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Senior Correspondent

Q. What’s the age cut-off for a heart transplant?

Age is not as important as the overall health of the patient. There is no widely accepted age cut-off. However, most transplant surgery isn't performed on people older than 70 because the procedure doesn’t have a high success rate for patients in that age group. The majority (52 percent) of candidates are between the ages of 50 and 64.

The survival rates for heart transplants have improved steadily since the first successful human heart transplants were done in the late 1960s.

Almost 9 out of 10 patients survive the first year following a heart transplant. After five years, the survival rate drops to about 7 in 10. After 10 years, the rate drops again to about 5 in 10. After 20 years, about 1.5 in 10 are still ticking.

Approximately 2,300 heart transplants are now performed each year in more than 150 heart-transplant centers in the United States.

About 90 percent of heart transplants are performed on patients with end-stage heart failure. This means the heart can’t pump the blood the body requires, and a transplant is a last resort.

There is a stringent selection process for patients seeking a heart transplant. The applicants are required to need a new heart, but they also have to be healthy enough otherwise to get one. Eligible patients are put on a waiting list.

The waiting list usually has about 3,000 names on it. The average time a heart transplant candidate spends on the waiting list is about 266 days.

This waiting list is part of a national allocation system for donor organs run by the Organ Procurement and Transplantation Network (OPTN). The OPTN is the unified transplant network established by the United States Congress. The OPTN is a unique public-private partnership that links all of the professionals involved in the donation and transplantation system.

OPTN guidelines suggest that the donor be younger than 65, have little or no history of heart disease or trauma to the chest, and not be exposed to hepatitis or HIV.
During heart-transplant surgery, a bypass machine is hooked up to the arteries and veins of the heart. The machine pumps blood through the patient's lungs and body while the diseased heart is removed and the donor heart is sewn into place. Heart transplant surgery usually takes about 4 hours. Patients often spend the first days after surgery in the intensive care unit of the hospital.

A heart transplant recipient often spends one to two weeks in the hospital and three months of monitoring by the transplant team at the heart-transplant center.
The new heart is a "foreign body," which your immune system may attack if you're not receiving enough medicine to suppress your immune system after the surgery. Therefore, you and the transplant team will work together to protect the new heart by watching for signs of rejection.

The most frequent cause of death in the first 30 days after transplant is failure by the donor heart. Rejection is one of the leading causes of death in the first year after transplant.

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