Ethics and organ procurement.

Most recent information from the EFG (Etablissement Français desGreffes, French Transplant Organization) reveals that the issuerelated to the consent to an organ procurement from a person in astate of encephalic death in order to transplant it on a patient isdesperately confronted to psychological, philosophical but alsomaterial barriers. How can we explain this persistent reluctance ofour fellow citizens to an act which can save lives? Transplants frompeople in a state of encephalic death are still being opposed at a rateof one out of three (32%). In 2003, removal of an organ was doneon barely one out of two people in a state of recent encephalicdeath. Waiting lists are impressive (6597), and the number of annualdeaths (243) of patients waiting for transplants, even thoughstable, is unacceptable. Our society’s increasingly individualistbehaviours, which are supported by the notion of “individual autonomy”,explain this widespread indifference to an issue that shouldbe considered as a major public health priority. Is organ transplantationnot yet acknowledged as efficient? In fact, this question hasnever been truly addressed, and since 1988, in a report named“Aspects éthiques des choix collectifs en matière de santé” (Ethicalaspects of collective choices in health matters), the CCNE (NationalConsultative Bioethics Committee) has been requesting thoroughevaluations, from an economic angle as well as in terms of qualityof life, which have never been launched. Why are doctors and patients’associations, although well supported by the EFG, the onlyones to take initiative in finding a solution to the shortage of organdonations, and why are they not heard by politicians and by thosewho distribute means? If one excludes all possibility of commercializationof transplants, ethically unacceptable to us, several newtechnical orientations try to compensate the shortage of organ donationsfrom people in a state of encephalic death: living donation,non-heart-beating donation. These possibilities themselves raisedifficult ethical issues. In fact, without a formal choice of our society,a determined collective choice, and the politicians’ wish tohave it accepted or even imposed, there are no valuable and durablesolutions. A healthcare reform would have been a good opportunityto include organ transplantations, especially since the issue was notabout the cost but rather about a preferential choice for a validatedtreatment based on solidarity. Unfortunately, this reform, which wehave long been hoping for and expecting, does not seem to be thetopic of the day anymore.