From the Guidelines
There is no specific age limit for liver donors, as the decision to donate is based on overall health status rather than chronological age. According to the most recent guidelines from the European Association for the Study of the Liver (EASL) 1, a potential candidate for liver transplantation should not be disqualified based on age alone. The assessment of candidacy for liver transplantation in the elderly population should include cardiopulmonary, frailty-sarcopenia, and nutritional status, anatomical and surgical factors, as well as age- and risk factor-based screening for asymptomatic malignancies.
Some key points to consider when evaluating the suitability of a liver donor include:
- The donor's overall health status, including the presence of any comorbidities
- The donor's cardiopulmonary reserve and ability to withstand surgery
- The donor's nutritional status and presence of any malnutrition
- The donor's anatomical and surgical factors, such as the presence of any vascular disease
- The donor's age- and risk factor-based screening for asymptomatic malignancies
It's worth noting that while there is no specific age limit, older donors may have a higher risk of complications and decreased liver function, which can impact the success of the transplant. However, with careful selection and evaluation, older donors can still be considered for liver donation. As stated in the EASL guidelines, the definition of elderly has shifted over time, and more recent studies have focused on septuagenarians, showing comparable patient mortality and graft loss rates compared to younger patients 1.
In terms of specific age ranges, some studies have reported successful liver transplants from donors up to 70 years old or even older, although the long-term outcomes may be inferior in the elderly population 1. Ultimately, the decision to accept a liver donor is based on a comprehensive medical evaluation and assessment of the donor's suitability, rather than a specific age limit.
From the Research
Age Limit for Liver Donor
The age limit for a liver donor is a topic of ongoing research and debate. Several studies have investigated the impact of donor age on liver transplantation outcomes.
- Donor age older than 60 years: A study published in 2007 found that living donor liver transplantation (LDLT) can be safely performed in donors older than 60 years, with similar postoperative courses compared to younger donors 2.
- No upper age limit for donors: A 2019 review article stated that there is virtually no upper age limit for donors after brain death liver transplantation, but the selection, procurement, and matching of elderly donors require careful consideration 3.
- Living donor liver transplantation: Another study published in 2010 found that recipient age did not affect LDLT outcome when patients with a Model for End-Stage Liver Disease (MELD) score less than 20 received grafts from consanguineous donors, suggesting that the donor age limit is essentially guided by morbidity related to procurement 4.
- Donation after circulatory death: A 2018 study found that donor age at the cutoff of 60 years failed to stratify patient and graft survival in donation after circulatory death (DCD) liver transplantation, and that older DCD donors can be successfully used for liver transplantation with good long-term outcomes when further risk factors are limited 5.
- Use of very aged donors: A 2001 study found that donors over 70 years old can be used for liver transplantation, but great attention should be paid to the pathological conditions of arterial vessels caused by atherosclerosis, which might represent the source of severe complications 6.
Key Findings
- Donor age is not the only factor determining the outcome of liver transplantation.
- Careful selection, procurement, and matching of elderly donors are crucial to ensure good results.
- The use of older donors may require additional considerations, such as the presence of comorbidities and the risk of complications.
- The age limit for liver donors may vary depending on the specific context and the type of liver transplantation being performed.