[Organ procurement and transplantation: a public health mission for the year 2000]

Organ procurement is the limiting factor in cadaver organ transplantation in France. The number of organs currently available is insufficient to meet demands while there are a sufficient number of potential donors. This critical situation has created difficult problems at all levels of the transplantation process: long waiting lists, discouraged patients, use of grafts of limited quality, selection of candidates on the basis of uncertain scientific criteria due to the lack of choice. This unsatisfactory situation after 30 years of successful transplantation raises many unanswered questions for decision makers including political leaders (the 1994 bioethics law will be revisited in this summer's session of parliament), health professionals (selection of candidates), hospital administrators (planning hospital structures) and ordinary individuals who are called upon to think about their own death. According to the data from the French graft control center, organs are not procured from approximately half of subjects in a state of brain death, because of refusal in 1 out of 3 cases. What is the meaning of this refusal? Solutions are available, what is lacking appears to be the will to solve the problem.