Outlook on the Kidney Paired Donation Program in France

Many countries, including France, have seen a sharp increase in the number of renal disease patients waiting for a transplant. The shortage of kidney transplants has led some countries to develop "paired donation" programmes, which allow patients who can only find incompatible living donors to "swap" donors in order to receive a compatible transplant. In France, the number of additional transplants obtained through this programme is very limited, due in large part to the strict legal framework governing paired donations. For example, the law stipulates that an exchange can only take place between two patient / donor pairs. In its June 2018 summary report, the French National Consultative Ethics Committee (CCNE) lays out avenues to reform the paired donation programme. The French government is expected to present a draft law on revision of the bioethics law in the coming months. It therefore struck us as important to assess the potential effect on transplant numbers if the law were changed to authorise more exible practices in the paired donation programme. On the face of things, increasing the number of patient / donor pairs allowed to take part in an exchange seems like a good way of generating more transplants, but we show that this measure has only a modest impact. A different approach, which has proven effective in other countries, is to allow "donation chains". We show that allowing donation chains that begin with deceased donors, even at modest frequency, can more than triple the number of transplants.