Is there an age limit for a lung transplant?

The increase in patients over 70 years old on waiting list for a lung transplant has reopened one of the most complex debates in modern medicine: Should there be an age limit to receive an organ?

In the 46th Annual Meeting of the International Society of Heart and Lung Transplantation (ISHLT)held in Toronto, experts from the Harvard Medical School have exposed opposing positions on how to allocate increasingly scarce organs, in a context marked by the aging of the population and the advance of respiratory therapies.

Maintain the age limit due to risk of complications

Experts from Harvard Medical School (United States) debate within the framework of the 46th Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (ISHLT), the upper age limit for the lung transplantsespecially given the growing number of older people on the waiting list for lung transplants.

Brian Kellerassociate professor of Medicine at Harvard Medical School and medical director of lung transplantation at Massachusetts General Hospital (MGH), argued that the current upper age limit for being a lung transplant candidate should be maintained, even as a growing number of adults over 70 years old they undergo the procedure.

Until 2014, being over 65 years old was considered a contraindication for lung transplant. However, a 2021 update to the ISHLT guidelines on lung transplant eligibility raised the age limit to 70 years.

“At MGH, most recipients are between 60 and 70 years old, with a fairly significant number of people over 70 years old” says Keller. “We have more older candidates for lung transplants as a result of the aging population and advances in medical therapy for lung diseases that prolong survival and delay the need for a transplant.”

Organ allocation is a constant dilemma due to severe shortage of usable donor lungs compared to the number of patients on the waiting list. In 2023, 3,385 new adult candidates were added to the lung transplant waiting list, which represents an increase of 37.4% in the last decade.

According to Keller, many elderly transplant recipients have pre-existing conditions and are at higher risk of developing cancer and cardiovascular diseases due to their age, the transplant procedure, and immunosuppressive therapy. Still, Keller recognizes the distinction between chronological age and biological age.

On this issue he took a position Thomas Egan, professor of Surgery in the Division of Cardiothoracic Surgery at UNC. “There is 75 year old people who have a biological age of 60. And there are people in their 60s who look 75 or 80 and probably should not undergo a lung transplant.” As one of the pioneers of lung transplants, both single and double, made it clear that: “Establishing a strict age limit ignores this biological variability.”

Egan insists that recent research shows that outcomes in lung transplant recipients from carefully selected older donors are comparable to those of younger patients.

He cited a single-center study that found no differences in three-year survival between recipients over 70 years of age and those between 50 and 60 years of age. In another single-institution study with 1,025 patients, short-term outcomes in older patient groups were comparable or even superior to those in younger cohorts. However, lung transplant recipients from donors aged 65 years or older had poorer long-term survival.

According to Dr. Keller, however, the Survival rates after transplant are an important factor to considersince one- and three-year survival rates are used as an indicator to evaluate the performance of transplant programs.

In this way, the experts concluded that the final objective should be minimize deaths on waiting lists and ensure that organs go to candidates who will truly benefit, which is best achieved through individualized assessment, not age limits.

In Spainmore than chronological age, medical teams assess biological agethe general state of health, the absence of other serious diseases (comorbidities) and the fragility of the patient.