Aging and transplantation - a topic for biomedicine or bioethics?

The aged patient stands at the nexus of significant biomedical and bioethical issues in transplantation. This in itself can be seen as a microcosm of an imminent global tempest, stemming from expanding numbers and longer lives of the aged population. As a candidate for receiving organ and tissue transplants, the geriatric patient is challenging because they present unique physiology for medical management. As organ and tissue donors, the aged are perceived of as providing "marginal" organs, which drives the fear that the graft will fail before the recipient. Such difficulties lead inexorably to several unique bioethical considerations for transplantation with this population. The thorny conundrums for society hinge on fairness versus discrimination based on age, played out under the enormous and probably intractable problem of severe donor organ shortages. Fortunately, recent findings offer some rather unexpected new and favorable prospects. Notably, aged donors can provide organs with good, lifesaving function, even though there are nonetheless age-related compromises present. On the other side of the coin, there is less doubt that recipients can have their lives extended with high quality through transplantation. Here they benefit from some (counterintuitively) positive attributes for aging, such as reduced immune function, making immunosuppression less rigorous. Finally, the pressure of organ and tissue shortages plus the lifting of bans on embryonic stem cell research have portents for an explosive alternative to transplantation of adult organs. Stem cells also lend credibility to prospects for realizing regenerative medicine, assuming ethical and religious concerns can be satisfied.