Patients 65 years of age and older represent 22% of our heart transplant population. The donor criteria used for transplant patients between 65 and 69.9 years of age were similar to those used for younger patients. Although it can be argued that older patients are utilizing a limited resource of donor hearts at a time when there is an increased demand for organs, we believe that the indications for heart transplantation are constantly evolving, particularly the recipients' upper age limit. Further, to deny these patients the benefits of transplantation solely on the basis of age seems very controversial. However, patients 70 years of age and older are placed on an "alternative" list to avoid taking the scarce donor organs away from younger patients. This involves the use of organs deemed unsuitable by other transplant centers because of the donor's weight, lack of an available recipient for their blood type, or high-risk donors with potentially compromised organs. To date, 6 carefully selected patients aged 70 to 77 years have undergone heart transplantation, with a morbidity comparable with that in younger patients and excellent short-term survival and quality of life.
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