ABSTRACT
Abdominal Organ Transplantation in the Older Person: (by Antonio di Carlo, MD and Sunil Karhadkar, MD) Antonio di Carlo, MD, Professor and Chief, abdominal organ transplantation, Lewis Katz School of Medicine, Temple University, along with Associate Professor Sunil Karhadkar, MD, cover the important issues in the transplantation of kidneys and livers into older persons. In North America there are no unified criteria for transplanting older patients for any organ. Of all the potential abdominal organs that can be transplanted, the kidney is the one that older patients need most. There have been anecdotal reports of kidney transplantation in octogenarians, with the oldest patient in personal experience being 85 years old. Pancreas and intestinal transplantation is usually limited to recipients younger than 60 to 65 and liver transplantation to those below 70 years. When being considered for an organ transplant, older patients frequently encounter discrimination and selection bias. Organ transplantation for end-stage disease is limited by a global shortage of organs. Allocation of scarce organs to older recipients raises ethical questions. The living donor option is discussed. In comparison to staying on dialysis, there is data to suggest that the life expectancy of an older patient is better with a kidney transplant. Rigorous evaluation must be undertaken prior to surgery to assess survivability, as well as immunosuppression tolerance.
