Rethinking age: from chronological to physiological
Historically, arbitrary age cut-offs, like 70, were often used to exclude patients from organ transplant waiting lists. This approach is now widely considered outdated. Advances in medical technology and surgical techniques have shifted the focus from a patient's chronological age to their physiological or biological age. This means a robust, healthy 70-year-old can be a better candidate than a younger person with significant health complications.
Physiological age is determined by a battery of tests that assess overall organ function, cardiovascular health, mental acuity, and physical fitness. This holistic evaluation provides a more accurate picture of a patient's ability to tolerate the surgery and manage the necessary post-transplant care.
The evaluation process for older transplant candidates
The screening for older candidates is more rigorous than for younger patients to ensure the best possible outcome. While younger patients may need a standard evaluation, a senior candidate can expect additional scrutiny on key health indicators. The evaluation typically includes:
- Cardiac Assessment: Comprehensive heart studies, often including a cardiac catheterization, to ensure the cardiovascular system can handle the stress of surgery and lifelong immunosuppression.
- Frailty Measurements: Tests such as the six-minute walk test, sit-to-stand test, and grip strength measurement help gauge a candidate's physical resilience. Frailty has been shown to be a strong predictor of post-operative outcomes.
- Cognitive and Psychosocial Assessment: The transplant team evaluates cognitive function and psychosocial support to ensure the patient can adhere to a complex medication regimen and follow-up schedule.
- Comorbidity Review: A thorough review of existing conditions like cancer history, diabetes, or obesity to assess their impact on transplant success.
Organ-specific considerations for seniors
The viability of a transplant for a patient over 70 also depends on the specific organ needed and the patient's individual condition.
Kidney Transplants
Kidney transplantation is increasingly common among older adults. A growing number of recipients are over 65, and data shows that for carefully selected candidates, outcomes can be excellent, especially with a living donor.
- Expanded Donor Criteria: Older recipients are often willing to accept organs from older donors or those with extended criteria, which can shorten waiting times.
- Preemptive Transplants: Receiving a transplant before requiring dialysis is a protective factor linked to better outcomes in older patients.
Liver Transplants
For liver transplants, age has also become less of a barrier. Many centers now seriously consider patients in their early 70s based on physiological function. While long-term outcomes may be slightly lower than for younger recipients, the benefit gained from transplantation remains significant.
Heart Transplants
While data on heart transplants in older adults is limited, some studies suggest that highly selected recipients over 70 can achieve survival rates comparable to younger recipients, often receiving hearts from older donors.
Comparing transplantation to other treatment options
For seniors with end-stage organ disease, transplant is often compared to other options, such as long-term dialysis for kidney failure. While transplantation carries risks, many studies indicate that a successful transplant can significantly improve life expectancy and quality of life compared to being on dialysis. The decision requires a thorough, multi-disciplinary review of potential benefits versus risks.
Life after a transplant at 70
Successfully undergoing a transplant at 70 is only the first step. Long-term success relies heavily on patient adherence to the post-operative care plan, which includes lifelong immunosuppressive medications, regular check-ups, and a healthy lifestyle. Older recipients face a higher risk of complications from infection and cardiovascular issues, so vigilant management is crucial.
Living vs. deceased donors
For older candidates, securing a living donor can dramatically improve the chances of a successful and timely transplant. Living donation offers several advantages, including a shorter waiting time and a scheduled procedure, which can be critical for older patients. Many centers actively encourage seniors to explore this option.
The importance of finding the right center
Since each transplant center sets its own specific criteria, a patient may be considered ineligible at one center but accepted at another. It is crucial for older candidates to seek evaluations at multiple institutions. Connecting with resources like the Organ Procurement and Transplantation Network (OPTN) or United Network for Organ Sharing (UNOS) can provide valuable information on center-specific policies and help locate suitable options.
Conclusion: Age is just a number, physiology is key
In conclusion, the answer to Can you get a transplant at 70? is a definitive yes, provided the patient is in good physiological health. The emphasis has rightly moved away from chronological age and towards a comprehensive evaluation of overall health, functional status, and potential for a good quality of life post-transplant. With careful candidate selection and advances in medical care, a transplant can be a viable and life-extending option for many seniors.
Visit UNOS.org for more information on the transplant evaluation process.
