[Which graft for which patient? and when? II. Organ supply and allocation]

Despite progress realised in transplantation and organ procurement, there is an increasing gap between the number of patients on the national waiting list and the number of harvested organs. As a result, the appropriate organs must be matched with the appropriate patient, with two constraints: equity and efficacy. In a context of lack of organs, another public health problematic is to conciliate both the interests of a given patient and the interests of those on the waiting lists. In 1996, the French secretary of state for health instituted a public consultation committee chaired by the vice-president of the Comité consultatif national d'éthique, Counsellor Jean Michaud, to study organ allocation rules and to plan recommendations for the future. Using, as a starting point, the allocation rules initiated in the past by France Transplant and transiently applied by l'Etablissement français des Greffes, the committee conducted a large audition of health care professionals concerned with transplantation, individuals qualified in ethics, laws, sociology or ethnology, politicians and a sample representation of the population. A new corpus of allocation rules and procedures was then defined according to the committee recommendations and the advice of all medico-surgical transplantation teams, and published as a ministerial order in the Journal officiel de la République française in november 1996. It specifies shared principles and organ by organ specific allocation rules.