[Which graft for which patient? and when? I. Graft shortage: causes and solutions]

According to the report from the Medical and Scientific Council of Etablissement français des greffes, 2807 organ transplants were performed in France during 1996. After a noticeable decline which started in 1991, transplantation activity has remained stable during the last three years, but does not succeed in satisfying the needs. For instance the average waiting time for a renal graft is longer than two years for certain groups of patients. The origin of this graft shortage is multifactorial, but a certain lack of confidence expressed by family refusal to organ donation is the main reason. Public opinion might have been disturbed some years ago by publications about some dysfunctions in transplantation activity, and by rumors of organ thefts which arise from time to time. Medical information regarding organ harvesting has not always been suitable. Nevertheless, new legal frameworks and new regulations recently established by the public administration, the development of national information campains aimed to health staff and the public, efforts engaged in the use of organ sources other from those harvested from brain dead patients, and the intensification of research, particularly in the field of xenotransplantation are likely to launch once again this magnificient human and scientific adventure, organ transplantation.