Alexandre Loupy, MD PhD Necker Hospital Head of team at National institute of Medical research (Inserm)

French More Likely to Transplant Kidneys from Older, Sicker Patients Interview with:

Alexandre Loupy, MD PhD Necker Hospital Head of team at National institute of Medical research (Inserm)

Prof. Loupy

Alexandre Loupy, MD PhD
Nephrologist, Department of Nephrology & Kidney Transplantation
Necker Hospital, Paris
Head of the Paris Transplant Group (Inserm) What is the background for this study?

Response: The lack of organs for kidney transplantation is a major public health problem across the world, due to its attributable mortality and excess cost to healthcare systems while waitlisted patients are maintained on chronic dialysis. Nearly 5,000 people in the US and 3,500 people in Europe die each year while waiting for a kidney transplant. Yet in the US, over 3,500 donated kidneys are discarded annually, representing almost 18% of the available organs, while the discard rate in France is only 6,8%, though these countries have similar organ allocation systems and offer the same treatments to patients after transplant.

We thus compared the use of donated kidneys in the US to France from 2004-2014 in much more depth, using a new approach based on validated analytic methods and computer simulation. What are the main findings?

Response: The main finding is that French transplant centers are far more likely to transplant donated kidneys from older kidney donors or donors with comorbidities, compared to their US counterparts. What should readers take away from your report?

Response: By redesigning their kidney allocation system and including organs from older donors or donors with comorbidities, US transplantation specialists could provide major health benefits to thousands of American patients suffering from kidney failure. Thousands more discarded kidneys would be transplanted annually, which would also benefit the US healthcare system through the tremendous savings that results from taking patients off costly dialysis.

The average age of kidney donors in the US (39-year-old) did not change over the 10 years of study, which was quite surprising because the US transplant waiting list is 95,000 patients long and we know that many patients on the US waiting list are elderly and would certainly benefit from a kidney transplant from a donor of the same age group. This feeling was reinforced by the fact that the average age of kidney donors in France is 56 years. What recommendations do you have for future research as a result of this work?

Response: Chronic kidney disease is a major and growing public health problem, with 10% of the world population (up to 15% in the United States) affected. It is the 12th most frequent cause of death, with 1.1 million deaths per year worldwide. There is thus still a lot of research to be done. The current research focuses on how to get more transplants. We expect the next breakthroughs to come around helping transplants to last longer by preventing rejection and customizing precise treatments that match each patient’s biological profile. Is there anything else you would like to add?

Response: This analysis builds on the long-standing tradition of utilizing international comparisons to identify best practices for treating patients with chronic conditions. We would like to emphasize the fact that international collaborations are key to improve clinical practice and tackle complex issues for the benefit of patients and the whole society.

We are optimistic that US centers are going to adapt. Our study adds to work by several other groups, such as the National Kidney Foundation, pleading for more emphasis on getting transplants done and not discarding kidneys that can bring the exceptional benefits of transplantation to more patients.


Aubert O, Reese PP, Audry B, et al. Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance. JAMA Intern Med. Published online August 26, 2019. doi:10.1001/jamainternmed.2019.2322

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Last Updated on August 26, 2019 by Marie Benz MD FAAD