Background
Whole organ pancreas-kidney transplantation has become the standard treatment for type 1 diabetes mellitus patients with renal failure. However, not all patients eligible for pancreas transplantation can benefit from this therapeutic option, mainly because of the well-known shortage of donor organs. The waiting time for receiving a pancreas transplant has considerably increased in several European countries over the last few years. In addition, the majority of pancreases that are offered for allocation are not transplanted. 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Belgium, Croatia, Germany, Luxembourg, the Netherlands and Slovenia, indicate that 71% of all offered pancreases are withdrawn or discarded.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 Data from the UK indicate that the majority of organs are withdrawn from the allocation process because they are repeatedly turned down from the contacted transplant centers due to medical characteristics of the donor. In Germany, data from 2005–2009 show that 43% of pancreases are withdrawn before recovery because of repeated refusals, and 20% are discarded at the time of intended recovery, or after recovery, mainly due to poor organ macroscopy.
When an organ is consented to be allocated for transplantation, the physician or surgeon from the transplant center with the patient ranked highest on the waiting list is contacted by phone. In parallel, a recovery team in the region of the donor hospital is instructed to perform the donor surgery. The final decision whether to use the organ is prerogative of the transplant surgeon and/or physician responsible for the care of the recipient. Many of these offers are turned down on the phone; data from German pancreas donors show that a pancreas is offered to a median of three centers before it is placed; those pancreases withdrawn from the allocation process had been offered to a median of eight patients in five centers. This begs the questions as to which factors may influence a transplant surgeon's decision to accept or refuse a pancreas offer. For example, it is not known whether medical characteristics of the donor are judged in a similar way by different transplant surgeons, and if so, what the underlying reasons may be. Based on the data from the allocation process in Germany, there is no consistency in the decision-making process using single donor characteristics (e.g. BMI, ICU stay, age). It has also been speculated that administrative (e.g. staff shortage) or strategic aspects (e.g. survival rates) may play a role when refusing organ offers. Whether these considerations actually affect the decision-making process has not been analyzed yet. Neither has it been studied whether the decision is rather intuitive, or based upon sound evidence or consensus as to the medical criteria of the donor.
The objective of this study was to analyze
Which medical donor characteristics have an impact on a transplant surgeon's decision to accept or refuse an organ offer;
Whether there are differences in evaluating medical donor characteristics between transplant surgeons of different centers with regard to acceptance of an offered pancreas;
To what extent non-medical reasons, e.g. staff shortage, may play a role in the accept/refuse decision in pancreas transplantation.