Saturday, January 22, 2011

When Will Dick Cheney Be Too Old for a Heart Transplant?

The question of age affecting eligibility for an organ transplant arises frequently and this article addresses the issues physicians must consider when listing a candidate for a heart transplant.

By Katherine Hobson Wall Street Journal Health Blog

Former Vice President Dick Cheney said earlier this week, in an interview on the Today Show, that at some point he’ll have to make a decision about whether to seek a heart transplant.

Cheney has in the past experienced atrial fibrillation, an irregular rhythm of the upper chambers of the heart. And last summer he received a left ventricular assist device to help him regain function he’d lost due to congestive heart failure. LVADs are approved both as a stopgap measure for people waiting for a transplant and for those who don’t intend to seek a transplant.

To find out more about heart-transplant eligibility, we chatted with Jon Kobashigawa, director of the heart transplant program at the Cedars-Sinai Heart Institute. Kobashigawa, who isn’t involved in Cheney’s care, was one of the authors of the transplant guidelines developed by the International Society for Heart and Lung Transplantation.

Most of the guidelines deal with the clinical factors that make someone eligible for a transplant — normally end-stage heart failure with a high chance of death within a year. Potential recipients have poor scores on measures of heart-pumping efficiency and the ability to consume oxygen during an exercise session, for example.

But age is also a factor. The guidelines say that generally speaking, heart transplants are considered an option for eligible patients aged 70 and under. Cheney turns 70 on Jan. 30, but that doesn’t necessarily mean he has to make a decision in the next year, because the guidelines also say that “carefully selected” older patients may also be considered.

“Older patients in general can do as well as the younger patients at least in the short term,” says Kobashigawa, who wrote the section of the guidelines pertaining to age. But over time, obviously, they are more likely than young ones to experience other diseases that may kill them, he says.

There are more patients requiring heart transplants than there are donors, and some people do die while awaiting a donor organ. So the committees at transplant centers that decide how to allocate organs have to consider the ethics of taking, say, a 26-year-old’s heart and implanting it into someone who is not likely to live for another two decades rather than someone with a much longer life expectancy, Kobashigawa says.

One way to manage the ethical issue is through the “use of an alternate list or strategy where organs from donors (usually older donors) that would otherwise remain unused are allocated to older recipients,” the guidelines say.

At Cedars-Sinai, the oldest patient was a 77-year-old, says Kobashigawa. (There’s no lower bound; infants can have heart transplants, he says.)

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