Should There Be an Upper Age Limit to Transplantation? A Pilot Questionnaire Survey.

Being self-renewable, the hematopoietic stem cells are seemingly unlimited. Scarcity of donor tissues, unlike the solid organ transplantation, is not a limiting criterion for stem cell transplantation (SCT). We are interested in the public opinion of the upper age limit for transplantation and a pilot questionnaire survey was designed. The survey was approved by IRB and conducted among ASCO participants who visited one of our posters in 6/2004. Forty-seven questionnaires were returned on site. Among those who completed the respective questions, 63% were males, median age was 39 (range 30–60) years, 81% were medical doctors, 51% currently worked in the US, 50% graduated their highest academic degrees in the US, and median time interval from graduation was 8.5 (range 1–37) years. When asked to comment on "There should be an upper age limit to transplantation", 11% strongly and 39% somewhat disagreed, 11% were neutral to the statement, and 35% somewhat and 4% strongly agreed. Among those who completed the respective questions, 52% and 62% felt that 70 years should be the upper age limit for kidney and autologous SCT respectively; whereas 61%, 71% and 68% felt that 60 years should be the upper age limit for liver, heart/lung and allogeneic SCT respectively. "Should transplantation be offered to people older than 65?" For kidney and autologous SCT, the majority (64% and 94% respectively) answered yes. For liver, heart/lung and allogeneic SCT, the majority (60%, 56% and 59% respectively) answered no. "Should transplantation be offered to people older than 70?" For autologous SCT, 52% still answered yes. For kidney, liver, heart/lung and allogeneic SCT, the majority (60%, 76%, 77% and 83% respectively) answered no. To investigate specifically SCT, we asked, "Should autologous SCT be offered in the following scenario - 5-year overall survival with transplantation is 50% compared to <20% without transplantation and early transplant mortality is 5%?" Over 86% felt that autologous SCT should be offered in people 70 years of age or younger. When we asked, "Should allogeneic SCT be offered in the following scenario - 5-year overall survival with transplantation is 50% compared to <20% without transplantation and early transplant mortality is 20%?" Over 86% felt that allogeneic SCT should only be offered to people 60 years of age or younger. We analyzed the possible correlation of various factors, age, gender, occupation, current residence, country of graduation, and time interval of graduation, to their comments to the statement, "There should be an upper age limit to transplantation", by chi-square test. Interestingly, the country of graduation, but not the current residence, correlated with their answers. Participants who graduated from outside US are more likely to agree (52%) to the statement than those who graduated in the US (25%) (chi sq p= 0.02).

CONCLUSION: In this pilot study, about half of the participants strongly and somewhat disagreed that there should be upper age limit to transplantation. Among those who completed the questions, 70 years should be the upper age limit for kidney and autologous SCT, and 60 years for liver, heart/lung and allogeneic SCT. In addition, there is a significant difference in the opinion of U.S. versus non-U.S. graduates whether there should be an upper age limit for transplantation. Further study is required to confirm these findings.