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A closer look at age limits for registry members

All registry members are automatically moved to inactive status on their 61st birthday.

Every member joined the registry in hopes of one day saving a life. Being told you are no longer eligible can cause sadness or frustration. Many members who are healthy and willing to donate don’t want to be removed from consideration. They want to know why age matters.

There are several reasons NMDP follows age guidelines for donors

1. Transplant doctors prefer younger donors for their patients

One reason for the upper age limit is to provide the best treatment for patients. Doctors weigh many factors when selecting a donor for one of their patients; the age of the potential donors is one of them. Transplant doctors want younger donors. Some of this is data-driven; some of it is judgment. It is very clear that blood stem cells age just like other organs; the cellularity of blood stem cells declines with age. You can’t get as many cells out of an older donor as you can from a younger one, and higher cell dose improves the chances of success.

Additionally, there are little parts of each cell’s chromosomes, called telomeres, whose length reflects the residual ability of the cell to divide. Guess what? — the telomeres of blood stem cells get shorter with aging. If you do blood stem cell transplants serially in mice, the blood stem cells poops out when the telomeres are gone. Can blood stem cells from a 65-year-old donor last another 45 years or more in a 20-year-old recipient? We don’t know, but a lot of doctors are reluctant to do the experiment. Most would like to put young blood stem cells in young patients, and older patients, too, for that matter. Finally, it is also true that diseases of the bone marrow, like myeloproliferative syndrome, myelosdysplastic disease and acute leukemia, are diseases of aging; their frequency begins to increase around age 45 and continues relentlessly throughout older age.

2. World Marrow Donor Association standards

NMDP participates in the World Marrow Donor Association (WMDA), an organization that facilitates international donation and transplantation, and promotes the interests of donors. WMDA standards require donor registries to stipulate an upper age limit not to exceed 60 years. In fact, many other donor registries have set lower age limits for joining: age 55 in Germany, 50 in Canada, 40 in Australia and in the United Kingdom, 54 in Japan. Most of these registries consider members already on the file eligible to donate up to age 60. NMDP could work around this standard if there was a compelling reason to do so, but the simple fact is—no registry in the world keeps donors past the age of 60.

3. Age is a factor in a person’s health

We know there are many people over age 60 who are in excellent health. There are also many who are not. Health problems increase with age. The rate at which potential donors are found medically unable to donate is highest in NMDP’s older donors. This higher rate of medical deferral matters because it presents a risk to patients. When the selected donor turns out to be unable to donate, transplant may be delayed, which can jeopardize a patient’s likelihood of success. Medical deferral often happens late in the process, after a potential donor has been contacted, and begins the process to confirm they are able to donate to the specific patient. Being deferred late in the processis a huge disappointment for everyone, and can lead to dangerous delays. This is another reason that transplant doctors prefer younger donors.

Our chief medical officer explains

Chief Medical Officer Dennis Confer, MD, says, “I myself turned 61 in March. I’m no longer on the registry and I am righteously indignant about it. I started exercising 3 years ago and I have lost 20 pounds. I am in the best condition of my adult life. That nobody wanted me during the 20 years I was on the registry only further irritates me. But in reality, I would not be a good donor. There are more than 200 people with my HLA type on the registry and they are all younger than I am. So, there are other ways (in addition to doing my job) that I will be making a difference — and other ways you can, too. Contributing money or hosting a donor recruitment drive may not offer the same joy and satisfaction that the opportunity to donate blood stem cells would, but these acts are crucial to saving more lives. I am also encouraging my son to join the registry. He is 18 and can be a member for a very long time. And it’s about time he did something that makes sense!”

More ways to help

There are many ways to help patients in addition to donating blood stem cells. You can: