[Ethical and social problems posed by organ transplantation]

Organ transplantation more than a scientific fact is now a social fact. Since the first organ transplantations in France, forty years ago, medicine demonstrated its ability to perform the operation and to obtain (what was more difficult) the tolerance of the graft but medicine so far remains unable to give the material: organs. These organs are given by the donor's relatives when the kidney is concerned and when it is a donation from a living person. But such donation remain strictly limited in our country (less then 5% of the kidney transplantations) due to the risk of moral pressure and commercialization. More often and for the other organs (liver, heart, lung) a the donation is obtained after death, a special and dramatic death: the brain death. The nowadays spectacular results of organ transplantation 70 to 80% survival rate at 10 years with a complete rehabilitation gave a considerable increase on the demand. Unfortunately organ transplantation is the victim of its success, the number of donor's organ being insufficient to satisfy the needs. So in December 1990, 6,055 patients were on the waiting list and only 3,772 (56%) were transplanted. In December 1991, 6,334 patients were on the waiting list and may be only 4,000 could be transplanted. So the difference between the needs and the possibilities is increasing each year with for consequences, the death of 10% of the waiting patients and, for those who could be transplanted, a considerable increase in the waiting period responsible for slow deterioration of their status and less chances of success. The reason of the lack of organs is not due to the lack of brain deaths which are unfortunately too numerous, but to the impossibilities of organ retrieval due to: too advanced age or the presence of a transmissible disease of the donor, lack of medical means in some intensive care units, and family refusal. This refusal is easily understood and due to the very peculiar conditions in which the donation is required: the unexpected death of a loved parent and such a death with some life appearance. To avoid the increasing number of such refusal two actions are possible. One is the modification of the law. The French law is the Caillavet law which requires for organ retrieval, the written permission of the parents for a minor, or for an adult the absence of refusal expressed during his or her life.(ABSTRACT TRUNCATED AT 400 WORDS)