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Background: The routes of transmission of human herpes virus 8 (HHV-8) remain unclear. In particular, HHV-8 transmission by blood components and organ transplantation is still debated and raises public health issues. The objective of this study was to determine the prevalence of anti-HHV-8 in selected populations of persons or patients with or without risk factors for the transmission of viral infections, in order to determine the routes of HHV-8 transmission.Study Design and Methods: A total of 1431 persons or patients at low or high risk of sexually, blood-, or graft-transmitted viral infections were tested by means of a standardized immunofluorescence serologic assay detecting anti-HHV-8.Results: The persons or patients could be classified into three distinct groups according to anti-HHV-8 prevalence: a low prevalence group (0.0% to 5.0%), including healthy blood donors, healthy pregnant women, multiply transfused patients with thalassemia major, and IV drug users; an intermediate prevalence group (5.0% to 20.0%), including organ donors, kidney transplant recipients, and multiply transfused patients with sickle cell disease; a high prevalence group (>20.0%), including HIV-negative persons at high risk of sexually-transmitted viral infections, and HIV-infected homosexual men and heterosexuals.Conclusion: The sexual route appears to be the main route of HHV-8 transmission; bloodborne transmission of HHV-8, if it exists, is rare. In contrast, organ transplantation recipients might be exposed to HHV-8 transmission by the transplanted organ, which raises the issue of systematic screening of organ donors. [ABSTRACT FROM AUTHOR]

Organ transplantation recipients are exposed to the transmission of various viruses. Viral safety is based on careful selection of the grafts, based on both clinical criteria and systematic screening for the following markers: anti-human immunodeficiency virus antibodies and p24 antigen, anti human T-cell leukemia virus antibodies, anti-cytomegalovirus antibodies, anti-Epstein- Barr virus antibodies, HBs antigen, anti-HBs antibodies and anti-HBc antibodies, and anti-hepatitis C virus (HCV) antibodies. A residual risk of HCV transmission is theoretically associated with the "serological window" that can occur in an acutely infected patient before seroconversion, and that can last for up to 70 days. The objective of this study was to determine the value of HCV core antigen detection and of nucleic acid testing (NAT) to improve viral safety of organ grafts. We tested blood samples prospectively collected between may 1992 and may 2000 in 2000 consecutive organ donors from the Paris area for the presence of: i) HCV core antigen with a new enzyme immunoassay (Core Antigen ELISA Test System, Ortho-Clinical Diagnostics, Raritan, New Jersey), ii) HCV RNA using the Transcription-Mediated Amplification assay (Chiron Procleix[sup TM] TMA HIV-1/HCV Assay, Chiron). HCV core antigen positive results were confirmed by neutralization. Of 2000 samples tested, 5 were found to be positive for the HCV core on first determination, among which 4 were confirmed to be specific (prevalence 0.20%; 95% confidence interval: 0.10%-0.30%). These four donors were also anti-HCV antibody-positive. The donor with a nonspecific reaction was antibody-negative and HCV RNA negative in PCR. NAT preliminary results show that 1.2% of sample tested were reactive. In conclusion, the residual risk of HCV transmission by organ transplantation appears to be very small. HCV-infected patients are well identified by the detection of anti-HCV antibodies and implementation of HCV core antigen detection would increase the cost without clear benefit for viral safety. [ABSTRACT FROM AUTHOR]

Introduction: Despite an increase in the number of brain deaths over the past 10 years, France faces a shortage of organs for transplantation. A high percentage of families oppose organ donation. Over the past decade, the mean age of organ donors has risen by 10 years., Methods: Specific provisions of the public health code have regulated transplantation activity since 1994. Implementation of the Transplant Plan in 2000 led to the investment of substantial financial and human resources in this area. The data reported here come from the 2004 report of the French Transplantation Agency, now the Biomedicine Agency, and from its database., Results: Data for 2004 show more than 2500 listed donors, with at least one organ taken from 1291 and more than 4000 organ transplants. The donors' mean age was 47 years. Cerebrovascular diseases accounted for most of the deaths; traffic accidents, which have decreased substantially in recent years, caused only 16%. The number of people with brain death reported in France is difficult to measure but we estimate the figure to be 3500. Refusal rates remain high and are an obstacle to increasing transplants., Discussion: We need to appeal to live donors. We are also setting up pilot programs to use organs from non-heart-beating donors. With these new initiatives we hope to reach rates equal to those in Spain, the European leader in organ transplants.

This paper advocates the value of simulation to promote changes in kidney allocation. Due to the scarcity of organs and to the competition between transplantation centers to obtain the best organs for their patients, any change in organ allocation policy remains a sensitive issue in public health decision-making. Organ allocation is not easily available for prospective experimental study. Observational stud-ies only support limited changes. A simulation tool in this context permits the comparison of observed results against simulated ones. In our experience in France, it has shown to be a helpful tool during the allocation design phase providing objective facts for the debates and increasing the potential for change.

This study explored the access to the French national renal transplantation waiting list and the waiting time before transplantation for the patients with ESRD on dialysis living in the FOT. Overseas health authorities gave data on ESRD incidence and prevalence. Data on patients registered between 1997 and 2000 were extracted from the French national waiting list (390 patients from the FOT and 9378 from continental France). Registered prevalence of ESRD in FOT (726 to 1418 per million population (pmp)) were higher than continental France (580 pmp). The yearly incidence of registration on the national French waiting list was 36 pmp. The same figure was observed in the FAT (French Guyana and Caribbean's islands: 36.8 to 43 pmp), very low in New Caledonia and Tahiti (7.7 and 18.1 pmp), and very high in the Reunion Island, where a renal transplantation unit is available (77.5 pmp). Median waiting times before transplantation varied significantly, FAT: 35.4 months, Reunion Island: 9.9 months, Pacific Territories: 8.8 months and the Metropolitan territory: 12.2 months. After adjustment on risk factors known to be associated with the waiting times before transplantation, we still observed a longer waiting time for patients from FAT (RR = 1,4, p < 0.05) and a lower waiting time for patients from Reunion Island (RR = 0.6, p < 0.001) compared to waiting time observed in patients from continental France. Consequently, transplantation teams in FAT must be developed.

Objective: To identify factors to improve the identification of brain dead patients in intensive care units (ICUs)., Design and Setting: Prospective study conducted in 79 ICUs in 54 hospitals., Patients: All hospitalized patients with a Glasgow Coma Scale (GCS) score less than 8., Measurements and Results: During the study period hospital staff completed a form for each patient with a GCS less than 8. Hospital information units provided us with statistics from the discharge forms. The characteristics of the hospitals were also recorded. We included a total of 792 patients with a GCS less than 8; 120 of these patients were diagnosed as being clinically brain dead (15.1%). These patients accounted for 11.8% of the comatose patients in ICUs, 11.7% of the deaths occurring in ICUs, and 3.3% of the deaths that occurred in the hospital during the study period. Two multivariate linear regressions were performed to predict the number of clinically brain dead patients in the ICUs. The regression analyses included causes of death or causes of coma, and hospital characteristics. The presence of a coordination team and the number of transplant coordinators were positively associated with the number of brain dead patients in both models. The number of patients carried to the ICU by a mobile emergency unit was also positively associated in the model with causes of coma., Conclusions: Increasing the number of hospital coordinators and collaboration with mobile emergency units should lead to the identification of more brain dead patients among comatose patients in ICUs.

Organ and tissue procurement strongly increased during the past decades to become a common activity among accredited hospitals. Structuring efficient regional organ procurement organisations appear as an important goal in order to offer the relevant number and quality of transplants to the patients on the national waiting list maintained by the Etablissement français des Greffes. Two structures acting together coordinate organ and tissue procurement: (i)accredited hospitals allocate some medical and non medical personal interfacing; (ii) the Etablissement français des Greffes through one of its seven regional units or its national unit. These units are in charge with the operational responsibility of multiorgan and tissue retrieval co-ordination in their geographical area, with organ allocation and with an institutional role of local and regional organ procurement development and promotion.

Despite progress realised in transplantation and organ procurement, there is an increasing gap between the number of patients on the national waiting list and the number of harvested organs. As a result, the appropriate organs must be matched with the appropriate patient, with two constraints: equity and efficacy. In a context of lack of organs, another public health problematic is to conciliate both the interests of a given patient and the interests of those on the waiting lists. In 1996, the French secretary of state for health instituted a public consultation committee chaired by the vice-president of the Comité consultatif national d'éthique, Counsellor Jean Michaud, to study organ allocation rules and to plan recommendations for the future. Using, as a starting point, the allocation rules initiated in the past by France Transplant and transiently applied by l'Etablissement français des Greffes, the committee conducted a large audition of health care professionals concerned with transplantation, individuals qualified in ethics, laws, sociology or ethnology, politicians and a sample representation of the population. A new corpus of allocation rules and procedures was then defined according to the committee recommendations and the advice of all medico-surgical transplantation teams, and published as a ministerial order in the Journal officiel de la République française in november 1996. It specifies shared principles and organ by organ specific allocation rules.

Cytomegalovirus infections are transmitted among adults by transfusion of fresh blood. This benign infection is characterised by a single febrile syndrome that appears, on an average, 22 days after the transfusion and may last as long as 6 weeks. Hematological anomalies are significant: inversion of the leucocytic formula with high rate of mononucleosis, founded on the presence of hyperbasophilic mononuclear cells that appears about the 30th day, will be confirmed when the virus is isolated in mononuclear cells and in urine and by means of situation fo C. M. V. antibodies. Those post-transfusion C. M. V. infections are frequent after extra-corporeal circulation but only appear clinically in 1 p. cent of cases.