with at least one interview with a clinical psychologist referent to the transplant department, and the need to reinforce donor support.

As part of the deployment of the ministerial plan for organ and tissue procurement and transplantation, the Agence de la biomédecine has appointed Dr. Laurent Durin as operational referent to support teams involved in living donor kidney transplants throughout France. His status will enable him to liaise with the institutions' governing bodies, the professionals concerned, and the supervisory authorities. On a case-by-case basis, depending on the difficulties identified, it can propose a shared action plan with the establishment's players. His priority targets are teams whose living donation rate is below the national average (15.2%), by acting on the main levers identified by the Agence de biomédecine for this mission: access to operating theatres, mobilization of the human resources required, assessment of economic impact, quality of life for patients, etc.

Dr. Durin has worked since 2004 in the Grand Est regional department of the Agence de la biomédecine's Procurement and Transplantation Division. He was previously an emergency physician at Epinal Hospital, notably in the intensive care unit. Since 2021, he has held a Master's degree in public health, focusing on the relaunch and identification of obstacles to living donor transplants in France.

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, it is responsible for organ, tissue and cell procurement and transplantation, as well as human reproduction, 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 equity; - Evaluates the medical activities it oversees; - Manages the national transplant waiting list and the national register of refusals; - Coordinates organ procurement and the distribution and allocation of transplants; - Promotes and develops information on donation, procurement and transplantation.