Best Possible Use of a Donor Organ: Is There a Need for Age Matching in Heart Transplant Allocation?

Abstract

<h3>Purpose</h3> The rate of heart transplantation (HTx) in adults, particularly in patients 65 years and older is rapidly increasing, 40% in the last five years. The purpose of this study is to characterize the donors used by older adults and investigate the effect of donor age on post-transplant survival for different age recipients. <h3>Methods</h3> The United Network for Organ Sharing (UNOS) database was used to identify HTx recipients ≥18yo from 1987 to 2020. Recipients were divided into four groups [18-49, 50-59, 60-64, and ≥65 years old (yo)]. Corresponding donors were divided into three groups (12-24, 25-39, ≥40yo). Post-transplant benefit was compared between combinations of recipient and donor age groups. <h3>Results</h3> 66,201 heart transplant recipients were identified. Recipient age groups: 18-49yo (34%, n=22,341), 50-59yo (35%, n=23,358), 60-64yo (18%, n=11,999), ≥65yo (13%, n=8,503). ≥65yo recipients were 13% of all transplants, utilized 10% of 12-24yo donors, 12% of 25-39yo donors and 17% of ≥40yo donors. Younger donor age provided greater benefit for younger recipients [<b>Figure</b>]. The improvement in median post-transplant survival (years) from using a 12-24yo donor instead of a ≥40yo donor was greatest in the 18-49yo recipient group (3yr benefit) compared to the ≥65yo recipient group (1yr benefit): 18-49yo recipients [13.8yrs (95% CI:13.3-14.2) with 12-24yo donors to 10.9yrs (10.4-11.4) with ≥40yo donors] vs. ≥65yo recipients [10.3yrs (9.8-10.0) with 12-24yo donors to 9.0yrs (8.5-9.6) with ≥40yo donors]. <h3>Conclusion</h3> There is a disproportionate (3x) benefit in median survival by using a younger donor heart (12-24yo) in younger recipients (18-49yo) compared to ≥65yo recipients. The potential gain in number of total post-transplant years by an age-specific organ allocation should be considered in this supply-constrained climate of transplant "economics".