Norway cuts lung transplant age limit from 65 to 60

Last October, the approximate upper age limit for lung transplantation in Norway was reduced from 65 to 60. At the same time, the number of patients on the waiting list fell sharply.

SOURCES | SOCIETY

June 8, 2026

Image by AI/S&P

THIS ARTICLE IS PART OF A SERIES
Article 1 | Article 2 | Article 3 | Article 4

Norway operates a publicly funded healthcare system, and lung transplant candidates are prioritized according to medical criteria regardless of social status. Crown Princess Mette-Marit, who is currently on the lung transplant waiting list, is therefore subject to the same prioritization framework as other patients awaiting transplantation.

New findings and inadequate explanations

Society and Politics has previously published two articles examining discrepancies in communication and documentation from Rikshospitalet, Norway’s national hospital, concerning lung transplant waiting lists and prioritization criteria.

The first article examined significant anomalies in the waiting list that emerged during the final quarter of last year. These irregularities continued into the first quarter of this year. Among other things, 11 patients disappeared from the waiting list over the course of a few months. Read the article here.

The second article documented that the lung transplant prioritization process was updated in the hospitals electronic handbook (eHåndboken) on 17 October last year without any public announcement. The update occurred during the same period in which the number of patients on the waiting list declined. Read the article here.

This article reveals that the updated handbook states that age above 60 constitutes a relative contraindication, corresponding to what is generally described as the approximate upper age limit for lung transplantation. However, an earlier document listed this threshold as 65 years in 2024.

The article also examines whether the explanations provided by Rikshospitalet for the sudden decline in the waiting list can be substantiated by available evidence.

The approximate age limit was reduced from 65 to 60 years, internationally it is 70 years

Metadata from Oslo University Hospital (OUS) and Rikshospitalet show that the document "Indications and Prioritization for Lung Transplantation" in the eHandbook was updated to version 4 on 17 October 2025. Sources for this finding are provided in the second article in this series.

In 2024, the approximate upper age limit (relative contraindication) was listed as 65 years. In the updated handbook it is listed as 60 years. This change has not been communicated publicly through any channel other than the handbook itself.

The downward adjustment of the age limit appears striking in contrast to the recommended international age threshold of 70 years. It becomes all the more remarkable given that Mette-Marit's pulmonologist Are Martin Holm, who is behind the change in the eHåndbok, is a co-author of the international guidelines that define 70 years as a relative contraindication (corresponding to an approximate upper age).

However, it is not possible to determine whether this was the only modification made to the prioritization process in October. Changes in medical thresholds or prioritization criteria directly affect which patients are considered eligible for placement on the waiting list.

Previous versions of the document are not publicly available, meaning there is no documentation against which potential additional changes can be compared. Even if earlier versions were released later, the public would be unable to independently verify the change, since those versions were not publicly accessible when S&P uncovered the issue.

Could the waiting list have fallen because more patients were transplanted?

On 19 December last year it was announced that Crown Princess Mette-Marit's lung disease, pulmonary fibrosis, had progressed and that lung transplantation might become necessary.

A press conference was held at Rikshospitalet on the same day, during which senior consultant Are Martin Holm stated that the waiting list was currently short. He explained that the reduction was due to a high number of lung transplants being performed in 2025.

However, figures from Scandiatransplant, which are reported by Rikshospitalet itself, show that 37 lung transplants were performed in 2023, 31 in 2024, and 36 in 2025. Data from earlier years are of limited relevance because patients are generally not placed on the waiting list until their expected survival is estimated at one to two years.

The explanation provided in December does not correspond with a 46 percent reduction in the waiting list and the disappearance of 34 percent of listed patients. The decline occurred abruptly during the final quarter of last year and continued into the first quarter of this year. Details and sources concerning this sudden reduction can be found in the first article in the series.

Could the waiting list have fallen because of natural fluctuations?

On Friday, 5 June, a new press conference was held at Rikshospitalet after Crown Princess Mette-Marit was formally placed on the lung transplant waiting list.

In addition to discussing transplant prioritization and eligibility criteria, Are Martin Holm referred to the electronic handbook and the document updated on 17 October last year.

Holm further stated that eight patients are currently on the waiting list. At the same time, he presented two new explanations for the sudden decline.

The first explanation was that the reduction reflected normal fluctuations. S&P examined this claim extensively in the first article of this series. Neither historical Norwegian data nor statistics from other Nordic countries show fluctuations of this magnitude. Nor are there any other public statistics suggesting that the number of patients with severe lung disease declined correspondingly during the relevant period.

Could the waiting list have fallen because of new cystic fibrosis treatments?

The second explanation offered by Holm was that new medications for cystic fibrosis had reduced demand for transplantation. S&P has now examined this claim.

A new generation of medicines known as CFTR modulators has significantly reduced the need for lung transplantation among patients with cystic fibrosis. Kaftrio became available to Norwegian patients on 1 June 2022. Experiences from Denmark and Sweden, as well as Norwegian sources, show that the effect of CFTR modulators became apparent shortly after their introduction.

Historically, cystic fibrosis accounted for 10.8 percent of all lung transplants in Norway, corresponding to an average of 3.3 transplants annually. According to sources identified by S&P, and documented separately below, this number appears to have fallen immediately in 2022, 2023, and 2024 following the introduction of CFTR modulators.

Notably, Holm stated in an interview with the Norwegian Organ Donation Foundation in January this year that the need for lung transplantation in this patient group had almost disappeared following the introduction of Kaftrio. He further stated that no patients with cystic fibrosis underwent lung transplantation in Norway during 2025.

S&P therefore sees no clear connection between cystic fibrosis and the sudden reduction in the waiting list that occurred during the final quarter of last year and the first quarter of this year.

Could a reduction in the approximate age limit from 65 to 60 explain the decline?

It is reasonable to consider whether the three explanations provided by Rikshospitalet collectively could have contributed to the reduction in the waiting list. S&P cannot rule out that they may have had some effect. However, based on an extensive review of publicly available sources, S&P concludes that the number of affected patients would have been too small at the relevant time to account for the full decline.

Norwegian research on lung transplantation shows that the median age of transplant recipients is 55 years. This means that half of all recipients are younger than 55 and half are older. The research also shows that patients up to 67 years of age have undergone lung transplantation.

However, no publicly available statistics show the age distribution of patients on the waiting list or how many were between 60 and 65 years old. S&P therefore cannot quantify the impact of the reduced age threshold. It should also be noted that other prioritisation criteria may have been tightened in October last year.

S&P considers it likely that patients over the age of 60 were present on the waiting list and that a reduction in the age threshold may have affected the number of listed patients.

Fewer patients on the waiting wist increase survival chances

At Friday’s press conference, Holm explained that waiting times for transplantation become shorter when fewer patients are on the waiting list. Historically, approximately 20 percent of listed patients did not receive a transplant. This included both patients who died while waiting and patients who became too ill to undergo transplantation before a suitable donor organ became available.

A shorter waiting list substantially improves survival prospects for patients who remain on the list, while the prospects are correspondingly reduced for severely ill patients who, for various reasons, are not allowed onto the waiting list.

This is precisely why questions concerning waiting lists, prioritisation criteria and changes to those criteria are matters of considerable public interest. For patients who remain outside the waiting list, such decisions may ultimately be a matter of life and death.