[Organ procurement in France: new challenges]

France has reached a pretty good level of activity, comparable to southern European countries: in 2011, 4945 transplantations (TX) have been performed among them, 2976 (60%) kidney TX, 1164 (24%) liver TX, 398 (8%) heart TX and 312 (6.3%) lung TX. However, the progression has slowed down since 2008 like in many countries. The potential of donors is mainly represented by the donor after brain-death (DBD) (90%), living donor (LD) for kidneys transplantation participates for only 10% of the overall kidney TX, and donor after cardiac death (DCD) activity, just started in 2006, for 2.2%. Current challenges to maximize the existing activity of DBD rely upon the implementation of program aimed to monitor deceased organ donation potential, a comprehensive approach of the regional disparities covering the steps of the detection of the potential donor, the rate of organ procurement and the refusal rate to organ donation. The profile of the donors has changed due to substantial epidemiologic shifts and a growing shortage of organs. The resource of expanded criteria donor (ECD) is widely used, mainly defined by a criteria of age. This policy is acceptable and successful under specific allocation scheme based on a donor-recipient matching. Before the TX needs of the population have been adequately met, the opportunities for improvement should be the development of DCD and LD activities, in addition to DBD activity. The extension to the DCD of the 3rd category of Maastricht is currently devised as a possible option for the future. The development of perfusion machine, available for kidney preservation and soon for the other organs is a new technical challenge that might increase the donor pool to previously discarded grafts. This superior and cost-effective method evaluated for ECD kidney preservation has also a potential of resuscitation and prediction of post-transplant outcome. To give a new launch to the TX activity as it was done in 2000, the Agency together with the professionals, has elaborated a "new action plan" for the next few years, which has been acted on April 2012 by the Minister of health.