Use of older donors for lung transplantation-you can't get there from here.

The expansion of inclusion criteria and relaxation of the age limit for lung transplantation have resulted in substantial growth of the transplant waiting list. Even with an increase in overall organ donation rates, lung donations and transplant rates have been unable to keep pace with the growth in the numbers of patients seeking a transplant. The pre-lung allocation score (LAS) allocation system favored patients able to wait 2 to 3 years for lungs. The LAS, seeking to alleviate deaths of acutely ill patients on the list, provides much improved access to transplantation for patients with grave disease and great urgency. After an initial drop in waiting list deaths after the introduction of the LAS, the waiting list death rate is rising again, suggesting that increased access is insufficient to reduce waiting list deaths from diseases that may be treated by lung transplantation. One method to address rising waiting list death rates is to increase the donor supply, specifically, with donor lungs previously deemed unacceptable. The 2003 International Society for Heart and Lung Transplantation (ISHLT) Consensus Statement on lung donor acceptability criteria reports a negative effect on post-transplant survival with increased donor age (4 60 years). With only modest increases in the donation of ideal organs and a more rapidly expanding candidate list, the age limit for donor use is being pressed. The 2012 ISHLT Registry reports the median age of lung donors steadily increased during the past decade, from 34 years in 2000 to 39 years in 2010. In part, this reflects the increased use of donors previously classified as too old for lung donation. In 2000, 5.7% of all lung donors were aged 60 years or older. By 2010, this number had risen to 10.9%. Reported survival outcomes for recipients of older lungs are conflicting. In this issue of the Journal, Bittle et al present the latest and probably most extensive study of transplant outcomes using older donor lungs. They used the United Network of Organ Sharing database to examine the