Agence de la biomédecine pursues its commitment to boosting living kidney transplantation

The Agence de la biomédecine is firmly committed to boosting kidney transplants from living donors. Concrete actions with hospital teams, new recommendations and a collective awareness campaign are all converging towards a common goal: saving lives by encouraging kidney donation between relatives. France must continue its efforts to achieve the objectives set by the transplant plan in terms of living donation, and thus offer patients waiting for transplants a better quality of life.

The Agency unveils its action plan in a video featuring Dr Durin, newly appointed to develop living kidney donation in France, and reminds us of the still little-known benefits of kidney donation between relatives in two testimonial videos. Click on the photos or titles to view the videos:

• Introducing Dr. Durin and his missionsAn emergency doctor trained in public health, Dr. Durin has been commissioned by the Agence de la biomédecine to support France's 33 kidney transplant teams: "France is the third country in the world with the highest number of organ donations per inhabitant from deceased donors, but when it comes to living donation, our country is at the bottom of the Western league table. That's why we meet with all our teams to identify the obstacles to the development of living organ donation.

• Eric and Charlotte, father and daughter, donor and transplant recipientEric: "I'm a little proud to have done this for my daughter. Charlotte: "I was able to have a child. When you have a transplant, you go back to a normal life, there's nothing impossible.

• Marc, a kidney transplant recipient thanks to his sister's living donation:"I've been able to start looking for work again. I do boxing, badminton and bodybuilding. My future today is first and foremost to keep the kidney, and for that I have a healthy lifestyle that I hope is beyond reproach."

In 2022, France recorded 3,377 kidney transplants, including 511 from living donors. Although these figures represent an increase on 2020, they still fall short of the "Prélèvement et Greffe" plan's target of 20% living-donor kidney transplants by 2026 (compared with 16% at present). Despite convincing results for transplanted patients, this practice remains underdeveloped in France compared with other countries, and with the needs of patients, which are constantly increasing.

On January 1, 2023, 9,816 patients were on the active waiting list for a kidney transplant, and 9,091 on the inactive list. Transplants from living donors are increasing slightly but steadily. However, further efforts are needed to achieve the plan's objectives.

The Agency's efforts to boost living-donor activity are guided by three major priorities:

• the revision of national good practice guidelines dating from 2009: the fruit of a collective effort, the Agency will publish new recommendations in early 2024, aimed at harmonizing practices in line with regulatory and scientific developments;
• the appointment of a national "living donor" referral physician, who will meet with all transplant teams to raise awareness and encourage them to develop this activity;
• and the launch of a cross-donation initiative with the creation of a dedicated working group.

Kidney transplantation from a close relative is the best therapeutic solution for chronic end-stage renal failure. Yet it is often considered as a last resort. At the end of this year, a communication campaign launched by the French Kidney Agency aims to make kidney donation more visible, and to raise its profile among patients and their families, as well as among doctors.

• Early awareness: information on kidney donation needs to be provided at a sufficiently early stage by doctors, from general practitioners to nephrologists, who themselves need to be made aware of the importance of mentioning this possibility earlier in the course of treatment.
• Known benefits, but under-utilized: although 98% of French people know that a kidney can be donated during their lifetime, 93% of French people consider living kidney transplants to be a last resort. It is crucial to correct this perception, but also to encourage professionals to broach the subject earlier.

More than 90,000 patients are currently being treated for chronic end-stage renal disease, and these numbers are rising every year. Kidney transplantation from a living donor remains the most effective treatment for a number of reasons:

Reason no. 1: Faster transplants than post-mortem donationsThe early scheduling of a transplant from a close relative offers the recipient greater peace of mind, with no waiting list, unlike a post-mortem donation.

Reason no. 2: Better-quality transplantsAfter ten years, the survival rate for transplants from living donors is 76.3%, compared with 61.4% for transplants from deceased donors. Healthcare professionals play a decisive role in informing and supporting donors and recipients.

Reason no. 3: Reduced risk of rejectionKidney transplants between close relatives, especially members of the same family, offer excellent compatibility, reducing the need for heavy anti-rejection treatments.

Reason n°4 : Much better quality of life than dialysisKidney transplantation significantly improves quality of life compared with dialysis, offering greater freedom and less strain from immunosuppressive treatments.

Reason n°5 : Longer life expectancy for the patientDonating a kidney to a loved one gives the patient a longer life expectancy and prevents a deterioration in health.

Reason n°6 : Unchanged life expectancy for the donorThe risks involved in kidney donation are minimal, and the donor can lead a normal life with just one kidney, with no significant impact on life expectancy. Annual follow-up is scheduled.