Utilization and Outcomes of Septuagenarian Donation After Circulatory Death Donors

The ongoing organ shortage and aging global population necessitate the utilization of older donors. However, the transplantability of donation after circulatory death (DCD) grafts from septuagenarian donors remains uncertain.

Adult DCD donors in the United Network for Organ Sharing database between 2020 and 2024 were stratified on the basis of age 70 y or older (septuagenarian donors) and younger than 70 y. The utilization and posttransplant outcomes were analyzed.

There were 24 258 DCD donors, of whom 195 (0.8%) were septuagenarians. Among 364 recovered kidneys, 58 livers, and 8 lungs from septuagenarian donors, 61 (16.7%) kidneys, 50 (86.2%) livers, and 6 (75%) lungs were transplanted. There was no significant difference in 1-y graft survival for either kidney (92.9 versus 91.6%, P = 0.99) or liver (92.3 versus 90.1%, P = 0.82) recipients. There was heterogeneity across regions in septuagenarian donor practices: 2 (3.6%) of 55 organ procurement organizations recovered 33.8% of all septuagenarian donors, whereas 4 (1.8%) of 218 centers transplanted 34.8% of all septuagenarian grafts used.

Septuagenarian DCD grafts achieved favorable graft survival after kidney or liver transplantation. Although significant variation exists across organ procurement organizations and transplant centers, aggressive exploration of septuagenarian DCD donors is warranted to resolve the organ shortage.