Organ Donation

In 2024, 29,000 people were waiting for an organ transplant in France, and only 6,034 transplants were performed during the year. 852 people died in 2024 while waiting for a transplant. The gap between the number of available transplants and the number of patients waiting for a transplant has been widening since the 1990s; there is talk of a shortage of transplants. There is therefore an urgent need to find more transplants and mobilize the entire population to this end. There are many prejudices and misconceptions about organ donation, which hinder its acceptance. In fact, the rate of opposition to donation has only increased in recent years. Even among the healthcare community, organ donation suffers from a lack of knowledge, which potentially contributes to difficulties in acceptance. This lack of knowledge is probably linked to insufficient training and practice. The aim of the research is to study the perception of training, knowledge, and experience of organ donation by our healthcare professionals and future healthcare professionals in Alsace, France.

In 2024, 29,000 people are waiting for organ transplants in France, and only 6,034 transplants were performed during the year. 852 people died while waiting for a transplant. The gap between the number of available transplants and the number of patients waiting for transplants has been widening since the 1990s; there is talk of a shortage of transplants. There is therefore an urgent need to find more transplants and mobilize the entire population to this end. French law supports presumed consent, meaning that we are all donors unless we have expressed otherwise during our lifetime. In fact, 80% of French people say they are in favor of organ donation after their death, but few discuss it with their loved ones. When families are approached about multi-organ removal to gather any opposition from the deceased, the refusal rate is 37% (compared to an expected 20%). It is difficult to determine whether this opposition truly comes from the deceased themselves, their loved ones, uncertainty, or the situation. As this is the leading cause of non-donation, it is essential to better characterize this opposition in order to reduce it and allow for more organ donation and, ultimately, transplantation.

The most common reason for not obtaining donation after brain death (DBD) or donation after controlled circulatory death (DCD) in France is refusal of consent by the relatives. Many observational studies suggest that consent rates may increase when the request is made by specially trained and highly experienced professionals. One technique that may maximize the consent rate is collaborative requesting made jointly by the physician in charge of the patient and an organ procurement coordinator (OPC). Although the general principles are the same for DCD as for DBD, several differences and specificities exist. First, withdrawal of life-sustaining treatments (WLST) decisions should be entirely independent from organ-donation considerations, in order to eliminate potential conflicts of interest. However, separating conversations about WLST and donation may not always be possible. Potential DCD situations often occur after an extended ICU stay with the development of close ties between families and staff. The ICU physician may therefore feel that suggesting donation during the WLST conversation serves the family-ICU staff relationship. An unblinded multicenter randomized controlled trial tested the null hypothesis of no difference in organ-donation consent rates between collaborative requesting (clinical team and OPC together) vs. the clinical team only (routine requesting). The potential donors met criteria for brain-stem death or had impending brain-stem death; none were candidates for DCD. Collaborative requesting did not increase the consent rate. The PRODON study will test whether collaborative requesting by the ICU team and OPC decreases the rate of DCD refusal by families compared to routine requesting by the ICU team only.