Given the choice, most people on the kidney transplant wait list would choose an organ from a younger donor.
But in some cases, receiving a lifesaving kidney from an older donor — alive or deceased — may be better than having no donor at all.
This new thinking is being driven, in part, by the shortage of kidneys available for transplant.
According to the National Kidney Foundation, of the more than 121,000 people in the United States awaiting an organ transplant, about 100,000 are waiting for a new kidney.
New research shows that while a kidney from an older donor may not last as long as one from a younger person, kidneys from older donors can still work long enough to extend a person’s life and get them off dialysis — providing them with a better quality of life.
Older but still good
One such study, published in the Clinical Journal of the American Society of Nephrology (CJASN), found that kidneys from donors aged 50 to 79 years can function for years after transplantation.
Italian researchers looked at 647 cases where kidneys from deceased people were donated. The donors included people over 60 years of age and those between 50 and 59 years who had certain risk factors. These are known as “extended criteria” donors.
Five years after a transplant, survival rates, on average, for both the transplanted kidneys and recipients were similar for all age groups.
Between 88 and 90 percent of patients were alive after five years. Also, between 66 and 75 percent of the kidneys were still functioning after five years. Kidney function was similar for all age groups throughout the follow-up period.
However, when a single kidney from a donor over 80 years of age was transplanted, it did not function as long as when both kidneys were transplanted into the same recipient.
“According to these findings,” the authors write, “organs from extremely aged donors represent a resource that should be accurately evaluated.”
One of the biggest concerns about using kidneys from older donors is how well they will function after transplant.
All kidneys being considered for a transplant, though, routinely undergo a number of tests to make sure they will work properly, including special X-rays, blood tests, and biopsies.
This in-depth examination can identify kidneys that are not good candidates for transplant.
In this study, researchers found that many more kidneys from octogenarian donors were discarded before transplantation, compared to the other groups.
A viable option
A previous study by researchers at Johns Hopkins University supports the use of kidneys from donors over the age of 70.
In this case, researchers looked at 219 living people in the United States over age 70 who donated a kidney.
Kidneys from live donors over age 70 were more likely to fail within 10 years, compared with kidneys that came from live donors between 50 and 59 years of age. Recipient survival rates, though, were similar for both groups.
The researchers wrote that kidneys from older donors were comparable to kidneys from deceased donors aged 50 to 59.
With a kidney from an older living donor likely to last as long as one from a younger deceased donor, more people on the kidney wait list may find a kidney from an older donor a viable option.
According to the National Kidney Foundation, the average wait time for a kidney in the United States is three to five years, although it can be much longer in some parts of the country.
“Deciding to forgo live donor transplantation from an older donor might mean waiting several years for a deceased donor transplant,” the Johns Hopkins researchers wrote.