"To get on the Canadian list for a heart transplant, patients must be
diagnosed with end-stage heart disease. They cannot smoke or abuse
drugs. Donor hearts go to whoever on the waiting list is the sickest.

"If you have two or three patients in the same category in terms of
sickness, whoever has been waiting the longest will get that heart,"
Wang said."

You're never too old for a new heart, U of A study shows
Health, not age, key factor in transplant success: Success rates for
patients over 60 equal to younger ages

David Howell
The Edmonton Journal
http://www.canada.com/edmonton/edmontonjournal/news/story.html?id=192d254f-8d50-
4085-95a5-7c759411e4cc

February 3, 2005

EDMONTON - Age should not be a factor in deciding who gets a heart
transplant, says a team of University of Alberta surgeons whose
research has shown that older patients fare as well as younger ones.

Six cardiac surgeons reviewed clinical data on 50 heart transplant
recipients aged 60 and older and compared that group's results against
another group of 225 recipients aged 18 to 59.

All 275 patients received new hearts at the University Hospital between
January 1990 and December 2000.

The research showed the two groups had similar rates of organ
rejection, transplant coronary artery disease, cancer and death.

Five-year survival rates were nearly identical for the two groups.

"We conclude that patient age ... should not be an exclusion criterion
for heart transplantation," the authors write in their study, which was
published in the November issue of Journal of Cardiac Surgery.

Dr. Shao Hua Wang, the study's lead author, said he hopes older people
are encouraged by the findings.

"People should know that there is an option when you are older and you
are sick and you might be a candidate for heart transplant," Wang said
in an interview.

"If you are 65 and running out of options, a heart transplant could be
a reasonable option with very good results."

Some hospitals won't give new hearts to people older than 65, but the U
of A takes a more "aggressive" approach that doesn't rule patients out
by age alone.

Still, few patients older than 70 are judged to be suitable
heart-transplant recipients, Wang said.

In December 1999, U of A surgeons made medical history by giving a new
heart to 79-year-old Ray Nelson, co-founder of Nelson Lumber.

Nelson, a friend of cardiac surgeon Dr. Dennis Modry, got on the
waiting list with conditions attached. "We would only offer an older
heart that nobody else would need," Wang said. "That meant we would not
let some other younger patient wait for too long because of him needing
a heart."

Wang said Nelson's case alone doesn't illustrate the benefits of giving
new hearts to older patients. "The 50 patients we used for the whole
study are a much, much stronger voice," he said. "But Ray's story is a
fabulous one."

Five years after his transplant, Nelson remains the oldest person in
the world to get a new heart. But he hopes that someone older than 79
will get the opportunity to break his record.

"That will be fine," Nelson said from his home in Lloydminster.

"Part of the reason they'll get it is because of the early work by this
university."

Nelson said he believes eligibility for a heart transplant should not
be linked to age. He said it would be wrong for doctors to discriminate
based only on a patient's age.

Now 84, he said he still feels great and is forever grateful for his
new heart and the extra years it has given him. "We just celebrated my
fifth anniversary," he said.

Leo Goebel, 73, got a new heart at the U of A in May 2000, when he was
68.

"At the time I was being recommended for it, I think the feeling was if
you were over 65, you weren't eligible," said Goebel, a retired
Edmonton Transit worker. "I think (Nelson) changed the thinking of the
transplant people. I followed him and I've always felt that his
operation affected whether or not I was going to get a heart
transplant. I was very near death when I got that heart."

Like Nelson, Goebel said he feels terrific these days. "I live a normal
life. I do anything that a normal 73-year-old guy can do."

Medical ethicist Dr. Ian Mitchell, director of the Office of Bioethics
in the University of Calgary's faculty of medicine, has seen the U of A
study.

"Ageism is rampant and this is evidence that ageism is not always
justified," Mitchell said, adding that Wang and his colleagues have
taken the right approach to the age question.

"I would totally support the decision that you don't select on the
basis of age alone," Mitchell said. "It would be very unfortunate if we
systematically discriminated against older people.

"It depends on their health. If you have a very healthy 68-year-old,
they may have 10 or 15 years of really good health. If you have a frail
40-year-old, you may only have a few years of good health."

Wang said patients who need heart transplants and can't get them
usually die within six months or a year. Patients who do get new hearts
can enjoy 15 or more extra years of life. "To me, that's a huge deal,"
he said.

Dwight Kroening of Edmonton got a new heart in 1986 in Tucson, Ariz.,
three days before his 27th birthday. A former physical-education
teacher now working with a software company, he's in training for a
triathlon.

He said he's surprised that older patients do as well as their younger
counterparts. But he believes donor hearts should be available to
anyone who can benefit.

"I agree that there shouldn't be discrimination in terms of age," said
Kroening, now 45.

To get on the Canadian list for a heart transplant, patients must be
diagnosed with end-stage heart disease. They cannot smoke or abuse
drugs. Donor hearts go to whoever on the waiting list is the sickest.

"If you have two or three patients in the same category in terms of
sickness, whoever has been waiting the longest will get that heart,"
Wang said.

"It's a very fair system, and it doesn't matter if you are in Toronto
or if you are in Vancouver."

dhowell@thejournal.canwest.com
© The Edmonton Journal 2005