Abstract
What role should age play in the allocation of organs for transplantation? Historically, older patients have not been listed as candidates for transplantation on the assumption that greater benefit could be obtained by favoring younger candidates, raising questions of equity and age discrimination. At the same time, organs offered for donation by the very old are frequently rejected because of concerns about length of viability. We examine a local case that challenges these practices: the liver from an elderly donor was successfully transplanted into an older patient. After exploring some of the potential problems with such a solution, we propose creating a second pool of organs from the very old for transplantation into older candidates, thus expanding the number of organs available, saving additional lives, and including the elderly more visibly in our transplant system.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bilbao, I., Balsells, J., Lazaro, J.L., Charco, R., Murio, E., Gifre, E., Ruiz, C., Edo, A., and Margarit, C. (1995) Liver Transplantation in Patients Over 60 Years of Age. Transplantation Proceedings 27(4), 2337–2338.
Devlin, J., and O’Grady, J. (1999) Indications for Referral and Assessment in Adult Liver Transplantation: A Clinical Guideline. Gut 45(suppl VI), V11–V122.
Emre, S., Mor, E., Schwartz, M.E., Katz, E., Acarli, K., Fukuzawa, K., and Miller, C.M. (1993) Liver Transplantation in Patients Beyond Age 60. Transplantation Proceedings 25(1), 1075–1076.
Evans, R.W. (1991) Advanced Medical Technology and Elderly People. In R.H. Binstock, and S.G. Post (Eds.), Too Old for Health Care?(pp. 44–74). Baltimore and London: The John Hopkins University Press.
Langone, A.J., and Helderman, H.H. (2003) Disparity Between Organ Supply and Demand. New England Journal of Medicine349(7), 704–706.
Levy, M.F., Somasundar, P.S., Jennings, L.W., Jung, G.J., Molmenti, E.P., Fasola, C.G., Goldstein, Gonwa, R.M., Klintmalm, T.A., and Goran, B. (2001) The Elderly Liver Transplant Recipient: A Call for Caution. Annals of Surgery233(1), 107–113.
Patel, J., and Kobashigawa, J.A. (2004) Cardiac Transplantation: The Alternate List and Expansion of the Donor Pool. Current Opinion in Cardiology 19(2), 162–165.
Port, F., Bragg-Gresham, J.L., Metzger, R.A., Dykstra, D.M., Gillespie, B.W., Young, E., Delmonico, F.L., Wynn, J.J., Merion, R.M., Wolfe, R.A., and Held, P.J. (2002) Donor Characteristics Associated with Reduced Graft Survival: An Approach to Expanding the Pool of Kidney Donors. Transplantation74(9), 1281–1286.
Rosengard, B.R., Feng, S., Alfrey, E.J., Zaroff, J.G., Emond, J.C., Henry, M.L., Garrity, E.R., Roberts, J.P., Wynn, J.J., Metzger, R.A., Freeman, R.B., Port, F.K., Merion, R.M., Love, R.B., Busuttil, R.W., and Delmonico, F.L. (2002) Report of the Crystal City Meeting to Maximize the Use of Organs Recovered from the Cadaver Donor. American Journal of Transplantation 2, 701–711.
Sheehy, E., Conrad, S.L., Brigham, L.E., Luskin, R., Weber, P., Eakin, M., Schkade, L., and Hunsicker, L. (2003) Estimating the Number of Potential Organ Donors in the United States. New England Journal of Medicine 349(7), 667–674.
Shaw, B.W. (1994) Transplantation in the Elderly Patient. Surgical Clinics of North America74(2), 389–400.
Stratta, R.J., Rohr, M.S., Sundberg, A.K., Armstrong, G., Hairston, G., Hartmann, E., Farney, A.C., Roskopf, J., Iskandar, S.S., and Adams, P.L. (2004) Increased Kidney Transplantation Utilizing Expanded Criteria Deceased Organ Donors with Results Comparable to Standard Criteria Donor Transplant. Annals of Surgery 239(5), 688–697.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hackler, C., Hester, D.M. Age and the Allocation of Organs for Transplantation: A Case Study. Health Care Anal 13, 129–136 (2005). https://doi.org/10.1007/s10728-005-4476-x
Issue Date:
DOI: https://doi.org/10.1007/s10728-005-4476-x