Heart transplants in France increase slightly

In 2025, 421 heart transplantations were performed in France, compared to 414 in 2024, representing an increase but still falling short of meeting demand. During the same year, 581 new patients were added to the heart transplant waiting list.

Waiting list reflects identified needs

The French Agency for Biomedicine notes that these new registrations reflect needs identified by transplant teams, though they may not fully represent actual demand. In 2024, among the 942 candidates for heart transplant who were either on the waiting list or newly registered, 73 died or were removed due to worsening conditions making them incompatible with transplantation.

Heart grafts come from deceased donors

Heart grafts in France come exclusively from deceased donors, whose death has been properly ascertained. Two main scenarios are recognized: brain death, which remains the primary source, and death after controlled circulatory arrest, known as Maastricht III, a more recent development in France.

Brain death and organ retrieval

Brain death is defined as the complete and irreversible destruction of brain functions, confirmed through clinical and paraclinical assessments. Retrieval of organs must be conducted in specifically authorized establishments, with strict separation of roles between the teams involved in determining death and those performing the retrieval or transplant.

Consent and refusal to donate

In France, consent to organ donation is presumed unless explicitly refused, with the most reliable way to formalize this refusal being registration in the National Register of Refusals. The Maastricht III program, introduced in 2014 and expanded to cardiac retrieval by a decree in March 2026, allows for the retrieval of hearts from patients who have undergone a decision to limit or stop life-sustaining treatments.

Maastricht III retrieval process

The process of Maastricht III retrieval involves two distinct decisions: the medical decision to stop life-sustaining treatments, which must be made independently of organ donation, and the subsequent verification of the donor's will and organization of potential retrieval. Death is ascertained after five minutes of continuous circulatory arrest.

Heart preservation techniques

Two strategies are used to preserve the heart: rapid retrieval and evaluation on a normothermic perfusion machine or restoring limited circulation to the thorax and abdomen. These procedures require strict ethical, psychological, and cultural considerations, including ensuring no confusion between end-of-life care and organ donation.

Improving graft use

Improving the use of available hearts is another critical area. Some grafts are currently excluded due to uncertainty about their quality or function. Techniques such as ex situ perfusion machines can help preserve grafts and provide more accurate evaluations.

Limit and expanded criteria grafts

The use of "limit" or "expanded criteria" grafts, which deviate from traditional donor criteria, remains a challenge, as their acceptance must be balanced with the risk of graft failure. These grafts may come from older donors or those with certain medical conditions.

Xenotransplantation research

Xenotransplantation, involving the transplantation of organs from other species, has been explored in clinical trials, with two patients receiving genetically modified pig hearts in the United States. While these cases showed temporary success, long-term effectiveness remains unproven. Research in this area is ongoing.

Partial heart transplants

Partial heart transplantation, involving the transplantation of valves and part of the major vessels from a donor heart, has been used in children to allow growth of the transplanted tissue. This approach is limited to specific indications but may improve the use of donations.

Artificial intelligence in donation

Artificial intelligence is being explored for its potential to assist in identifying donors, assessing risk, and improving logistical planning, though its role must be carefully managed to avoid replacing human medical judgment.

Donor identification and opposition

Better identification of donors within hospitals is crucial. Effective organization must occur at multiple levels, including hospital, territorial, and national, to ensure efficient donor identification and retrieval. In 2025, the national rate of opposition to retrieval reached 37.1%, highlighting the need for public education and family discussions about donation.