Organ donation: the law favorable to families

Much ado about nothing, finally. The implementing decree for the organ donation law fell on August 25. It sets the framework within which doctors can proceed with the sample and the conditions under which families must be involved in this intervention. The text will certainly allay the fears raised during the filing of theTouraine amendment, Last year.

The affair had indeed caused a stir. To cope with the shortage of transplants, the legislation on organ harvesting had to evolve. The amendment tabled by the deputy Jean-Louis Touraine provided for no longer consulting bereaved families to ask them for authorization to take samples, but only to inform them of the nature of the samples – except for people registered on the National Register of Refusals. .

Families testify

The stated objective was to limit the refusals which do not have to be, whereas only 93,000 people are registered on this register and that in parallel, nearly nine in ten French people say they are in favor of organ donation. .

” In the majority of cases, [l’] opposition is expressed by a family which, for lack of information on the choice of the deceased, refuses, as a precaution, the removal of organs. The manifestation of this refusal is moreover often in contradiction with the text of the law: indeed, it is not the opinion of the family which is required by the law, but the fairest and most assured testimony. of the will of the deceased ”, specifies the amendment.

In the end, the decree will not change much to the current situation. Once clinical death has been established, the family will always be consulted during an interview. It will have to report the will of the deceased person, even if the latter has manifested it only orally. In the event of refusal, relatives must transcribe in writing the testimony of the deceased in a document signed, dated and provided with specific elements. So the doctors will not oppose this testimony and will not remove an organ.

“This is good news,” rejoices Dr. Jean-Marie Faroudja, president of the ethics and professional conduct section of the National Council of the Order of Physicians. This decree is in harmony with the feelings of the collectors ”. In fact, the Order had strongly opposed the Touraine amendment and had campaigned for the National Register of Refusals not to be the only source of expression of the refusal. “We have been listened to and this is important: we cannot take samples without consulting the family”.

Good practices

Has there been a backlash on the part of the health authorities, faced with the outcry caused by the Touraine amendment? “No, says Olivier Bastien, director of the organ-tissue transplant sampling section at the Biomedicine Agency. We remain in the continuity of the law and in the spirit of presumed consent. However, there had never been a decree implementing this law, which remains poorly understood and applied in a very variable way depending on the establishment ”.

The text thus establishes a framework and the best practices to be implemented, “which will make it possible to harmonize the situation” in the territory. In addition, in the event of family disagreement on the will of the deceased, “it will be the most precise testimony that will be retained”, specifies Olivier Bastien.

The frame was fixed very precisely. The interview with the families should preferably take place “during the day”, specifies the text, in order to allow time for relatives to become aware of the clinical death, often declared in the evening. “We wanted to stress the importance of temporality,” explains Olivier Bastien.

A dedicated room, “comfortable, equipped with means of communication with the outside” should be set up to accommodate these interviews. “Hospital coordination must accompany emotions, respect silences and promote a time of intimacy between relatives and the deceased”, further specifies the decree. After this visit to the deceased, the team should inform the families of the nature of the organs and tissues potentially removed.