Heart transplant age may rise

JAPAN - The Health, Labor and Welfare Ministry has begun studying the advisability of raising the age limit for heart transplant recipients by five years, The Yomiuri Shimbun has learned.

Currently, those aged 60 or older are ineligible for heart transplants, but the change under consideration could raise that standard to 65.

The ministry's studies are in response to a proposal by the Japanese Circulation Society, a nationwide group of cardiovascular specialists, calling for the extension of the heart transplant age limit.

It may be advisable to raise the eligibility age in light of the rapid aging of society and moves in the business world to allow employees to continue working up until 65, according to ministry officials.

The JCS and related expert organizations jointly decided in 1997 on heart transplant guidelines, which said heart transplant recipients "should preferably be younger than 60."

Because of the guidelines, it has been extremely difficult for those on the cardiac transplant list who are aged 60 or older to undergo transplant operations.

Transplant expert bodies had judged that the small number of donated hearts for transplants should be used for heart disease patients of working age.

According to the Japan Organ Transplant Network, the nation's sole organization for matching brain-dead organ donors with organ recipients, 127 heart transplant operations had taken place as of April 20 this year since the enforcement of the Organ Transplants Law in 1997. All but five of the recipients are still alive, the network said.

A breakdown showed that recipients in their 20s to 50s accounted for 111 of the 127, or 87 per cent of the total, while six others were in their 60s.

The JCS said Japan is the only country to have set a uniform age limit on cardiac transplant recipients.

In the United States and European countries, heart recipients in their 60s accounted for about 10 per cent of all recipients when heart transplants began in the 1980s.

Due mainly to advances in transplant operation techniques, the percentage of recipients in their 60s has risen to about 25 per cent of the total in the United States and Europe in the past decade, according to the JCS.

In the United States, people aged 60 or older have accounted for about 30 per cent of all heart transplant recipients in recent years.

In March this year, former US Vice President Richard Cheney underwent a heart transplant operation at the age of 71.

The new proposal by the JCS says heart transplants should be performed on patients younger than 60 in principle.

But the proposal also says people aged 60 or older should be able to receive a heart in certain cases. For example, if a younger prospective recipient declines a transplant due to the high age of the donor, the heart could be offered to an older patient.

The current age limit for heart transplants has given rise to problems in the treatment of heart disease with embedded auxiliary artificial hearts (EAAHs), the use of which has been covered by health insurance since last year.

EAAHs have proved highly effective, with the survival rate of those receiving EAAH operations standing at more than 80 per cent one year after the operations.

The application of health insurance to the operations, however, is limited to patients who are "on the waiting list for heart transplant operations," effectively disqualifying people aged 60 or older from receiving EAAHs.

In response to the JCS proposal, an expert section of the health ministry will study raising the heart transplant age limit and the advisability of creating a priority list of those who are on the waiting list, the ministry officials said.

Prof. Mitsuaki Isobe of Tokyo Medical and Dental University's Cardiovascular Medicine Department said, "While top priority [in heart transplants] should of course be placed on the will of a donor, it is imperative to raise the age limit on recipients in accordance with the raise of age limits in businesses."

"Given how expensive artificial hearts are, the patients allowed to receive them should be decided selectively depending on the seriousness of their conditions," Isobe noted.