[Access to origins for persons conceived by donation in France]. / L'accès aux origines pour les personnes conçues par don en France.

It was a strong and long-standing demand of people born of gamete donation: to know who is the person who allowed them to come into the world. The French legislator seemed to take this need into account during the last revision of the bioethics law. But if the rules have already changed for donors, for whom anonymity becomes fixed-term, for individuals born from a donation, access to their origins is far from being guaranteed to this day.

[Epidemiological profile and analysis of predictive factors of organ donation refusal in the Moroccan population]. / Profil épidémiologique et analyse des facteurs prédictifs du refus du don d'organe chez la population marocaine.

Organ donation is influenced by several factors. A better understanding of the reasons for organ donation refusal would allow an increase in the number of donors. The objective of our study is to assess the knowledge and position of the general Moroccan population considering organ donation and to determine the factors that influence their positions. In this study, socio-demographic data, knowledge and attitude towards organ donation and reasons for refusing organ donation were collected from 677 Moroccan participants. Although only 1% of participants are enrolled in the donor registry, our survey showed that 64.7% of participants are in favor of organ donation. The level of education, the socio-professional category, the marital status, the ethnic origin and the medical coverage are the socio-demographic factors most discriminating concerning the will to donate organs or not. The binary logistic regression made it possible to identify the factors that prevent organ donation, namely the problem of confidence in the health system, personal and religious reasons but also the lack of valid reasons. Thus, a better knowledge of the legislation in force and of the position of the Islamic religion as well as the establishment of training and information programs through advertising campaigns will promote organ donation. LEVEL OF EVIDENCE: 3.

[Legal aspects of medically assisted reproduction in France]. / Aspects juridiques de l'assistance médicale à la procréation en France.

Determined in 1994, the legal framework for medically assisted reproduction has barely evolved since. French legislation is among the strictest in Europe. Sweeping changes are planned for the next review of the law on bioethics which should be put to a vote in 2020. The current ban on surrogacy should however remain in place.

Fertility and Pregnancy in Turner Syndrome.

Turner syndrome (TS) occurs in one in 2500 live female births and is one of the most common chromosomal abnormalities in women. Pregnancies in women with TS, conceived with either autologous or donated oocytes, are considered high risk because of the associated miscarriages and life-threatening cardiovascular complications (aortic dissection, severe hypertension). Therefore, it is imperative to conduct a full preconception evaluation and counselling that includes cardiac assessment with Holter blood pressure monitoring, echocardiography, and thoracic MRI. Abnormal findings, such an aortic dilatation, mandate close monitoring throughout the pregnancy and the immediate postpartum period and could possibly contraindicate pregnancy. When in vitro fertilization using donated oocytes is performed in these women, only a single embryo should be transferred. Women with a Turner mosaic karyotype appear to have a lower risk of obstetrical and cardiovascular complications but should nevertheless undergo the full preconception evaluation. In this article, we offer guidelines on the management of women with TS in the preconception period, during pregnancy, and postpartum.

[Factors influencing the choice of nondonor families in a French organ-harvesting center]. / Analyse des raisons motivant le refus du don d'organes par les familles de patients en état de mort encéphalique dans un centre régional de prélèvement.

OBJECTIVES: Report the reasons that lead families to refuse organ donation during their close solicitation by hospital coordination. MATERIAL AND METHODS: A retrospective study was conducted between 2012 and 2015, including 148 (34%) refusal of organ donation among 426 patients identified in a state of brain death. A questionnaire of the family was completed for each interview. Collected data concerned patient characteristics, cause of death, description of the interview and reasons for refusal. A descriptive statistical analysis was performed. RESULTS: The median age of patients was 50 years with a sex ratio of 1.4 men to 1 woman. The most common reason for non-donor family was the desire to maintain the integrity of the body of the patient (28%) followed by a religious order pattern (11%), brutality and suddenness of death (9%), the denial of death (6%) and early age of the donor (5%). In 39% of cases, the family said that the donor had expressed a written or oral refusal in his lifetime. CONCLUSION: A better understanding of the reasons leading to the refusal of non-donor family could provide assistance to the medical team on actions to general public with the aim to reduce the refusal rate. LEVEL OF EVIDENCE: 4.

[Towards the development of living donor kidney transplantation]. / Vers un développement des greffes de rein à partir de donneurs vivants.

Living donor kidney transplantation has been increasing since 2008. Living donors represent a significant potential for organ transplants, in a context where the needs outstrip the availability of organs from deceased donors. However, patients are still poorly informed regarding the conditions in which these transplants are possible.

[Draw me a donation, ethical reflection with children in pediatrics]. / Dessine-moi un don, réflexion éthique avec les enfants de pédiatrie.

An organ and tissue removal coordination department organised a drawing competition for the children in the paediatric unit, on the theme: "Donation, passing on the baton". This ethical reflection combining respect for the children, interaction with the parents and multi-disciplinary collaboration provided an opportunity for exchanges on the topic of organ donation and encouraged a different approach on the part of the medical team.

[Family refusal of organ donation: a retrospective study in a French organ procurement center]. / Opposition des familles aux dons d'organes: analyse rétrospective des causes de refus dans un centre régional de prélèvement.

OBJECTIVES: In France, organ donation refusal rates approach 32% of eligible brain deaths. Outright family refusal represents the primary barrier reason for declining organ donation. This retrospective study evaluated factors influencing this decision. MATERIAL AND METHODS: A retrospective chart review at Lille Hospital, France, was conducted on brain-death patients eligible for organ donation between 2010 and 2011. Data were collected regarding patient characteristics, death conditions and reasons for refusal based upon family interview. Descriptive statistic analyses were conducted to identify circumstances associated with family refusal. RESULTS: Of 227 eligible organ donors identified, 70 families (30.8%) refused organ donation. The most frequent reason for refusal was desire to keep the body's wholeness (46.3%), followed by religion (16.4%), mistrust of the medical community (13.4%), and revolt against society (6%). The most common causes of death associated with refusal were brutality and suddenness of death (44.8%), early age (23.9%), denial of death (17.9%), and the family culpability (11.9%). In 30% of cases, the family followed the deceased's wishes before his death. CONCLUSION: Family refusal remains a significant factor associated with the approximately one third of declined eligible organ donations. This retrospective analysis suggested that the most important cause for refusal was a desire to keep the body's wholeness, and the brutality and suddenness of the potential donor's death. Additional research addressing these factors, and their underlying causes, paired with measures to improve professional training and public awareness are warranted to improve organ donation rates.

[Impact of donor parity on oocyte donation outcomes]. / Impact de la parité des donneuses sur les résultats du don d'ovocytes.

OBJECTIVES: Since 2015, in France, men and women who have never procreated are allowed to donate their gametes. This has led to an increase in the number of female oocyte donors, whereas there are many couples waiting for gametes that have a long waiting time. The aim of this study is to compare the results of donation with oocytes from nulliparous and non-nulliparous donors. METHODS: Monocentric retrospective observational study (Lille University Hospital) between January 1st, 2016 and December 31st, 2019. Phenotypic characteristics and clinical and biological outcomes of oocytes donations were compared according to donor parity (nulliparous versus primiparous or multiparous). RESULTS: One hundred and eighty-five donors (66 nulliparous and 119 non-nulliparous) were included in the study, allowing 284 ICSI cycles to be performed in recipient couples. On average, 11.5 oocytes were obtained per donation cycle, of which 7.8 were mature. In total, 4.6 mature oocytes were obtained per attempt and per recipient couple. Nulliparous donors are younger than non-nulliparous ones. An early pregnancy was obtained in 55.6% of the nulliparous donors and in 50.8% of the non-nulliparous donors (P=0.55). A progressive pregnancy was obtained in 49.2% of the nulliparous women and in 42.1% of the non-nulliparous women (P=0.36). There was therefore no difference in terms of early pregnancy and ongoing pregnancy whether the donation came from a nulliparous or non-nulliparous woman. CONCLUSION: Donor parity does not seem to have an impact on the success of oocyte donation attempts.

[Becoming requesting couples after their registration in oocyte donation]. / Devenir des couples demandeurs après leur inscription en don d'ovocytes.

OBJECTIVES: Many studies have investigated the causes of discontinuation during intraconjugal medically assisted procreation. However, there are currently very few data justifying the causes of discontinuation during the oocyte donation program. The main objective of this study is to determine the causes of discontinuation in oocyte donation and their respective frequency, excluding live births by oocyte donation in our center. METHODS: This is an observational, retrospective, single-center study focused on receiving or requesting couples who stopped their oocyte donation program between January 1, 2005 and April 29, 2021. A total of 390 couples were included in the study. RESULTS: Of the 390 couples included, 306 couples or nearly 80%, left our oocyte donation program without obtaining a live birth through this method. The three most frequent reasons for discontinuation were: failure of several oocyte donations (18%), desire of the couples to voluntarily discontinue their care (15%) and separation (14%). Finally, 84 couples obtained at least one live birth by oocyte donation in our center. In addition, 38 women conceived spontaneously and 33 couples benefited from an oocyte donation abroad. CONCLUSIONS: The most common reason for discontinuation in oocyte donation program, excluding live births by oocyte donation in our center, is failure after several oocyte donations. However, 40% of the couples in the study obtained at least one live birth.

[The impact of oocyte cryopreservation time in oocyte donation on the clinical success rate]. / Impact de la durée de cryoconservation ovocytaire dans le cadre du don d'ovocytes sur le taux de succès clinique.

OBJECTIVES: To evaluate the impact of the cryopreservation time of vitrified oocytes on the success rates in oocyte donation cycles. METHODS: A retrospective study was carried out on 156 cycles with donated oocytes from January 2012 to September 2021. All the cycles were sorted according to the storage time of the oocytes (25 in the group 1:<3 months, 32 in the group 2: between 3 and 6 months, 39 in the group 3: between 6 and 12 months, 38 in the group 4: between 12 and 24 months and 22 in the group 5:>24 months). Clinical outcomes after ART, survival rates at thawing and oocyte fertilization rates were compared between the different cohorts stratified according to oocyte storage duration. A binary multivariate logistic regression was performed adjusting for the identified confounders. RESULTS: Prolonged storage time of vitrified oocytes had an effect on their survival post-thawing rates, but no significant effect was identified on fertilization rates or clinical outcomes. After adjusting for the confounders, the relationships between clinical outcomes and oocytes storage time did not reach statistical significance. Our study was characterized by a limited cohort with data from a single ART center. CONCLUSIONS: Our study doesn't highlight any significant difference in the use of long-stored vitrified oocytes (more than 2 years) on clinical issues in ART. The conclusion of our study needs to be verified in further studies with larger cohorts.

[Diagnosis of encephalic death and donor resuscitation for harvesting purposes]. / Diagnostic de mort encéphalique et réanimation du donneur en vue de prélèvements.

Encephalic death is a rare and unique pathophysiological process. Its diagnosis and management in the intensive care unit, which are well codified, determine the possibility and short- and long-term outcome of organ and tissue transplants.

[Interviewing relatives with a view to organ donation from a deceased person]. / Entretien avec les proches en vue du don d'organes d'une personne décédée.

Talking to a deceased patient's next of kin about organ donation is a sensitive, emotionally-charged collective practice. It must be prepared and organized by the coordination and resuscitation team. The quality of the support and follow-up offered to the deceased's family and friends remains essential.

[Ethical issues surrounding the donation process and support for loved ones]. / Questionnement éthique autour du processus de don et de l'accompagnement des proches.

In France, since the 1970s and the so-called Cavaillet law, has the body of a deceased person been treated as a possible object of public health, and his or her organs as public property? It is first and foremost at the heart of intimate social relations and singular suffering.

[Organ donation is not a gift]. / Le don d'organes n'est pas un don.

If the obligation to donate as defined by French law ("we are all donors") remains in the wake of sociologist Marcel Mauss's Essai sur le don (Essay on donation), there the similarity ends. How do you make a counter-donation to a deceased person? In the case of inter vivos organ donation, the act is more akin to mutualization than donation.

[Legal provisions governing organ and tissue donation in France]. / Dispositions juridiques relatives au don d'organes et de tissus en France.

As an expression of the general will, the law makes organ removal and transplantation a lawful activity. The legislator makes them conditional on the primacy of the person, the inviolability of the body and the need for consent.

[Preliminary study on the experience of egg donors at the CHRU in Tours: Key features for future research]. / Étude préliminaire sur le vécu des donneuses d'ovocytes au CHRU de Tours : des éléments clés identifiés pour de futures recherches.

OBJECTIVES: This exploratory survey aims to identify the obstacles to egg donation (ED), based on the donors' experience. Despite 30 years of practice and awareness-raising campaigns, ED in France suffers from a shortage of female donors due to a lack of knowledge of this donation (Agence de la biomédecine, 2017). METHOD: Qualitative study by semi-directive interviews conducted between January and August 2018 at the CHRU in Tours with 15 egg donors in the postoperative period. RESULTS: The donation generated a sense of pride and personal accomplishment among the donors, in contrast to the lack of recognition of their actions by professionals and their entourage. Physical commitment does not seem to be a barrier to donation. The organisational and logistical constraints were identified as one of the main obstacles, while 70% of the interviewees stressed the benevolence of the practitioners. Finally, the donation opened up questions for them on female fertility, maternity and the role of gender norms in gamete donation. CONCLUSION: The survey reveals the technical dimension of ED imposed by the biomedical system deplored by donors, and highlights the need to recognize their actions. Physical engagement is not a major obstacle, unlike organizational and relational aspects. This study opens up an important field of investigation, which should be explored in particular in the perspective of a French bioethical reform of ED.

[The limits of a principlist approach in the ethics of donation of elements and products of the human body. About some examples]. / Les limites d'une approche principiste dans l'éthique du don d'éléments et produits du corps humain. À propos d'exemples.

Voluntary, non-remunerated donations are fundamental principles with anonymity regarding donations of elements and products of the human body in France. Blood donation was a model to organize donation of organs, hematopoietic stem cell or gamete. These principles, which at first glance appear to be intangible, commonly accepted and transposable between the different types of donation, though reveal singularities regarding to a collective imagination, a biological reality, evolution of society, medicine and science. Through the study of these different principles applied to donated human body parts, this article aims to highlight the ethical limitations of a single principlist approach. The notions of anonymity, consent, voluntariness, non for profit, under their universal aknowledge, reveal variability of interpretation and scope due to the heterogeneous characteristics, implications and purposes between these donations of different elements and the uses made of them.

[Decision-making in the context of organ donation]. / La décision en matière de don d'organe.

The medical decision regarding organ removal is an act which the law tends to reduce and subject to a simple legal process. The complexity and extreme sensitivity of the human principles, values and sentiments at play do not warrant this simplification. The decision-making process involves several parties and respects the temporality of the families.

[The anticipated organ donation approach]. / La démarche anticipée de don d'organe.

The anticipated organ donation approach aims to increase access to donor organs in France. It concerns patients with neurological injuries in a serious condition, for whom there are no treatment options, but who could be suitable for organ procurement if their condition were to evolve towards brain death. This approach requires meticulous preparation, fulfilment of the required conditions and close support for the family.