Heart transplants in France remain limited by donor shortages

Heart transplants save lives for patients with end-stage heart failure, but the number of available donor hearts is limited. In 2025, 421 heart transplants were performed in France, up slightly from 414 in 2024, but this is still far from meeting the demand, as 581 new patients were added to the waiting list that same year.

Donor heart sources in France

In France, donor hearts come from deceased individuals whose death has been properly certified. The two main situations are brain death, where all brain functions are permanently lost, and Maastricht III, which involves declaring death after a decision to stop life-sustaining treatments. Maastricht III is a newer approach in France.

Expanding donor sources with Maastricht III

Since 2014, France has had a program based on Maastricht III, and in 2026, it was expanded to include heart harvesting from these donors. This could increase the donor pool, as some hearts previously excluded might now be usable. Other countries have shown this method can boost transplant activity without compromising short-term outcomes, provided strict protocols are followed.

Public opposition and how to address it

In 2025, 37.1% of the public opposed heart harvesting. Reducing this rate requires respecting the deceased’s wishes, not just persuasion. Efforts include public education, school programs, family discussions, and training medical staff to communicate about death and donation effectively.

Improving donor heart utilization

Better identification of potential donors, reducing organizational losses, and more accurate evaluation of donor hearts are key. Some hearts are currently excluded not because they are unusable, but because their quality is hard to assess. Techniques like echocardiography and ex situ perfusion machines can help evaluate and preserve these hearts more effectively.

Xenotransplantation as a potential solution

Xenotransplantation, using animal organs in humans, is being explored, with genetically modified pig hearts showing promise. In 2022 and 2023, two patients at the University of Maryland Medical Center received pig hearts and survived for 60 and 40 days, respectively. While these cases were exceptions, they suggest that animal hearts may be viable in the short term.

Partial heart transplants for children

A different approach, partial heart transplantation, involves transplanting only valves and parts of large vessels from a donor, preserving the recipient's heart muscle. This helps children grow with their new tissues, avoiding the need for repeated surgeries. The first such transplant was performed at Duke University Hospital in 2022, with results published in 2025.

Artificial intelligence in heart transplantation

Artificial intelligence holds potential for improving heart transplant outcomes by predicting patient risks, evaluating donor-recipient compatibility, and anticipating complications. However, there is a risk that AI could be used to exclude patients or hearts based on flawed historical data, rather than supporting medical decisions.

Improving donor identification in hospitals

Hospitals are a key source of potential donor hearts, but not all are identified or evaluated effectively. A structured approach is needed, with dedicated teams in each hospital, regional support teams, and national oversight to ensure consistency and efficiency in donor identification and heart harvesting.