Perspectives on the kidney paired donation programme in France

Many countries, including France, are facing a significant increase in the number of patients with kidney disease awaiting a transplant. The shortage of kidney grafts has led some countries to develop what are known as paired donation programmes. These programmes allow patients who can only find incompatible donors to “exchange” their donors in order to obtain a compatible graft. In France, the number of additional transplants made possible by this programme is extremely limited. One of the main reasons for this poor performance is the very strict legal framework governing paired donation. For example, the law stipulates that an exchange can only take place between two patient/donor pairs. In its June 2018 summary report, the National Consultative Ethics Committee mentions possible avenues for reforming the paired donation programme. The bill revising the bioethics law is expected to be presented by the government in the coming months. We therefore felt it was important to assess the impact, in terms of the number of transplants, that a change in the law could have if it allowed for more flexible practices within the paired donation programme. Increasing the number of patient/donor pairs authorised to take part in an exchange may, at first glance, seem an effective lever for increasing the number of transplants performed, but we show that the impact of such a measure remains modest. Another approach exists, which has proven effective in other countries: authorising “donation chains”. We show that authorising donation chains initiated by deceased donors, even at modest frequencies, makes it possible to more than triple the number of transplants.