Hospitals reassess the age factor in evaluating candidates for kidney transplants

Robert Brown was healthy, willing and a good match: So why not give a kidney to his wife, who otherwise would need dialysis?

There was just one potential obstacle: Brown was 74, an age once unthinkable for a kidney donor.

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For this retired psychologist from Columbia, that wasn’t an issue. “I didn’t think about the age thing, not at all,” Brown said about his decision two years ago to offer a kidney to his wife, Sue. She was 71 at the time and ill with Fabry disease, a rare genetic disorder that can lead to a harmful buildup of fat in the kidneys.

For the Browns’ physicians, what counted was the couple’s physiological age — how healthy and strong both of them were — rather than their chronological age.

“We feel very strongly that healthy older adults should receive organ transplants and be considered as organ donors,” said Dorry Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine, whose colleagues operated on the Browns.

Many of the nation’s transplant centers agree, at least in part. More than half of them do not have upper age limits for kidney transplant recipients.

But physicians are conservative about living kidney donors: Nearly three-quarters of transplant centers have not accepted organs from people older than 70, according to Johns Hopkins research.

Caution makes sense because the long-term effects of kidney donation on older adults are unknown, Sameh Abul-Ezz, a professor of nephrology at the University of Arkansas for Medical Sciences, noted in a 2010 commentary in the journal Kidney International.

In 2011, 96 people age 65 and older served as living kidney donors in the United States, according to data from the United Network for Organ Sharing, which manages the nation’s transplant system. Between 1990 and 2010, 219 men and women between the ages of 70 and 84 donated kidneys, according to an article published in 2011 by Segev and colleagues.

Older kidneys

Most commonly, these seniors gave the organs to middle-aged and older adults whom they know well, unlike the system that distributes kidneys from deceased donors anonymously. The usual recipients were their children (37 percent), followed by their spouses or partners (35 percent), siblings (14 percent) and other relatives and friends.

Data about medical outcomes when using older kidneys, while relatively scarce, are encouraging. In his 2011 study, Segev found that 93 percent of patients who received kidneys from live donors 70 and older were alive one year after transplant surgery, and 74.5 percent survived five years. As for patients who got kidneys from live younger donors, 96 percent were alive at one year and 83 percent at five years, a result considered statistically equivalent.

A separate report from Sandip Kapur and colleagues from New-York-Presbyterian/Weill Cornell Medical Center found that kidneys from living donors age 60 and older were equally likely to be going strong after five years as those from younger donors. No differences were observed in results for a subset of donors 70 and older.