At the Toulouse University Hospital, the long and unpredictable wait for future kidney transplant recipients

The hospital is suffering from lack of doctors, caregivers, resources, logistics. everywhere. Many activities are struggling to return to their pre-Covid-19 levels, greatly affecting patients. Last month, in a column published by the newspaper Le Parisien, doctors’ and patients’ associations warned of the “significant but endangered” situation of transplantation activity in France today.

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This is due to difficult access to the operating room, including kidney transplants from living donors, which are easier to program than transplants from deceased donors. In 2023, the University Hospital Center (CHU) of Toulouse thus performed 74 kidney transplants from a living donor out of a total of 201 kidney transplants, making it the leading center in France, well above the French average (with 37% of transplants). living donor compared to 16% nationally).

Better quality of life and savings for society

“This is one of our levers to reduce the waiting time for a kidney transplant, which is between 3 and 7 years depending on the patient. In Toulouse, we have 1,300 on the waiting list. Transplant kidneys allow better quality of life for patients. And great savings compared to dialysis which costs €80,000 per patient per year”, underlines Professor Naseem Qamar, Coordinator of the Department of Nephrology and Organ Transplantation at Toulouse University Hospital.

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“Financial incentives are significant to support the activity of transplants, which, together with all the organs, brought to the Toulouse University Hospital in 2023 4.150 million euros based on the 2022 activity. If the Toulouse University Hospital succeeds in reaching this 37% of transplants. Living donors, because That all the nephrologists in the Midi-Pyrénées are involved, advanced consultations take place in 7 peripheral hospitals, our coordination team is exceptional and the urologists of the CHU have invested a lot in innovation,” adds the expert. .

“Toulouse could be number 1 in Europe!”

Except that the good figures for 2023 stop and Professor Naseem Qamar, like his colleagues at the Francophone Society of Transplantation (SFT), of which he is a member of the board of directors, does not hesitate to condemn it. All call for protection of working time dedicated to transplantation activity from living donors. “Due to shortage of operating room nurses, nurse anesthetists, anesthesiologists, the operating time of urological surgeons (who undertake kidney transplant activity) is reduced and there is no priority for kidney transplants from living donors. For me, it is a priority. Lack of institutional political will. We should sit everyone around the table and see which specialty can give time. The implant should not compete with the knee prosthesis, cataracts or all the activities the patient can get elsewhere! Transplantation is our monopoly, we must. Consider it 100%. Of all the 48,000 interventions per year at Toulouse University Hospital, if we dedicate 40 to 50 dates – in addition to the 40 already listed in the urologist’s schedule – it is really epsilon. Because we have what it takes. To become a leading center in Europe”, assured Professor Naseem Qamar.

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“Patients whose file is ready have to wait for a year and go for dialysis”

With his calendar in front of him, he doesn’t lose his temper. “For the first six months of 2024, I have 24 dates. At best, we will do 50 transplants in 2024 but I have 80 files in progress as of March 21… Patients who have a donor, who are ready, will have to wait. A year, probably on dialysis, or 156 sessions of 4 hours. Associations are mad with anger and rightly so. Transplants from living donors are beyond everything we know in medicine, we are in an intimate relationship. What can we say? All these families stopped in the momentum of their generosity? Chronic kidney diseases will increase with aging, high blood pressure, diabetes and overweight. And also our waiting list “, concludes the expert.