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Wednesday, June 27, 2012
Calls increase to lift age cap on organ recipients
OKAYAMA — Calls are growing to raise the upper age limit of recipients of organ transplants from brain-dead donors as elderly people make up a greater segment of society.
Since a landmark law was enacted in 1997 to facilitate organ transplants from brain-dead people, the opportunity for transplants has increased, improving the survival prospects of people facing the risk of organ failure due to intractable diseases.
However, elderly people have been denied this opportunity as there are age limits for who is allowed to join the transplant waiting list.
The caps are particularly strict for lung and heart transplants, while for other organs there are few age requirements. Patients hoping to receive a lung must be 59 or younger, while the age limit for people requiring two lungs is 54. The upper age limit for a heart transplant is also set at 59 years old.
The limits were determined by relevant academic medical societies.
Would-be transplant recipients undergo screening by hospitals and academic societies. They are registered on the waiting list of the Japan Organ Transplant Network if they are found to be suitable for a transplant and meet the age limit requirement when their application for a transplant is received by the relevant academic society.
The Japanese Respiratory Society and other academic societies introduced age limits in 1997, when the organ transplant law came into force, in light of U.S. and European data indicating relatively low survival rates for elderly transplant recipients.
The upper age limits were also intended to increase transplant opportunities for younger people.
When the law was amended in 2010 to ease restrictions on transplants from brain-dead people, such as abolishing the minimum age requirement for donors, the upper age limits for recipients were left intact.
The need for the upper age requirements has been called into question by a case in which a patient who joined the waiting list while younger than the limit underwent transplant surgery after crossing it.
There have also been agonizing cases. For example, in December a woman suffering from interstitial pneumonia who was about to turn 60 visited Okayama University Hospital in the hope of joining the waiting list for a lung transplant from a brain-dead donor.
Takahiro Oto, an associate professor at Okayama University who handled the case, had some reservations about giving the green light because the patient had only one month left before reaching the age limit. It takes at least three months to prepare the formal application for a transplant.
Oto sounded out the Japanese Respiratory Society about the possibility of giving the go-ahead, but the society stuck by the rule and rejected the application.
Oto recommended that the woman receive a transplant from a living donor, in this case a relative, for which there is no age limit requirement. Her oldest son and daughter offered to become donors.
Although the woman had qualms about her children's offer, she eventually accepted and underwent successful transplant surgery in February.
"I was lucky," said the woman, who believes the age limit requirement should be scrapped. "What's the difference between being 59 years and 11 months old and being 60 years and one month old?" she asked.
Oto has handled several cases in which a would-be recipient has died after being unable to join the transplant waiting list because of age or receive a transplant from relatives or other living donors.
To prevent such unfortunate cases, he proposes that people aged 60 or older be allowed to receive transplants from brain-dead donors when there are no suitable recipients among younger people.
Last August, the Japanese Circulation Society presented the health ministry with a proposal to raise the upper age limit for heart transplants from brain-dead donors to 64.
The proposal reflected the expectation that advances in medical technology will increase the survival rates of elderly people who receive organ transplants.
In other countries, an increasing number of elderly people are receiving lung transplants. According to the International Society for Heart & Lung Transplantation, people aged 60 or older accounted for around 25 percent of the total number of recipients in lung transplant cases in 2000 through the middle of 2010 and that the five-year survival rate for this age group was not much different from the rate for younger people.
The situation is similar when it comes to heart transplants.
A member of the lung transplant screening committee under the Japanese Respiratory Society conceded that the age limit requirement may have to be reviewed in the future. "The challenge will be how to ensure a fair allocation of organs," the panel member said.