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.
For this retired psychologist from Columbia, Md., that wasn't an issue. "I didn't think about the age thing, not at all," Brown said of 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 each was — 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.
Where their organs go
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), 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.
A case for expansion?
These and other good results "argue for the expansion of older living-donor transplantation because this may represent an important solution to the organ shortage," Kapur and his colleagues concluded.
But other transplant experts such as Abul-Ezz are less hopeful, citing evidence raising red flags.
In one analysis of 12 studies, patients who received kidneys from older living donors were less likely to be alive five years after than patients transplanted with kidneys from younger donors. Also, organs that came from older living donors were more likely to fail during this time period than those from younger donors.
While short- and intermediate-term outcomes for older kidney donors are generally positive— Segev's study found that nearly 96 percent of living donors 70 and older survived five years after surgery — some experts worry that older donors might experience potentially harmful, age-related declines in the functioning of their remaining kidney. Long-term research examining this question has not been done.
Then there is the reality that surgery can present additional risks for older patients; this requires physicians to be especially careful about whom they deem fit to undergo transplant procedures.
Almost half of the 871,000 Americans with advanced kidney disease are older than 65, and rates of chronic kidney disease in this age group more than doubled between 2000 and 2008, according to the National Institutes of Health.