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Saint-Denis-d'Oléron, France

Letur H.,Institute Mutualiste Montsouris | Merlet F.,Agence de la Biomedecine
Gynecologie Obstetrique Fertilite | Year: 2012

In France, medically assisted procreation (MAP) activities and gamete donation are strictly regulated by the bioethics law. The main ethical principles applied to the donation-no remuneration, anonymity, and the requirement for free and informed consent-aim to protect donors. In the same spirit, since MAP with oocytes donation is recognized as a healthcare activity, receiving couples benefit from exemption from co-payments by the health insurance system. Thus, it is widely accessible to couples presenting medical infertility requiring oocytes from a donor, but availability is insufficient to cover needs. This shortage in supply results in moving the demand abroad where this particular MAP is exercised at varying levels of supervision. © 2012 Elsevier Masson SAS. All rights reserved. Source

Antoine C.,Agence de la Biomedecine
Reanimation | Year: 2013

Extended-criteria donors are increasing due to aging of the donor population, changes in causes of death, and medical progresses in the field of transplantation, allowing to transplant grafts from older and/or with vascular co-morbidities donors. The use of grafts from such donors is evidence-based and beneficial for recipients with respect of certain conditions including maintenance of donors as well as evaluation of viability, conservation, and allocation of the organs. Scoring systems allow the detection of grafts at significant risk of failure, for which diagnostic tools will be developed in order to better assess their quality and function. This policy should lead to the implementation of all strategies to optimize graft function but also allow, when appropriate, the recognition of grafts that present the risk of poor or no functional status, to be discarded from transplantation. © SRLF et Springer-Verlag France 2012. Source

Royere D.,Agence de la Biomedecine
European Journal of Public Health | Year: 2016

Background: French state health insurance has funded trisomy 21 prenatal screening for all pregnant women since decades. First-trimester combined screening was introduced nationally and funded in 2010. Objective: To evaluate the impact of the introduction, of a national policy of prenatal trisomy 21 first-trimester screening on the reduction of invasive prenatal diagnostic procedures. Methods: The results of all prenatal trisomy 21 screening and invasive diagnostic procedures were collected for the whole country over the period 2009-12. The screen-positive rates (risk cut-off 1: 250, including isolated nuchal translucency ≥ 3.5 mm), positive predictive values and percentage of cases diagnosed prenatally were calculated. Results: Over the study period the number of women undergoing serum screening (including first- and second-trimester screening tests) increased from 678 803 to 689 651 (83 to 85% of deliveries, P < 0.0001). By 2012, first-trimester combined screening accounted for 70% of all trisomy 21 screening. The screen-positive rate decreased from 9.5 to 4.8% (P < 0.001) resulting in a 37 478 (47%) drop (P < 0.001) in the number of invasive diagnostic procedures. The positive predictive value of screening increased from 2.6 to 6.1% from 2009 to 2012 (P < 0.001), due to the higher positive predictive value of first-trimester over second-trimester screening (9.1 vs. 1.8% over the period 2010-12, P < 0.001). The percentage of prenatally diagnosed cases remained high at around 80% between 2010 and 2012. Conclusions: The policy shift from second-trimester to first-trimester trisomy 21 screening allowed to reduce the number of invasive tests. The number of antenatal trisomy 21 diagnoses increased (+2.7%) over the study period. © 2015 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. Source

Organ transplants are not accessible to everyone. Less than a third of the people on the waiting list are able to benefit from one each year in France. Donor organs are rare. Everyone who has expressed a wish to donate their organs should, unless there is a medical contraindication, have the reassurance that this wish will be fulfilled. It is the moral responsibility of everyone, particularly caregivers, to respect their commitment. © 2014 Elsevier Masson SAS. Source

Lafarge M.,University Paris Diderot | Thabut G.,University Paris Diderot | Le Pimpec-Barthes F.,Hopital Europeen Georges Pompidou | Maury J.-M.,Hopital Louis Pradel | And 4 more authors.
Journal of Heart and Lung Transplantation | Year: 2013

Background Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation (LTx). However, data concerning this approach remain limited. Methods We retrospectively reviewed the medical records of all patients in France who received ECMO as a bridge to LTx from 2007 to 2011. Post-transplant survival and associated factors were assessed by the Kaplan-Meier method and the Cox model. Results Included were 36 patients from 11 centers. Indications for LTx were cystic fibrosis (CF) in 20 (56%), pulmonary fibrosis (PF) in 11 (30%), and other diagnoses in 5 (14%). ECMO was venovenous for 27 patients (75%) and venoarterial for 9 (25%). Mean follow-up was 17 months. Bridging to LTx was achieved in 30 patients (83%); however, only 27 patients (75%) survived the LTx procedure, and 20 (56%) were discharged from hospital. From ECMO initiation, 2-year survival rates were 50.4% overall, 71.0% for CF patients, 27.3% for PF patients, and 20.0% for other patients (p < 0.001). From LTx, 2-year survival rates were 60.5% overall, 71.0% for CF patients, 42.9% for PF patients, and 33.0% for other patients (p = 0.04). Conclusions Our study confirms that the use of ECMO as a bridge to LTx in France could provide a medium-term survival benefit for LTx recipients with critical conditions. Survival differed by underlying respiratory disease. Larger studies are needed to further define the optimal use of ECMO. © 2013 International Society for Heart and Lung Transplantation. Source

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