Jan. 29, 2013 -
Robert Brown was healthy, willing and a good
match: So why not give a kidney to his wife, who
otherwise would need dialysis?
But Brown was 74, an age once unthinkable for
a kidney donor.
For this retired psychologist from Columbia,
that wasn't an issue. "I didn't think about the
age thing, not at all," Brown said, describing
his decision two years ago to offer a kidney to
his wife, Sue, then 71 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 both of them were - rather than their
"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
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
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;
altogether, 1,382 older adults have done so
since 1988, 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. Most commonly, these
seniors gave the organs to middle-aged and older
adults that they know well, unlike the system
that distributes kidneys from deceased donors
anonymously. The usual recipients were their
children (37 percent), followed by their 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 study last year, 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
A separate report from Sandip Kapur and
colleagues at NewYork-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.
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
Who's Fit For Surgery?
But other transplant experts such as Abul-Ezz
are less sanguine, citing evidence that raises
In one analysis of 12 clinical studies,
patients who received kidneys from older living
donors were less likely to be alive five years
after the operation 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 who they deem fit to undergo
"Evaluating patients in their 70s [for
receiving or donating a kidney ] is one of the
most difficult things we have do to. Fifteen
years ago, we wouldn't have even seen these
patients," said Dr. Gabriel Danovitch, medical
director for the kidney and pancreas program at
Ronald Reagan UCLA Medical Center.
Highlighting risks that older adults face,
Danovitch said he often tells medical students
about an Army veteran in his 70s with severe
kidney disease who hated being on dialysis and
pushed for a transplant. "He had struggled all
his life and always beaten the odds, and he did
superbly well for two weeks after the
operation," the doctor said. But then, a small
abdominal sac known as a diverticulum ruptured,
and the patient went into septic shock.
Despite the man's eventual recovery, "he was
never the same, and I've often asked myself if
we did him a favor," Danovitch said. "I'm not so
There's no question about the burgeoning need
for kidneys. 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
There are two options for patients with
advanced kidney disease: a transplant or
dialysis. With a transplant, the risk of death
from severe disease is cut by about half,
compared with patients who depend on dialysis,
and quality of life is significantly improved,
according to 2003 research.
Adults 50 and older now represent 64 percent
of 94,374 people waiting for kidneys. Only a
portion of people with end-stage kidney disease
meet medical criteria for transplants and are
considered healthy enough to undergo these
procedures, said Dr. Leslie Spry, a spokesman
for the National Kidney Foundation.
Waits are lengthening because so-called
cadaveric kidneys remain a scarce resource.
Median wait times for patients 50 to 64 years
old are 1,573 days (4.3 years) while those for
patients 65 and older are 1,454 days (3.98
years), according to the data from the national
Organ Procurement and Transplantation Network,
operated by UNOS. In some parts of the
country, it can take six to eight years for
someone to rise to the top of transplant lists,
according to transplant surgeons.
The harsh reality is that more than half of
kidney transplant candidates over the age of 60
will die before receiving an organ from a
deceased donor, researchers estimate.
That is why such experts as Kapur, Segev and
Mikel Prieto, surgical director of the kidney
and pancreas transplant program at the Mayo
Clinic in Rochester, Minn., are trying to
broaden the pool of potential living donors to
include adults in their 60s and 70s.
Studies indicate that 10 to 20 percent of
seniors who need a transplant would find living
donors, many of them among people of their own
age, if they looked, Segev said. But many
doctors don’t believe this is a reasonable
option, and many patients don’t believe they
could be good candidates.
Although older kidney donors haven’t been
studied extensively, a handful of reports
suggest that this surgery is safe and
complications are relatively uncommon when
donors are carefully selected.
"It's very common that patients in their 70s
want to donate. It's less common that they are
fit to donate," said Prieto. Anyone with a
history of heart disease, stroke, diabetes,
cancer, cognitive impairment and several other
conditions common in older people are excluded
from donation. Often, a host of minor medical
issues that might seem insignificant
individually will also disqualify a prospective
elderly organ donor, he noted.
'A Good Decision'
Like Robert Brown and his wife, Shirley Hall
and her brother-in-law Hilding "Joe" Johansson
did not see age as an impediment to transplant
surgery. Hall, who divides her time between
Howard, S.D., and Apache Junction, Ariz., is 75.
Johansson, of Sioux Falls, S.D., is 71.
Johansson has polycystic kidney disease, and
over 15 years he had two operations to remove
growths on his kidneys.
After donating a kidney to Johansson at the
Mayo Clinic last fall, Hall felt "a little bit
of pain" but not enough to take the medication
doctors ordered. Several months later, she said,
"I'm feeling great." Johansson said he has a lot
more energy and is looking forward to traveling
and bow hunting in the year ahead.
After his September 2010, surgery at Johns
Hopkins, Robert Brown developed an infection at
an abdominal incision made to remove his kidney.
But it responded to topical treatments, and
several weeks later he began exercising again.
Sue Brown's post-transplant medication
regimen made her "unbalanced" and "lightheaded"
and it had to be adjusted over the course of
several months, but looking back over the
experience, she said she was convinced it was a
"We're taking great care of each other, and I
appreciate that," she reflected, noting that
their 50th wedding anniversary is coming up this
year. "For one thing, I know he loves me and
enjoys being with me and doesn't want to get rid