title: How France launched its donation after cardiac death program.
abstract: On the basis of the literature and results presented at the 6th International Conference, donation after cardio-circulatory death provides a significant, practical, additional high quality source of transplantable organs. The vast majority of DCD are 'controlled' Maastricht category III donors. In 2010, the parliamentary information mission on the revision of the bioethics laws invited the Intensive Care Societies to debate and to make recommendations to implement controlled donation after circulatory death. They came to the conclusion that such retrieval is possible in France and insisted on the medical criteria that frame it: the writing of the medical procedures, the ethical aspects and the delay. The major recommendations of the ethics committees were firstly, The WLST decision is independent of the possibility of organ donation; secondly, the strict respect of "The dead donor and organ transplantation rule" and the updated national guidance for the WLST; thirdly, the drafting of a nationally agreed protocol defining the mandatory conditions to determine death and to perform procurement and transplantation. Organ donation after WLST will be authorised only in pilot centres with a locally agreed WLST policy including external second opinion and written transcript of the WLST decision, experienced intensive care staff, a local organ procurement coordination team familiar with DBD and DCD protocols and only in hospitals authorised for organ procurement. It is important to have an optimal and standardized national guidance to limit the known risk factors of graft failure (donor and recipient choice, warm and cold ischemia time), to increase acceptance by medical community and civil society and to improve results and allow more powerful analysis.
authors.affiliation: Agence de la biomédecine, direction générale médicale et scientifique, direction prélèvement greffe organes-tissus, pôle stratégie prélèvement greffe, 1, avenue du Stade-de-France, 93212 Saint-Denis-la-Plaine cedex, France. Electronic address: corinne.antoine@biomedecine.fr.
authors.forename: C
authors.initials: C
authors.lastname: Antoine
authors.affiliation: Agence de la biomédecine, direction générale médicale et scientifique, direction prélèvement greffe organes-tissus, SRA Sud-Est/Océan Indien, bâtiment B, 162, avenue Lacassagne, 69424 Lyon cedex 03, France.
authors.forename: F
authors.initials: F
authors.lastname: Mourey
authors.affiliation: Directrice générale, Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-la-Plaine cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Prada-Bordenave
mesh_terms: D000367:Age Factors; D001926:Brain Death; D050377:Cold Ischemia; D003643:Death; D046148:Donor Selection / Q000592:standards; D005602:France; D006085:Graft Survival; D017408:Guidelines as Topic; D006291:Health Policy; D006323:Heart Arrest; D006801:Humans; D009926:Organ Preservation; D010865:Pilot Projects; D012307:Risk Factors; D012769:Shock; D014019:Tissue Donors / Q000145:classification*; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000592:standards; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D052096:Warm Ischemia; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence
keywords: Cardiac death donor; Circulatory death; Don d’organes; Donneur décédé après arrêt cardiaque; Donor selection; Décès par arrêt circulatoire; Limitation des thérapeutiques actives; Organ donation; Sélection du donneur; Withdrawal of life-sustaining therapy