How Old Is Too Old for Organ Donation and Transplantation?

With no established age limit for organ or tissue donors, there is hope and a legacy opportunity for our older loved ones. Since 1988, 30% percent of deceased organ donors have been over 50 years of age.

Meanwhile, 62% of organ transplant recipients have been over age 50. Organ transplantation is now a realistic possibility for older loved ones with end-stage conditions, such as kidney disease.

How old are the oldest donors in the United States?

Statistics gathered by the United Network for Organ Sharing (UNOS) reveal that in 2021, one of every three deceased organ donors was over 50 years of age. In addition, the oldest donors were in their 90s.

In May 2021, Cecil F. Lockhart, a 95-year-old World War II veteran, and coal miner, died as an organ donor. His donated liver saved a 62-year-old woman.

Before Mr. Lockhart’s gift, the oldest donor in the United States was 92 years old. Then, just nine days short of his 93rd birthday, Carlton, a retired teacher in Texas, died of a brain hemorrhage. His family donated his liver, saving a 69-year-old woman with advanced liver disease.

In 2019, spreading a little neighborly love, an 84-year-old man became a living donor, providing a kidney to a 72-year-old woman living on his street. He saw a sign in her front yard stating that she was blood type O and needed a kidney, and he did not hesitate to offer his.

Since 1995, over 200 people, 70 years of age or older, have become living donors.

Federal rules control how organs are allocated, but transplant hospitals set their policies on who is on their transplant list and whether a transplant will proceed.

Older organs are harder to place, especially at transplant centers worried about strict federal rules linking Medicare participation to survival outcomes. Potentially lower scores based on older organs or recipients make some centers leery of accepting older organ donors.

Who gets organs from older donors?

Ira Copperman, a Member of the Medical Advisory Board for LiveOnNewYork (an Organ Procurement Organization), states that in 202 1the United States had a record year for organ donations with 41,400 organs being donated. Older donors made a substantial contribution to this record:

• 4,271 donors, or 30%, were at age 50 to 64
• 819 donors, or roughly 6%, were aged 65 and older

These figures do not include additional live donor gifts that are not recorded by UNOS.

Ira Copperman and Glenda Daggert, a husband-wife team serving as patient advocates and activists in the transplant community and former Board Members of the Transplant Support Organization for Westchester County of New York State, explain that “organs from older donors are usually offered to older transplant recipients on the national waiting list maintained by UNOS.”

Last year, UNOS proposed guidelines to offer the best kidneys to the youngest on the national waitlist. Copperman and Daggert strongly support these guidelines.

Daggert received a pancreas and kidney transplant from a deceased donor on June 23, 1999, after a long battle with Type I diabetes. Now over the age of 70 and diabetes-free, Daggert has lived with her transplant for 23 ½ years. Daggert states that if she requires re-transplantation, she will accept subpar organs from an older donor, stating that “it’s the right thing to do.”

Copperman points out that although organs from an older donor have wear and less longevity, older transplant recipients have shorter life expectancies.

He quickly adds that post-transplant medical care, surgical techniques, and pharmaceuticals are so advanced today that additional longevity for the recipient, even with an older organ, is likely.

“If you are 78 and have a year to live on dialysis with end-stage kidney disease, why would you not accept an older kidney, with a chance to live another few years or more without dialysis,” he asks.

Are there restrictions on older donors?

Health, not age, is the key to organ donation. Older donors are assessed for health and whether the organ to be donated is suitable for a potential recipient. If a donor does not have cardiovascular disease, metastasizing cancer, an actively spreading infection, or another major health condition, the organ will likely be accepted.

Corneas or tissue may be donated even with some disqualifying conditions.

Are limitations changing for transplant recipients?

In 2022, doctors are adding older people with end-stage heart disease, kidney disease, and liver disease to the national waitlist to receive organs, usually from older donors, says Copperman:

• Through September 30, 2022, a total of 12,297 potential transplant recipients aged 65 and older.
• 23,441 potential transplant recipients ages 50 to 64 were added.

People with diseases that used to disqualify them from transplantation are now able to get transplants.

• Hepatitis C is no longer an automatic disqualification.
• Cancer that is encapsulated or has not metastasized will not disqualify someone from receiving an organ.
• An HIV-positive individual may receive an organ from an HIV-positive donor.

These transplant recipients are more likely to receive an older, subpar organ compatible with their stage in life and comorbidities.

In addition, those over age 65 who receive second kidney transplants have outcomes similar to first-time transplant recipients of the same age. Their outcomes are better than older transplant candidates who remain on dialysis.

Implications for older loved ones

An older loved one on dialysis or with end-stage heart or lung disease, or a failing liver may be a transplant candidate. Copperman urges people to explore this option. You can “shop” for transplant centers once a physician recommends your older loved one for the national waitlist.

The Scientific Registry of Transplant Recipients keeps statistics on which transplant centers have the highest success rates for organs and recipients of various ages. It is a good place to start when looking for a center to accept an older loved one.

Can I go to a transplant center outside my city or state?

If the transplant center in your area does not accept transplant recipients in your age range, and you find another center that does in another state, you certainly can have your surgery there.

The most difficult follow-up issue in the first year, says Daggert, is regulating your medications. However, lab work can be done anywhere and sent to your physician at the transplant center for any adjustments in your medications. Zoom call appointments can be scheduled, with an annual visit back to the transplant center.

Does Medicare cover organ transplantation

Medicare covers organ transplantation. However, end-stage renal failure patients who underwent transplantation used to receive only 3 years of coverage for immunosuppressant medications. These medications are expensive and are required for life to suppress rejection.

New legislation taking effect January 1, 2023, makes immunosuppressant medications available without limitation.

Other post-transplant factors affecting the success

Copperman and Daggert are animate that many other qualitative factors affect the success of an organ transplant recipient.

They feel a supportive Care Partner is needed to maintain a low-stress, healthy lifestyle. A Care Partner can be a spouse, adult child, other relatives, or friend who becomes knowledgeable about the organ recipient’s daily medications, follow-up appointments, and issues that should be reported for early intervention.

A healthy diet, exercise, routine preventative care, and a low-stress lifestyle are all qualitative factors that increase an organ recipient’s longevity. Bad habits like smoking, excessive drinking, poor diet, or lack of exercise should be eliminated.

Can hospice patients donate organs?

If your loved one wishes to die at home or in a hospice setting, solid organ donation will not be possible due to logistics. Organs like the heart, kidney, lungs, and liver will be viable for a short time once blood and oxygen flow stop.

Tissue and eye donations may be an option in this situation if arrangements are made with a local Organ Procurement Organization to get your loved one to a facility that can harvest these donations within a few hours.

Statistics show organ donors and transplant recipients are getting older. Improved surgical techniques and post-transplant care, as well as new medications, make organ donation and transplantation a potential possibility for more of our older loved ones.

It is still important to advocate that transplantation be considered for your older loved one who may be too sick or whose physician may not even think of transplantation as a care option.