The economics of heart transplant hinges on an inadequate supply, forcing doctors to decide the best candidates for each new heart based on factors such as age and overall health.
A paper published in the Journal of the American Geriatrics Society by a research team led by Dr. Abhishek Jaiswal, a transplant cardiologist at the Hartford HealthCare Heart & Vascular Institute, is setting that equation on end with the revelation that patients age 70 and older who receive a heart transplant fare as well as younger patients.
“It was very surprising, but logical if you think about it,” Dr. Jaiswal said, noting that older donors received transplants from older patients. “This should help eliminate selection bias based on age.”
The researchers examined the records of 37,135 patients who received heart transplants between 2000 and 2018. Of these, 2.2 percent were age 70 or older. The team compared general health and outcomes for all patients, further contrasting those for older and younger recipients.
The five-year survival rate of the over-70 group, when adjusted for relevant recipient and donor characteristics, showed no significant difference.
Besides improving the chances older patients will receive a heart transplant, the research could also potentially increase in the number of hearts being donated as older people once considered high-risk and unable to donate will be considered, Dr. Jaiswal noted.
“This can result in a good utilization of donor organs,” he said.
Until he conducted his research, mining the United Network of Organ Sharing database, he said there was no scientific reason to deny a donor heart to older patients in need of a heart transplant. But the increased risk of success and potential lifespan were always factors in multidisciplinary meetings held to determine who would get the donation.
Less than 10 percent of people needing a heart transplant will get one, Dr. Jaiswal said. At the same time, less than 50 percent of the organs offered for donation will be accepted for a variety of reasons.
After examining the data, Dr. Jaiswal and his research team came to three conclusions:
- There are only a limited number of people age 70 and older who receive heart transplants, even though the majority of people with heart failure fall into that age category.
- The older transplant recipients had the same survival rates as younger recipients, most likely because they were “highly selected.”
- Older people tend to get transplanted hearts from older donors.
“The selection criteria varies from (transplant) center to center, but age should not by a ‘yes’ or ‘no’ when determining if an individual is eligible,” Dr. Jaiswal said.
The heart transplant team at Hartford Hospital routinely brings older patients forward for transplant consideration.
“You should never take away people’s chances. I think things will update with this research so there will not be systematic approval of patients because of age,” he said.
He said centers should see the research as encouragement to try transplant in more people, revising their philosophy and change their practices.
For more information about heart transplant at Hartford HealthCare, click here.