Life-saving kidney transplants now available for older patients

In the past, a patient 55 or older had little or no chance of receiving a life-saving kidney transplant. But improvements in medicine have many doctors re-evaluating older patients who need a new organ.

"Dialysis is so much better than it was 40 years ago that we are even seeing people in their 80s who are healthy enough for a transplant," said Dr. A. Osama Gaber, director of the Methodist J.C. Walter Jr. Transplant Center in Houston. "Nearly half of the people on the waiting list are over 55 and 20 percent are older than 65, so times are definitely changing."

Gaber says a mixture of a patient's organ function, strength and ability to handle the surgery, will and desire to live, psychological health and support system all play pivotal roles in determining if an older person is a good candidate.

"A 65-year-old person who lives in a long-term care facility would not be as good a potential candidate as an active 75-year-old who has people to help take care of him," Gaber said. "Patients with strong social support will be better able to tolerate post-op rehab and they would have people around them to make sure they take their medications and get the proper nutrition needed to recover."

Improvements in transplantation have also made it easier to care for older patients.

"Surgical techniques have improved tremendously and organ preservation has gotten much better, which enhances the chance of immediate organ function. This is critical in older patients," Gaber said. "The most important determinant of one-year survival is the post transplant kidney function once they leave the hospital. So we have to pick a good kidney that is able to give these patients a survival advantage."

Gaber says patients are evaluated more closely when they reach age 70. These patients are ideal candidates for living donation; unfortunately many are reluctant to ask younger family members to be a living donor. Their unwillingness to reach out alas increases their risk of dying or not getting transplanted.

"If we put a 77-year-old on the list and he is on there for four years, he might be a completely different patient at age 81 because of dialysis morbidity and possible deteriorating cardiac and/or lung function," Gaber said. "It's a very slippery slope, but the bottom line is if these patients are healthy enough to receive a transplant and everything is in place for them to survive afterwards, we will give them an opportunity."