Safety of transplantation and satisfaction of needs: a crucial balance

In 1998, 3,033 organs were transplanted and 3,186 stem cell and 4,053 corne a grafts were performed in France. Organ shortage varies for each organ but is particularly critical for kidneys. Given the physiological and therapeu tic efficacy of grafting, an increase in organ procurement is likely to rai se safety problems. This paper concerns donor-transmitted infections, mainl y viral infections. Regulations on health risks express a social and cultural refusal to accept any hazard, This collective concern is however in opposition with the inte rests of individual patients mho are likely to accept a greater risk for an obvious benefit. Although the assessment of the risk/benefit ratio is clea rly different between organ and tissue transplantation, further thought nee ds to be given to the problem of acceptance of infectious risk in organ tra nsplantation. In France, special exceptions are now legally authorized for specific situations. Infectious agents transmitted by grafting have not been largely reported, m ainly because screening tests were not available. The number of transmitted infections is increasing with the expansion of transport facilities and wi th the various geographical origins of the population. In some cases, searc h for histocompatibility between relatives living in endemic areas introduc es new risks, for example tropical diseases. Diagnosis is often made by ser ological or molecular biological tests which mag be difficult to analyze de pending on their specificity.