The challenge of managing the care of older heart transplant recipients

Age is perhaps the most controversial exclusion criterion for heart transplantation. One concern focuses on whether chronological or functional age is the better predictor of positive outcomes when considering heart transplantation for an elderly patient with end-stage heart disease. Another concern is related to the philosophical and ethical rationale for allocation of scarce resources to those near the end of a normal life expectancy. However, the number of people who are older than age 65 years and have received a donor heart has increased and will continue to due to aging of the people who received a transplant a decade ago, as well as the growing number of people who undergo heart transplantation after the age of 65. In either case, the nurse must be aware of age-related concerns in this vulnerable population.