Reasons for Low Utilization of Pancreas for Transplantation From Deceased Donors: Analysis of Data From a Single Center in India

• Published in: Transplantation proceedings 2020-07, Vol.52 (6), p.1858-1859
• Main Authors: Mandwar, Milind, Sharma, Ashish, Singh, Sarbpreet, Kenwar, Deepesh Benjamin, Seth, Abhinav, Kallepalli, Vidyasagar, Pandey, Gaurav Shankar, Rally, Sahil, Thakur, Vivek, Patil, Shivakumar S.
• Format: Article
• Language: English
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.04.002

Although pancreas transplants were started at our center in 2014, the number of pancreases procured have remained low. This report presents an audit of donors over the past 18 months with the aim to identify factors preventing pancreas utilization. This was a retrospective study. All deceased donors from January 2018 to July 2019 were included in this study. The medical records of deceased donors were reviewed with regard to donor characteristics such as demographics, biochemical parameters, and preterminal management. Organs were retrieved from 49 deceased donors over the duration of the study. Mean age of the donors was 35.34 ± 18.2 years (11 months to 72 years). Most donors were men (M:F 41:8). In total, 45/49 (92%) donors had central nervous system trauma as a cause of brain death. Out of 49, multiple abdominal organs were retrieved from 21 donors (42.8%), whereas kidneys alone were retrieved from the rest. Pancreases were retrieved from 8 donors (16.3%). Pancreases were rejected in 21 donors (42.8%) because of age limit criteria. Other reasons for refusal included donor sepsis (n = 12, 24.5%), severe hemodynamic instability (n = 5, 10.2%), donation after cardiac death (DCD) (n = 2, 4.1%), and ischemic hepatitis (n = 7, 14.3%) while 3 (6.1%) donations happened while awaiting license renewal. A suitable recipient was not available for 1 donor (2.0%). Pancreas retrieval rates remain low because of donor-related factors. Expansion of age limits and better donor management could improve pancreas transplant activity. •Pancreas transplant remains the treatment of choice for patients with Type I diabetes and end-stage renal failure.•The pancreas is almost always procured from a deceased organ donor, but the rate of procurement of the pancreas remain low.•Even after procurement, pancreatic discard rates are close to 30% in the United States.•The various reasons for the low utilization range from the rigid criteria for the acceptance of the pancreas to a lack of trained surgeons and fewer centers performing pancreas transplants.