In summary, as our protocols of immunosuppression improve in selectivity and, more importantly, as we become more adopt at tailoring the degree of immunosuppression to the needs of individual patients, both our enthusiasm and our success with organ transplantation in the elderly will improve. This has particular relevance as the average age of our population increases. Arbitrary age limits, largely the products of the 1970s and early 1980s, have now been abandoned. Nevertheless, the enthusiasm to demonstrate skill in treating the older patient must be tempered by an understanding of the extreme shortage of available donor organs. In terms of life-years saved, the older patient offers much less potential than younger patients. At some point, the co-existence of other life-threatening illnesses in older patients must influence our desire to save older lives. One cannot overlook the probability that Medicare coverage of kidney transplantation since 1972 and heart and liver transplantation since the end of the last decade has served as a tremendous stimulus to the enthusiasm for treating older patients. In anticipation of further limits being placed on the availability of dollars for health care, the need for responsible stewardship of our precious donor and health care dollar resources becomes ever more important.
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