Just a number? Donor age and (lack of) associated reasons for heart offer refusal.

Use of 50+ year-old donors for heart transplant (HT) is rare in the US. We assessed reasons for this-and whether it reflects concern about age itself or associated risk factors-using a survey of US HT centers. The Donor Heart Study enrolled US adult potential heart donors from 2015-2020. 6,814 surveys across 2,197 donors cited, on average, 2.4 reasons (per donor) for offer refusal. Age was cited often (by ≥ 50% of centers surveyed) for 715 donors (33%). In this subgroup, accompanying donor-related reasons for refusal were infrequent, with no cardiac abnormality cited in most cases. Donor age showed associations with (1) age as a reason for refusal and (2) discard. Both abruptly increased at age 50: 55% of 50-51-year-old donors were refused often due to age (vs. 38% of 48-49-year-olds) and 72% were discarded (vs. 55% of 48-49-year-olds), despite no evidence of a threshold effect of age on outcomes.

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