Organ allocation in pediatric transplantation in France.

In France, ministerial decrees in 1995 and 1996 gave children under 16 who are awaiting transplantation national priority for kidneys and livers from donors under 16, and regional priority for kidneys and livers from donors under 30. We analyzed the effects of these changes on waiting time, death on the waiting list, and balance between demand and supply. The percentage of children who received a transplant during the year of registration increased from 40% in 1993 to 67% in 1998 for kidney transplantation, but only from 50% to 67% for liver transplantation. The number of new children registered on the renal transplant waiting list (84 in 1998) and the number transplanted (85 in 1998) are balanced. But, because of the number of children still on the waiting list at the end of each year, there remains an imbalance of about 70 for kidney transplantation. For liver transplantation, there remains an imbalance of about 35. Death on the renal transplant waiting list has been below 2% since 1993. Death on the liver transplant waiting list decreased from 10-20% in 1993-1995 to 3% in 1998. The number of children who died on the thoracic organ waiting list in 1998 was the same as the number transplanted. In conclusion, the new rules governing organ allocation to children in France have shortened waiting time for renal transplantation, but not for liver transplantation. Many children still die on the waiting list for thoracic organ transplantation.