The Rationale for the New Deceased Donor Pancreas Allocation Schema

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Abstract
Background. To ensure the continued success of whole organ pancreas and islet transplantation, deceased donor pancreas allocation policy must continue to evolve. Methods. To assess the existing system, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing Kidney and Pancreas Transplant Committee retrospectively analyzed the disposition and outcomes of deceased donor pancreata in the United States between January 1, 2000 and December 31, 2003. Results. During the time period studied, consent was obtained but the pancreas was not recovered in 48% (11,820) of organ donors. The most common reasons given for nonrecovery were poor quality of the pancreas and difficulty in placement. Of whole organ pancreata that were transplanted, 90% were from donors with a body mass index (BMI) ≤30 kg/m2 and age ≤50 years. Pancreata from older and more obese donors were used more often for islet transplantation or research. For simultaneous pancreas-kidney transplants, the 1- and 3-year pancreas graft survival was lower when the donor was age >50 years (P=0.04), and there were trends toward lower graft survival with donor BMI >30 (P=0.06) and increasing cold-ischemia time. Conclusions. Based on these data, the OPTN adopted a new allocation algorithm in which pancreata from donors >30 kg/m2 or >50 years of age are, unless accepted for a local whole organ pancreas transplant candidate, preferentially allocated for islet transplantation. These data also suggest that many good quality pancreata are not procured, emphasizing the need for improved communication and cooperation between organ procurement organizations and pancreas and islet transplant programs.