What Is The Maximum Age For A Lung Transplant?

Lung transplantation is a life-saving surgical option for patients with end-stage lung disease when other treatments have failed. However, questions often arise around age and eligibility, particularly among older individuals and their families. “Am I too old for a lung transplant?” is one of the most commonly asked questions, especially as medical advancements continue to improve outcomes across age groups.

While there is no absolute age limit for lung transplants, age remains a significant factor during the evaluation process. In general, individuals over 65 are scrutinized more carefully, and those over 70 or 75 may face more stringent criteria. Still, age alone is not an automatic disqualifier. Rather, the transplant team considers a combination of physical health, comorbidities, mental resilience, and overall fitness to determine candidacy.

Understanding Lung Transplantation

A lung transplant involves replacing one or both diseased lungs with healthy lungs from a deceased donor. It’s typically considered for patients with advanced chronic lung diseases such as:

• Chronic Obstructive Pulmonary Disease (COPD)
• Idiopathic Pulmonary Fibrosis (IPF)
• Cystic Fibrosis
• Pulmonary Hypertension
• Bronchiectasis

Candidates are thoroughly evaluated through a rigorous screening process that includes medical history, imaging, blood tests, cardiopulmonary function tests, and psychosocial assessments. The goal is to identify patients who are most likely to benefit from the procedure with the lowest risk of complications.

Is There a Maximum Age for Lung Transplantation?

No Absolute Age Limit

There is no definitive age cutoff for lung transplant candidacy. Instead, age over 65 is considered a relative contraindication—meaning it’s a factor to be weighed, not an automatic exclusion.

This reflects a broader shift in the medical field, where physiological and functional age are increasingly emphasized over chronological age. A healthy, active 68-year-old may be a better candidate than a frail 58-year-old with multiple comorbidities.

Age Over 65

Patients over 65 may have higher risks for postoperative complications, slower recovery, and reduced long-term survival. However, they also stress the importance of individualized assessments.

Patients over 65 can still be listed for lung transplants if they:

• Have no significant comorbidities (e.g., heart disease, kidney failure)
• Are physically active and have good exercise tolerance
• Have strong social support and psychological resilience
• Are likely to adhere to post-transplant care and immunosuppressive therapy
  

Age 70 and Beyond

Most transplant centers become more cautious when patients are over 70. Although not a firm rule, patients older than 70 are less frequently approved for lung transplants. Those above 75 face even higher scrutiny and are less likely to be listed.

This is due to several age-related factors:

• Reduced ability to recover from major surgery
• Higher risk of infections due to age-related immune decline
• Increased likelihood of complications from immunosuppressive medications
• Greater burden of age-associated comorbidities (e.g., osteoporosis, cardiovascular disease)
  

Still, select individuals over 70 have received successful lung transplants, especially in high-performing centers with experience managing older recipients.

Why Age Matters — and When It Doesn’t

Physiological Resilience

Age affects how the body tolerates surgery, recovers, and resists infections. Older adults may have less physiological reserve, meaning they recover more slowly or experience more complications. However, this is not always the case. Some septuagenarians remain remarkably fit and resilient.

Risk of Rejection and Complications

Older patients often have a weaker immune response, which may paradoxically reduce the risk of acute rejection. On the flip side, they may be more susceptible to infections due to the immunosuppressants required after the transplant. Balancing these risks is a key part of the evaluation process.

Comorbidities

The presence of other medical conditions—such as diabetes, kidney disease, coronary artery disease, or frailty—has a more significant impact than age alone. These can complicate both the surgical process and recovery, often tipping the scales more than chronological age.

Growing Trends: Lung Transplants in Older Adults

In the last two decades, the number of lung transplants performed in individuals over 65 has significantly increased. Data from major transplant registries show a growing willingness among centers to consider older candidates, driven by better surgical techniques, improved post-operative care, and more sophisticated selection criteria.

Some recent trends include:

• Higher 1-year survival rates in selected older patients: Carefully selected individuals over 65 often show comparable short-term survival to younger patients.
• Single-lung transplants more common in older adults: Single-lung transplantation (as opposed to bilateral) is less invasive and associated with shorter recovery times, making it a preferred option for older recipients.
• Specialized geriatric assessment tools: Some transplant programs now include geriatricians in the evaluation process to assess frailty, cognitive function, and resilience.

Realistic Expectations and Life After Transplant

The outcomes of lung transplantation vary widely based on the underlying condition, patient age, and postoperative adherence.

Survival Rates

• The average survival after lung transplant is 5–6 years.
• For patients over 65, median survival is slightly lower but still meaningful.
• One-year survival rates exceed 80%, even in older recipients, if they are well-selected.

Quality of Life

Most lung transplant recipients experience significant improvements in breathing, energy levels, and daily functioning. Older patients often regain independence and can resume activities they previously had to abandon.

However, lifelong medical monitoring and adherence to medications are crucial. Risks include:

• Chronic rejection (bronchiolitis obliterans syndrome)
• Kidney damage from immunosuppressants
• Infections
• Cancer (especially skin cancer and lymphoma)

What Transplant Centers Look For (Besides Age)

If you’re an older adult considering a lung transplant, here are factors that will influence your candidacy:

1. Nutritional Status: Malnutrition or obesity can impact recovery.
2. Functional Capacity: Your ability to perform physical tasks is often measured via a 6-minute walk test or VO2 max.
3. Support System: Having family, caregivers, and a stable home environment improves outcomes.
4. Psychological Readiness: Mental health, cognitive function, and medication adherence are vital.
5. Absence of Major Contraindications: Conditions like active cancer, severe liver disease, or recent stroke may exclude you from eligibility.

Conclusion

There is no strict maximum age for lung transplantation, but there are practical limitations. Most centers will approach patients over 65 with caution, and those over 70 or 75 must meet even stricter criteria. That said, age is only one piece of the puzzle.

Thanks to medical advances and more personalized assessments, age alone is no longer the barrier it once was. If you or a loved one is considering lung transplantation at an older age, speak to a transplant center with experience in evaluating older adults. A comprehensive evaluation will determine your candidacy based on your total health profile, not just your birth date.