The debate over age limits for lung transplantation is a complex and ethically fraught issue, with experts weighing in on the matter at the International Society for Heart and Lung Transplantation (ISHLT) 46th Annual meeting and Scientific Sessions. The question of how old is too old for a lung transplant has been a long-standing dilemma, with the current upper age limit set at 70 years old. However, this limit is being challenged by some experts who argue that it fails to consider important factors such as biological age, comorbidities, and the capacity to benefit from the procedure.
Dr. Brian Keller, Assistant Professor of Medicine at Harvard Medical School and Medical Director of Lung Transplantation at Massachusetts General Hospital (MGH), defended the current age limit, citing the severe shortage of usable donor lungs and the need to prioritize younger patients who will likely survive longer and continue to be part of the workforce. He argued that older patients have pre-existing conditions and are at greater risk of developing cancer and cardiovascular disease as a result of their age, the transplant procedure, and immunosuppression therapy.
However, Dr. Thomas Egan, Professor of Surgery at UNC and one of the early pioneers of single and double lung transplants, countered that an arbitrary chronological cutoff fails to reflect biological age, comorbidities, and the capacity to benefit in terms of survival and quality of life. He cited recent research that demonstrates comparable outcomes for carefully selected older donor lung recipients, with no difference in three-year survival between recipients over 70 and those in their 50s and 60s.
Dr. Egan argued that the focus should shift to increasing the supply of donor organs, including the use of lungs and other organs from sudden death victims, assessed by ex vivo lung perfusion. He believes that by investing in technologies and protocols to evaluate and rehabilitate more lungs, we can increase the donor pool instead of shrinking the candidate pool by excluding older individuals.
Dr. Keller agreed, stating that the upper age limit argument becomes less important if we are able to grow lungs in a lab or utilize xenotransplant organs in the future. However, he also acknowledged the importance of considering quality of life and patient-reported outcomes, rather than just survival rates, in assessing the performance of transplant programs.
In my opinion, the debate over age limits for lung transplantation highlights the need for a more nuanced approach to organ allocation. While it is important to prioritize younger patients who will likely survive longer, we must also consider the biological age and comorbidities of older patients, as well as the potential for improving their quality of life. By focusing on increasing the supply of donor organs and utilizing innovative technologies, we can work towards a more equitable and effective system for organ allocation.
