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J Thorac Cardiovasc Surg 2001;121:434-435
© 2001 The American Association for Thoracic Surgery

Editorials

Ethical implications of heart transplantation in elderly patients

From the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, Calif.

Received for publication Nov 21, 2000. Accepted for publication Nov 29, 2000. For related article, see p. 532.

The results of cardiac transplantation in patients over 69 years of age reported by Blanche and associates demonstrate that short-term survival can be achieved in a very select, small group of such patients. As the authors have stated, the statistical comparison of this small group of older patients to younger recipients is problematic because the selection process was not uniform for both groups of patients. These data do not justify the elimination of older age as a selection criterion for cardiac transplantation, because most reports identify increased recipient age as a risk factor for post-transplantation mortality. Expanding the upper age limit will result in a further distortion of the current recipient demand/donor supply dilemma and will produce an increased mortality for all patients awaiting cardiac transplantation. The article by Blanche's group does raise many important moral, ethical, and practical issues related to the treatment of patients with end-stage heart disease.

The concept of an alternative list for older patients seems rational but in turn introduces many theoretical and practical concerns. Use of marginal donor hearts for high-risk recipients seems likely to result in reduced recipient survivals both in the immediate post-transplantation period and in the long term. The actuarial survival for . . . [Full Text of this Article]

Related Article

Heart transplantation in patients seventy years of age and older: A comparative analysis of outcome

Carlos Blanche, Dominique A. Blanche, Brenda Kearney, Meenu Sandhu, Lawrence S. C. Czer, Andreas Kamlot, Ann Hickey, and Alfredo Trento
J. Thorac. Cardiovasc. Surg. 2001 121: 532-541. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				Y. S. Tjang, G. J.M.G. van der Heijden, G. Tenderich, R. Korfer, and D. E. Grobbee Impact of Recipient's Age on Heart Transplantation Outcome Ann. Thorac. Surg., June 1, 2008; 85(6): 2051 - 2055. [Abstract] [Full Text] [PDF]

				P. Demers, S. Moffatt, P. E. Oyer, S. A. Hunt, B. A. Reitz, and R. C. Robbins Long-term results of heart transplantation in patients older than 60 years J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 224 - 231. [Abstract] [Full Text] [PDF]