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Abstract
BackgroundMost offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon’s decision to select an offered pancreas.MethodsSemi-standardized interviews were conducted with 14 highly qualified transplant surgeons from all 14 German transplant centers performing > 5 pancreas transplantations per year. The interviews focused on medical and non-medical criteria on which the individual accept/refuse decision depends. Interviews were recorded, transcribed and underwent content analysis.ResultsThe interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay. However, there was no consistency in judging these parameters, and clear cut-offs did not exist. The pancreas macroscopy is a pivotal factor, as well as knowing (and trusting) the donor surgeon. 3/14 surgeons reported that they had occasionally refused a pancreas because of staff shortage. Some interviewees followed a restrictive acceptance policy, whereas others preferred to accept almost any pancreas and inspect it personally before deciding.ConclusionThe assessment of medical donor characteristics is highly inconsistent. Both very cautious as well as very permissive acceptance policies may render the allocation process less efficient. A more standardized policy should be discussed. Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.
Highlights
Not all patients eligible for pancreas transplantation can benefit from this therapeutic option, mainly because of the well-known shortage of donor organs
In Germany, data from 2005–2009 show that 43% of pancreases are withdrawn before recovery because of repeated refusals, and 20% are discarded at the time of intended recovery, or after recovery, mainly due to poor organ macroscopy [9]
Sample In Germany, 163 pancreases from donors after brain death were transplanted in the year 2010 [11]. These pancreas transplants were performed in 24 centers; the three hospitals with the highest volume transplanted 13, 14, and 16 pancreases per year, respectively. 14 of the centers transplanted more than five pancreases per year [11]. In all of these 14 relative ‘high volume’ centers, experienced transplant surgeons are on call to decide upon the acceptance or refusal of whole organ donor pancreases when offered by Eurotransplant
Summary
Not all patients eligible for pancreas transplantation can benefit from this therapeutic option, mainly because of the well-known shortage of donor organs. Data from Eurotransplant (ET), an international foundation responsible for the allocation of donor organs in Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands and Slovenia, indicate that 71% of all offered pancreases are withdrawn or discarded. The reasons for this pancreas under-utilization are not yet well understood. Data from the UK indicate that the majority of organs are withdrawn from the allocation process because they are repeatedly turned down from the contacted transplant centers due to medical characteristics of the donor [8]. In Germany, data from 2005–2009 show that 43% of pancreases are withdrawn before recovery because of repeated refusals, and 20% are discarded at the time of intended recovery, or after recovery, mainly due to poor organ macroscopy [9]
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