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France is a country in Western Europe with a population of 6706 million in 2020 (1). This country has a universal health care system financed by a compulsory health insurance taxation on the basis of worker income, which refunds patients 70% of most health care costs and 100% for costly or long-term diseases, such as Chronic kidney disease (CKD). CKD affects nearly 3 million people, and the prevalence increases by 2% each year (1). Among them, 89,692 are treated by dialysis or received a kidney transplant. France has been a pioneer in transplantation, with the first living donor kidney transplant performed in 1952 (2). After two decades of transplants with living donors, the first bioethics laws were enacted in 1976, authorizing deceased donor procurement and instituting three rules for organ donation: ( 1 ) all adult residents are presumed to be consenting to donate except in case of expression of refusal during lifetime, ( 2 ) donation is anonymized, and ( 3 ) donation is free of charge. Since 2004, organ procurement is organized by the Biomedicine Agency, which is in charge of ensuring equity and safety of organ allocation and collecting donor characteristics, recipient characteristics, and follow-up through the French national database called CRISTAL. The national allocation system for deceased donors is made on the basis of a scoring system from the local and national levels and also, some national allocation priorities (Figure 1). Kidney transplantation is currently performed in 47 centers, mostly public university hospitals, of which 14 perform 60% of the transplants (3). Figure 1. French national allocation policy for kidney from deceased donors. Adapted from the (rules of allocation of organs from deceased donor), Agence de la biomedecine, 2015. The French allocation system for deceased donors is on the basis of a scoring system, from the local and national levels and also, some …