Organ donation and transplantation in France: know everything
Donating all or part of one's organs is a concept that involves personal will and informed consent. According to the Civil Code, every person enjoys the principle of self-determination and is solely responsible for any decision concerning themselves. AdVitam guides you in making your choice.Organ donation in France concerns the entire population as transplants can come from all types of donors: young or old, alive or at the end of life, suffering from a particular pathology... The law considers each citizen a potential donor but respects anyone who clearly expresses their refusal for organ donation.
What is organ transplantation? Which organs are involved?
With the aging population and constantly improving medical techniques, life expectancy has increased, but not always under good conditions for patients with hope for a transplant. The number of people waiting for a transplant reached 23,828 in 2017. A figure that is increasing much faster than the number of transplants performed.
The lack of organ donations is responsible for five to six hundred patients succumbing to illness each year. Some patients are even removed from the waiting list, as their health has deteriorated too much due to the delay. For patients waiting for a transplant and their families, it is a question of receiving an organ that will save them from an engaged prognosis or improve their daily living conditions. Or for medical research, organs can be studied scientifically and encourage the perfection of surgical techniques.
Donations involve all types of organs and some human, even bone tissues. Indeed, it is now possible to donate and receive bone tissue. These will, for example, be sculpted into fixation screws, essential for proper recovery following major orthopedic operations.
There is no age limit for allowing the removal of any other organs. The consent of the parents or guardians is, of course, sought, but everyone, regardless of their age, is encouraged to express their opinion (by making a donor card or registering for refusal). Today in France, it is possible to extract:
hearts up to 65 years old,
lungs up to 70 years old,
livers up to 80 years old,
kidneys up to 85 years old,
and corneas up to... 90 years old (France-adot.org)
It is also possible to donate while alive. This obviously concerns organs that are not vital to the donor, such as a kidney and sometimes a liver lobe (for more details). Concerning bone marrow transplant and cord blood donation (called "placental blood"), they must be previously approved (request with compatibility study and health assessment) and registered and are limited to people aged between 18 and 60 years.
In 2017, the number of organ transplants exceeded 6,000.
This victory was displayed by the Biomedicine Agency as part of its Transplant III plan.
The reason lies in the improved public opinion, mainly aided by the efforts of various organizations concerned with bioethical issues (awareness campaigns, discussions with the government...). And the application of the right to withdrawal by medical staff reinforced by the principle of presumed consent.
The principle of presumed consent
This principle represents national solidarity towards transplant patients. Every person is now considered to have given consent for the removal of their organs and tissues.
Since December 22, 1976, all French citizens are considered potential donors unless "they have expressed their refusal during their lifetime." This refusal must be registered with the French National Registry of Organ Donation Refusals. The Cavaillet law was repealed and improved by the 1994 bioethical law. However, this legislation has long been ignored at the expense of the number of authorized transplants.
Indeed, whether it was public authorities and their duty to inform the population or families who never addressed the subject, the number of authorized removals did not meet the growing need for transplants. When a situation involving organ removal for transplant arose and without knowledge of the deceased's opinion, medical teams were often denied consent by the family.
Due to a lack of communication around the bioethical law, a reform has therefore reinforced the legislation. The implementation of the decree on January 1, 2017, highlights this national solidarity.
Refusal of organ donation - how to enforce one's choice?
Refusing organ donation
Today, eight out of ten French people declare themselves in favor of donating their organs, but only 45% have shared their unfavorable opinion with a loved one (survey by the Biomedicine Agency in June 2011).
The refusal rate, which remained above a third of the population for about twenty years, has dropped below 30% (29.6% in 2017 according to the Biomedicine Agency). This is a national first, supporting the ongoing five-year Transplant III plan initiated by the Biomedicine Agency.
Since January 1, 2017:
we are all presumed donors
donation is free
it is anonymous
it is possible to change your mind at any time
to ensure that our opposition to donation is respected, we must register with the National Register of Refusals, either online or by mail
the refusal of donation can be partial (affecting only the organs and tissues that must be specified in the registry)
If no trace is found in the Register, the medical staff must turn to the relatives to gather the deceased's opposition testimony. The relatives will have to mention the circumstances in which you expressed your refusal. Their testimony will be heard by medical teams, transcribed, and made official with their signature.
How to enforce one's choice?
Every individual is free to refuse the removal of organs and tissues.
A minor can also express their decision from the age of 13. To ensure that your choice is respected, the law considers registration with the French National Registry of Refusals of Organ and Tissue Donations. Since January 2017, it is possible to follow the instructions online (registration online or by mail) on the website governed by the Biomedicine Agency. A case number must be kept, especially for any change of mind. Indeed, the refusal of organ donation is revisable and revocable at any time, regardless of the reasons.
Partial refusal is another novelty that limits the removal of organs and tissues, also permitted by the Touraine decree of 2017. We can, therefore, authorize any removal from our own remains except, for example, the cornea or skin. This partial refusal option targets transplantation as well as studies (autopsy or medical research) of the designated body parts.
Any written evidence of your refusal will also be taken into consideration if it is an authenticated refusal statement:
written by oneself (full name, marital status, postal address, signature)
the nature of the refused removal acts: all types of acts, or certain designated organs/tissues, or the medical scope of the removal (research or therapeutic interest of others)
date, place of signatures on the original and the copy (given to the witness, often a family member)
You can find a sample refusal letter we provide here. If you are unable to write your refusal, another person, accompanied by two witnesses, can draft it on your behalf.
Conclusion
Donating one's body or organs is a question that should be raised during one's lifetime. The subject of donating all or part of oneself unfortunately often divides families. Grieving is all the more difficult to bear when a loved one's remains are the subject of divergent opinions.
That's why it's advisable to prepare for one's death as well as possible. It is possible to express different perspectives, especially within a legal framework for more respect and guarantee of application. Numerous foresight measures are available and legislated:
Consult our dedicated guides for support in your decision-making.