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the essentials Due to a lack of operating room slots, many patients have to wait before receiving a kidney transplant even though they have found a donor within their circle. The Toulouse University Hospital, best center in France in 2023, could see its activity drop between 18% and 30% in 2024.
Lack of doctors, caregivers, resources, logistics, the hospital is suffering. Everywhere. Many activities are struggling to return to their pre-Covid-19 level, strongly impacting patients. Last month, in a column published by the newspaper Le Parisienorganizations of doctors and patients have warned about the situation of transplantation activity, “vital but in danger” today in France.
The cause is difficult access to operating rooms, including for kidney transplants from living donors, which are easier to program than a transplant from a deceased donor. In 2023, the University Hospital Center (CHU) of Toulouse thus carried out 74 kidney transplants from a living donor out of the 201 total kidney transplants, which made it the leading center in France, well above the French average (37% of transplants with a living donor compared to 16 % nationally).
Better quality of life and savings for society
“This is one of our levers to reduce waiting times for a kidney transplant, which is between 3 and 7 years depending on the patient. In Toulouse, we have 1,300 on our waiting list. The transplant kidney allows a better quality of life for patients and a major saving compared to dialysis which costs €80,000 per patient each year”, underlines Professor Nassim Kamar, coordinator of the department of nephrology and organ transplantation at the University Hospital of Toulouse.
“The financial incentives are substantial to support the transplantation activity which, all organs combined, brought in 4.150 million euros in 2023 to the Toulouse University Hospital based on the activity of 2022. If the Toulouse University Hospital has succeeded in reach this 37% of transplants with living donors, it is because all the nephrologists of Midi-Pyrénées are involved, that advanced consultations take place in 7 peripheral hospitals, that our coordination team is extraordinary and that the urologists of the CHU have invested a lot in innovation,” adds the specialist.
“Toulouse could be number 1 in Europe!”
Except that the good figures for 2023 mark a halt and Professor Nassim Kamar does not hesitate to denounce it, like his colleagues in the French-speaking Society of Transplantation (SFT) of which he is a member of the Board of Directors. All are calling for the protection of operating time dedicated to transplantation activity from living donors. “Due to a lack of operating room nurses, nurse anesthetists, anesthesiologists, the operating time of urological surgeons (who carry out the kidney transplant activity) is reduced and there is no prioritization for transplants kidneys from living donors. For me, it is a lack of institutional political will. We must put everyone around a table and see which specialty can give time. Transplantation must not be in competition with knee prosthesis, cataract or all the activities that the patient can find elsewhere! Transplantation is our monopoly, we must assume it 100%. Out of all the 48,000 interventions per year at the Toulouse University Hospital, if we dedicate 40 to 50 dates – in addition to the 40 already listed on the urologists’ schedule – it’s really epsilon. Because we have what it takes to be the leading center in Europe”, affirms Professor Nassim Kamar .
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To talk about organ donation, a Toulouse nephrologist puts on sneakers
“Patients whose file is ready may have to wait a year and go to dialysis”
With his calendar in front of him, he doesn’t lose his temper. “For the first six months of 2024, I have 24 dates. At best, we will do 50 transplants in 2024 but I have 80 files in progress as of March 21… Patients who have a donor, who are ready, will have to wait a year, perhaps on dialysis, or 156 sessions of 4 hours. The associations are mad with rage and they are right. The transplant from living donors is outside of everything we know in medicine, we is in intimate bonds. What can we say to all these families stopped in their momentum of generosity? Chronic kidney diseases will increase with aging, high blood pressure, diabetes and excess weight. And our waiting list too “, concludes the specialist.
