Extended donor age in cardiac transplantation

Approximately one third of brain-dead organ donors are above the age of 35 years. These donors have not been used routinely for heart transplantation because the risks of compromised early graft function and potentially accelerated graft atherosclerosis remained unclear. The increasing length of the waiting list and a 30% death rate of those on the waiting list for donor organs in our heart transplant program led to acceptance of donor hearts up to 54 years of age. Of a total number of 233 donor hearts, 74 were between 36 and 54 years old (group 2). These hearts were compared for early and chronic graft function with a group of 159 patients who received hearts from donors aged 1-35 years (group 1). All but three group 2 hearts were accepted without coronary angiography. Early postoperative graft function was sufficient in all 72 group 2 patients, whereas in group 1, early graft failure in nine (5.7%) patients led to death or required retransplantation. Forty-one patients in group 2 and 79 patients in group 1 were restudied at annual intervals between 1 and 4 years postoperatively by complete cardiac angiography. Mean late postoperative left and right ventricular ejection fractions were normal in both groups. Graft atherosclerosis was found in seven (8.9%) patients in group 1 and in four (9.8%) patients in group 2. Twenty-five (31%) patients in group 1 and seven (17%) patients in group 2 had compromised graft function (left and right ventricular ejection fractions <50%). Death from graft atherosclerosis occurred in four (5.1%) group 1 patients and in one (2.4%) group 2 patient. We conclude that donor hearts up to the sixth decade yield satisfactory early graft function. Chronic graft function is as good as in patients with younger donor hearts. Late complications from reduced ejection fraction and accelerated graft atherosclerosis seem not to occur more frequently in older donor hearts. Our data indicate that exclusion of older organ donors from heart donation is no longer justified.