Organ transplantation: from donor to recipient, a “race against time” – Sciences et Avenir

In organ transplantation, from the moment of removal from the donor, a “race against time” begins until the transplant itself. The feat was made possible thanks to a living chain, which will open for several hours.

It all starts in Saint-Denis, north of Paris, at the headquarters of the Biomedical Agency. “This is where the distribution of transplants taken” from people in a state of brain death occurs – about 1% of deaths, Geraldine Malaken, head of the National Center for Distribution of Transplants (PNRG), explains to AFP.

This center first of all checks that the deceased, who should have no contraindications to transplantation, was not registered during his lifetime in the state register of refusals to donate. The medical team, along with his relatives, makes sure that he was not against donating his organs.

Then the distribution of organs begins. It takes into account the urgency of the transplant, the biological and medical characteristics of the patient, and the transport time that the transplants will undergo.

Some patients on the national waiting list are prioritized, such as children or recipients whose lives are at risk in the near term. There are currently about 10,800 patients actively waiting for transplants.

Thoracic surgeon Thomas Charrier of the Foch hospital in Suresnes looks at a monitor while extracting the lungs of a deceased patient, December 9, 2022, an organ destined for transplant in a hospital in the east of France (AFP – Christophe ARCHAMBAULT)

Five organs from a 45-year-old woman were offered at the Agency that morning: “Her heart and lungs were taken for a recipient whose life was in danger in the short term,” Liliane Letailandier, a dispatching nurse who takes turns with team members, tells AFP. for the center to operate 24 hours a day, 7 days a week. “The left lobe of his liver was accepted for pediatric emergency care, and the right lobe for another recipient,” she continues.

Goal: to minimize the time between extraction and transplantation in order to optimize the chances of success of the operation. Medical teams have limited time to decide whether to accept organs or not.

– “Extreme tension” –

Édouard Sage, Head of the Thoracic Surgery Group at the Foch Hospital (Hauts-de-Seine), is one of the lung transplant surgeons. “When I get a call from the Biomedical Agency, I look to see if I can accept an organ based on its known characteristics,” he says.

In case of a positive result, he sends a command to where the dealer is located. Each organ is likely to be assigned to a patient who can be anywhere in France.

It remains to be judged on the spot. “When we arrive at the site, we evaluate the graft, we need to touch it and see how it is ventilated to make sure that the conditions allow for a transplant,” says Thomas Charrier, 29, a doctor in Foch’s thoracic surgery department, which specializes in lungs. removal.

It’s only when he says “come on” to his manager on the phone that the transplant really begins.

Refrigerator for transportation of organs in an airplane, December 9, 2022 (AFP - Christophe ARCHAMBAULT)Refrigerator for transportation of organs in an airplane, December 9, 2022 (AFP – Christophe ARCHAMBAULT)

Lung removed. Around the same time, sometimes hundreds of miles away, the recipient returns to the operating room to be euthanized.

“From the moment of the trial, the race against time begins,” describes Edward Sage. Depending on the organ, the urgency is more or less long (maximum 4-5 hours for the heart, 6-8 hours for the lungs, 12-18 hours for the liver, 18-24 hours for the kidneys).

After sampling, the grafts are placed in sealed refrigerators where the temperature does not exceed 4°C.

Depending on the distance to be covered, the most efficient modes of transport are used: ambulance, train, plane…

“In order to go faster, we call a police escort, every minute is precious,” says Thomas Charrier.

Most often, transplantation is performed at night, when all teams can be mobilized and operating rooms are available. Hours of “extreme tension”. But, according to Thomas Charrier, “there is something magical about the fact that the lungs that we removed reventilate, change color.”

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