Age should not be a factor in determining heart transplantation eligibility

Older patients can take heart in new transplantation study

Policy makers who use age as a discriminating factor in determining eligibility for heart transplant surgery may want to reconsider their rules in the light of new research at the University of Alberta. Published in the Journal of Cardiac Surgery, the study shows that older heart transplant recipients fare just as well as their younger counterparts, even many years after surgery.

The study involved all 275 adult patients who received a heart transplant at the University of Alberta Hospital between 1990 and 2000. The researchers documented morbidity and mortality rates for up to 11 years after surgery and found no statistically significant differences between the 50 heart transplant recipients who were older than 60 when they received their new heart and the 225 recipients who were younger than 60. “There are many factors involved in determining who is and who isn’t an appropriate candidate for a heart transplant, but this study clearly shows that age should not be one of those factors,” said Dr. Shaohua Wang, an attending surgeon and clinical professor of cardiac surgery at the U of A and the lead author of the study.

Wang said patients who are at the end stages of heart failure and do not have any contraindications will generally be placed on a heart transplant waiting list. Some common contraindications include a smoking habit, a drug or alcohol addiction, excess weight, or a mental disease, Wang said.

However, Wang added that more than half of all institutions that currently offer heart transplants in North America consider age a contraindication and will not perform the surgery on patients who are 65 and older. “But our research shows age should not be considered a contraindication,” Wang said. “I wouldn’t say that you can’t be too old [to receive a heart transplantation], but, based on these results, I would say that if you meet all the criteria [to go on a waiting list], age shouldn’t prevent you from a getting a new heart that would save your life.”

Wang added that not only is a good, older heart transplant candidate just as good as a good, younger candidate, but a good, older donated heart is just as good as a good, younger heart.

The University of Alberta Hospital in Edmonton, Alberta performs the most heart transplantations in Canada each year, Wang said, adding that in 1999 doctors at the U of A Hospital performed a heart transplantation on a 79 year-old man. The patient is the oldest person ever to receive a heart transplant, and he remains in good health today. “We are very aggressive,” Wang said. “We don’t give up easily, and yet we still have one of the best success rates in the world.”

According to the Canadian Institute for Health Information, 375 Canadians died between 1993 and 2003 while on the waiting list for a donated heart. The Scientific Registry of Transplant Recipients says 494 people died while on the waiting list for a new heart in the U.S. in 2004 alone. “It’s always the case that there are more people on the waiting lists than there are available organs because of a shortage of donors,” Wang said. “We hope our research will help others see how they can save more patients, young and old.”