It all starts in Saint-Denis, north of Paris, at the headquarters of the Biomedicine Agency.

"It is here that the distribution of grafts taken" from people in a state of brain death - about 1% of deaths - explains to AFP Géraldine Malaquin, head of the National Center for the Distribution of Grafts (PNRG). ).

This center first checks that the deceased, who must not present any contraindications to a transplant, had not registered during his lifetime in the national register of refusal of donations.

A medical team makes sure with his relatives that he was not opposed to the donation of his organs.

The distribution of the organs then begins.

It takes into account the urgency of the transplant, the biological and medical characteristics of the patient and the transport times to which the grafts will be subjected.

Some patients on the national waiting list have priority, such as children or recipients whose life is threatened in the very short term.

Currently, some 10,800 patients are actively waiting for a transplant.

That morning at the Agency, five organs of a 45-year-old woman were offered: "her heart and lung were taken for a recipient whose life was threatened in the short term", tells AFP Liliane Letaillandier, dispatch nurse, who takes turns with the members of the team so that the center is operational 24 hours a day, 7 days a week.

"The left lobe of his liver was accepted for a pediatric emergency, and the right for another recipient," she continues.

Thoracic surgeon Thomas Charrier of the Foch hospital in Suresnes looks at a monitoring screen as he removes the lungs of a deceased patient, on December 9, 2022, an organ intended for transplantation in a hospital in eastern France © Christophe ARCHAMBAULT / AFP

Objective: to reduce the time between the removal and the transplant as much as possible to optimize the chances of success of the operation.

The medical teams have a limited time to decide whether or not to accept the organs.

"Extreme Tension"

Edouard Sage, head of the thoracic surgery team at Foch Hospital (Hauts-de-Seine) is one of the lung transplant surgeons.

"When I get a call from the Biomedicine Agency, I see if I can accept the organ based on its known characteristics," he says.

If positive, he sends a team to where the dealer is.

Each organ is likely to be assigned to a patient who can be anywhere in France.

It remains to judge on the spot.

"When we arrive on site, we evaluate the graft, we have to touch it and see it ventilate to be sure that the conditions allow a transplant", says Thomas Charrier, 29, doctor in the Foch thoracic surgery department, specializing in the lung removal.

It is only when he gives the "go" to his manager on the phone that the transplant really begins.

The lung is removed.

Around the same time, sometimes hundreds of miles away, the recipient returns to the operating room to be put to sleep.

An organ transport cooler on a plane, December 9, 2022 © Christophe ARCHAMBAULT / AFP

"From the moment the sample has taken place, a race against time begins", describes Edouard Sage.

Depending on the organ, the urgency is more or less great (4 to 5 hours maximum for a heart, 6 to 8 for a lung, 12 to 18 for a liver, 18 to 24 for a kidney).

Once taken, the grafts are placed in airtight coolers where the temperature does not exceed 4°C.

Depending on the distance to be covered, the most efficient means of transport is used: ambulance, train, plane...

"To go faster, we call on a police escort, every minute is precious," says Thomas Charrier.

Most often, transplants take place at night, when all the teams can be mobilized and the operating theaters available.

Hours of "extreme tension".

But, says Thomas Charrier, "seeing the lungs that we removed reventilate, recolor, there is something magical about it".

© 2023 AFP