Older Donors and Recipients Aid Transplants

With more older donors and transplant candidates, age-specific matching could boost transplants.

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We're all getting older, and that applies to organ donors and recipients as well. Demand for organs far exceeds supply. According to data from the national Organ Procurement and Transplantation Network (OPTN), more than 106,000 persons are now on the waiting list for an organ transplant. During the first 11 months of last year, slightly more than 26,000 transplants were performed in the U.S. People awaiting kidney transplants comprise 80 percent of the waiting list, while candidates for liver transplants make up 15 percent of the list. Other transplant needs include the pancreas, heart, lung, and intestine, plus multiple-organ transplants.

[See Best Affordable Places to Retire.] "The fastest growing part of our waiting list is older people," says Walter Graham, executive director of the United Network for Organ Sharing (UNOS), a Richmond, Va. nonprofit that operates OPTN under a federal government contract. At the end of 1989, only a few hundred of the roughly 15,750 people awaiting organ transplants -- about one in forty -- was 65 or older; 20 years later, more than 17,700 of the nearly 105,600-person waiting list -- one in six -- was at least 65 years old.

The donor side as well has grown older. In 1990, only 1 percent of donors were 65 years or older. This had risen to 5 percent in 2000 and stood at 7.8 percent in 2008. Likewise, donors aged 50 to 64 represented only 1.9 percent of donors in 1990, 5.1 percent in 2000, and 7.7 percent in 2008.

Partly as a result, Graham says, the development of age-matching of organ donors and recipients is under examination. Right now, the organ donation process is "age blind" except for a federal mandate that children receive priority as transplant recipients.

But in some cases, developing a specialized process for matching older donors and recipients could increase the pool of available organs and provide more transplants to older persons on the waiting list. That's because organs from older donors might be rejected for use in recipients of all ages, Graham explains, but would be acceptable for transplants into older recipients. Liver transplants are particularly suitable for such matching because liver function is sustained at older ages better than is the function of other organs. "The liver is a heartier organ," he says.

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Eurotransplant, which coordinates transplants in several European countries, introduced an "old for old" age-matching program more than 10 years ago. To date, it has successfully expanded transplant opportunities for older recipients. According to a 2003 analysis of early results from this program, published in the American Journal of Transplantation, age-matching expanded the pools of donors and recipients "without affecting patient and graft survival."

Generally, Graham says, people should not rule themselves out as either a donor or possible recipient because of their age. He knows of several cases where people in their 90s have been donors. Despite growing acceptance and promotion of organ donation, the need for more donors is a relentless reality. For example, Graham says more than half a million Americans currently are on kidney dialysis -- more than 30 times the number of kidney transplants in 2009.

While the number of potential donors has grown, the odds of a willing donor actually donating one or more organs when he or she dies is very small. Organs must be retrieved very quickly upon death, and usually transplanted soon after removal. The most favorable circumstance occurs when a person who has agreed to be a donor suffers brain death but their heart can be assisted to keep beating until their organs are removed.

Graham advises people who might wish to be organ donors to formalize their wishes. "If the family hasn't thought about it in advance," he says, "it's a very difficult issue to wrestle with" at the time of death. Increasingly, web-based state registries can be used to record legally binding preferences. Usually, such registries are linked to a state's department of motor vehicles.

[See 10 Trends in Longevity.]