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The announcement was made by the Biomedicine Agency: for the first time in France, three kidney transplants, with three pairs of donors and recipients, were carried out simultaneously. We explain why.
Live organ donation has been authorized since 2011. It is mainly carried out between relatives: the spouse, the parent, the brother, the sister or the friend. But it faces obstacles, particularly due to the difficult compatibility between donors. To improve the availability of grafts, a legislative advance has been designed: cross-donation.
Cross-donation consists of linking “pairs” of donors/recipients who are not compatible with each other, but whose recipient is compatible with the donor of the other pair – and vice versa. The new law relating to bioethics promulgated on August 2, 2021 has changed the terms of this type of donation. The number of donor-recipient pairs authorized as part of a cross-donation of kidneys has thus increased from two to six.
Once the groups of donors and recipients have been identified, “the medical teams concerned are contacted by the Agency to validate the project and carry out the final compatibility tests. The latter makes it possible to check the absence of incompatibility between the pairs obtained in cross-donation.“.
“The higher the number of donor-recipient pairs registered, the greater the chance of identifying compatible pairs at the national level.” estimates the Biomedicine Agency. It is studying “each month the possible matches between patients waiting for a kidney transplant who have an incompatible relative but who is willing to donate, registered in this program”.
6 patients operated on at the same time, a first in France
This year, for the first time in France, a first triplet took place, reveals the Biomedicine Agency in a press release. The operations were carried out on six patients in total, with the University Hospitals of Reims and Bordeaux. These surgeries could be carried out within 24 hours, the maximum time limit established by law. “A considerable organizational and medical challengee” reports the Agency.
The principle of anonymity of the donation is guaranteed by the Biomedicine Agency. Recipients cannot in any way know from whom they received the kidney, nor can donors know to whom their kidney was transplanted.
A second “triplet” is being organized, in order to operate the different individuals in the same way, at the end of the year. A challenge once again requiring coordination between hospitals but also efficient transport of grafts between establishments.
Kidney transplant, a solution against end-stage renal failure
In France, nearly 100,000 people suffer from end-stage renal failure, around half of whom have been treated by a kidney transplant. According to the Biomedicine Agency, “ten years after the transplant, the survival of grafts taken from living donors is 76.3%, compared to 61.4% for grafts from deceased donors”.
The 5 benefits of kidney transplantation with a compatible living donor
- Scheduling the transplant allows the recipient better preparation;
- The graft is of better quality, because the time interval between collection and transplant is shorter and the blood and immunological compatibility between donor and recipient is better.
- The transplant from a living donor works better and longer than that carried out from a deceased donor.
- A lower risk of rejection of the transplanted organ and complications linked to heavier anti-rejection treatments, particularly when an incompatible transplant is proposed.
- Controlled risks for the donor, particularly regarding the perioperative phase.
Kidney harvest does not reduce the life expectancy of donors.
Living donation therefore works better and offers better survival to transplant recipients. This new approach therefore increases the chances of obtaining a graft for patients who need it.
In the United Kingdom, more than a hundred kidney transplants are carried out in cross-donations each year and the number of incompatible grafts is very limited.