Donor Risk Indices

Simultaneous pancreas kidney (SPK) transplant has successfully treated patients with type I diabetes mellitus and end-stage renal disease for half a century resulting in euglycemia and normal renal function. However, despite long-term success, there has been a period (2004-2015) of decreasing enthusiasm for pancreas transplant and the average wait time for a SPK transplant in the United States is now 12-19 months. Although donor selection criteria were traditionally limited to mitigate early allograft loss, in response to changing donor demographics, programs now consider allografts from donors who are older, heavier, and have evidence of premortem injury. Similarly, organs procured from donors after cardiac death are being used more often than before. Predictive scoring systems have been developed to objectively assess the risk of early failure, especially when utilizing nontraditional donor organs. There are two established predictive scores/indices that have been validated to identify suitable pancreas donors: The P-PASS in Europe and the PDRI in the United States. The aim of this chapter is to touch on the history of how these scores/indices were formulated, compare them, and evaluate the feasibility of their practical application. We will also briefly touch on studies that include factors not considered in the P-PASS and PDRI scores.