Monday, October 31, 2011

Never Too Old to Donate?

Updated 3/2017-- all links removed as many no longer active.

I happened to see this press release from American Society of Nephrology via Eurekalert regarding an article in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN) advocating the safety of kidney donation in individuals over 70 years old.  The press release does note that kidneys from these elderly donors do not last as long as those from younger living donors.
Currently, as noted on the University of Maryland Medical Center website:
Donors need to be between the ages of 18 and early 70s and can include parents, children, siblings, other relatives, and friends. An ideal donor should have a genuine interest in donating and a compatible blood type with the recipient.
Donors should be in good general health. Donors do not need to be genetically related. Typically, someone who has cancer, diabetes, kidney disease, heart disease, liver disease, sickle cell disease, HIV or hepatitis will not qualify to be a donor. However, these diseases are not all absolute contraindications to donation. Every donor will be considered on an individual basis.
Many individuals over 70 years of age are ineligible simply due to chronic illnesses.   This recent article (full reference below) is a result of a study done by John Hopkins University School of Medicine. 
Jonathan Berger, MD, Dorry Segev, MD, PhD , and their colleagues studied 219 healthy adults over the age of 70 years who donated kidneys and compared them with healthy elderly individuals who were not organ donors.  The surgeries were done at 80 of the 279 transplant centers in the United States.
The researchers found that among recipients of older live donor allografts, graft loss was significantly higher than matched 50-to 59-year-old live donor allografts (subhazard ratio [SHR] 1.62, 95% confidence interval [CI] 1.16 to 2.28, P = 0.005) but similar to matched nonextended criteria 50-to 59-year-old deceased donor allografts (SHR 1.19, 95% CI 0.87 to 1.63, P = 0.3).
Mortality among living kidney donors aged ≥70 was no higher than healthy matched controls drawn from the NHANES-III cohort.
I don’t have full access to the article (only the abstract).  I wonder how old the oldest donor was (ie 72? or 82?).  I wonder if the risk is different for the 70-75 age group vs the 75-80 age group.

Living Donors Online: FAQ (kidney donation)

Living Kidney Donors Ages 70 and Older: Recipient and Donor; Jonathan C. Berger, Abimereki D. Muzaale, Nathan James, Mohammed Hoque, Jacqueline M. Garonzik Wang, Robert A. Montgomery, Allan B. Massie, Erin C. Hall, and Dorry L. Segev;  Outcomes CJASN October 27, 2011 CJN.04160511; published ahead of print October 27, 2011, doi:10.2215/CJN.04160511 (full article is not open access)

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