2025 Update of Heart Transplant Landscape in France

BACKGROUND: This article reviews the current situation of heart transplantation in France with regard to donation, waitlist and transplant rates, as well as waitlist and posttransplant outcomes. METHODS: Donors, transplant candidates, and recipients' characteristics as well as candidate and recipient outcomes were obtained from the registry of the French national transplant agency. RESULTS: The number of brain-dead heart donors has declined during the past decade, although the use of hearts from high-risk donors has increased. In 2024, 38% of new candidates and 34% of recipients were in cardiogenic shock, requiring venoarterial extracorporeal membrane oxygenation or inotropic infusion. Despite a 1-y cumulative incidence of transplant of 72% between 2018 and 2024, the incidence rate of waitlist mortality reached 17.6 per 100 patient-years in 2024. In 2024, the transplant rate was 6.1 per million population. Geographic variations in registration and transplant rates were still present. The incidence of early graft dysfunction was 44% in 2024. The median posttransplant survival was 150 mo for patients transplanted between 2009 and 2012. Waitlist outcomes differed between children younger than 11 y and those aged 11 y and older, with better outcomes for older children. The median posttransplant survival in pediatrics was 222 mo. CONCLUSIONS: This report provides a comprehensive overview of the current status of heart transplantation in France based on information from the French national transplant registry. This situation is expected to evolve in 2026 with the coverage of the cost of perfusion machines and the implementation of heart procurement in donation after circulatory death donors.