More Elderly Patients Are Having Transplantation Surgery

By Robert Davis

Transplant surgeons are increasingly pushing age limits and putting organs into older and older bodies as the baby boomers seek, and demand, cutting-edge care.

“Twenty years ago, if you had asked me to transplant a 70- or 75-year-old with a kidney, I would have said no. Now we transplant people into their early 80s,” says Michael Shapiro, a transplant surgeon at Hackensack University Medical Center and vice chairman of the ethics committee for the United Network for Organ Sharing, which oversees the national system that matches organs.

“If you look at what has happened in all organs over the past 25 years, we have broadened our horizons,” Shapiro says.

The number of people 65 and older who have received organ transplants nearly tripled between 1996 and 2005, according to federal data, going from 1,145 to 3,154.

The dilemma, Shapiro says, is that doctors must now often decide whether to give a lifesaving organ to a person who has lived a full life or to a younger patient with potentially more life to live.

A study published Monday in the Journal of Thoracic and Cardiovascular Surgery presented one solution — giving older patients imperfect organs — that has been worked out by lung-transplant surgeons at the UCLA Medical Center in Los Angeles.

Their elderly patients had “acceptable” survival rates, according to the study. It found that 73.6% of their elderly lung recipients were alive three years after surgery, compared with 74.2% of younger patients. The study also points to changes that might raise elderly patient survival.

“This is the first report to suggest that the idea that younger patients do better than older patients may not be valid in 2008,” says Abbas Ardehali, one of the study authors and associate professor of cardiothoracic surgery and director of the UCLA Lung Transplant Program. “In the rest of medicine, we don’t discriminate due to age. In transplant, we have to because of the limited organ supply.”

The team reviewed medical records of 100 patients who received lung transplants between March 2000 and September 2006 as the percentage of elderly patients getting transplants rose at UCLA.

The study found that surgeons usually gave elderly patients one lung instead of two and that they transplanted less-than-perfect lungs into the elderly patients. The elderly patients consented to getting an organ that was often not considered good enough for a younger patient.

“We try to take organs we would not use in a younger patient,” Ardehali says. “That is how I can morally justify this to myself.”

The study found the largest difference in survival between the two age groups within the first year; the researchers say that appears to point to the need to change the drug regimen for older lung recipients.

Recipients get drugs that trick the body’s immune system into accepting the foreign tissue so that it does not attack the new organ. But the same drugs that help prevent organ rejection also make the body more vulnerable to other common invaders, such as infection-causing bacteria.

Older patients were more likely to succumb to the infections as doctors struck that delicate balance in the first year.

“This finding warrants adjustments in the immunosuppression protocols for older patients,” lead author Raja Mahidhara, an assistant professor of cardiothoracic surgery at UCLA, said in a statement. He says the increased infection rate among the elderly patients may be the result of the gradual deterioration of the immune system known as immunosenescence.

Ardehali says more studies and discussions need to follow “to make a reasonable decision as a society as a whole. With the aging population being in better shape and taking care of themselves, who am I to be a god and say you can’t live because I want another person to live?”

Shapiro agrees that if patients have “reasonable” survival rates, then society needs to decide how to proceed. “If these were organs that were going to go into the trash, then it seems like a win-win.” (c) Copyright 2005 USA TODAY, a division of Gannett Co. Inc.