Pancreas donor selection

Pancreas transplantation is the only durable cure for insulin-dependent diabetes mellitus. While results have significantly improved, listing for and transplantation of pancreatic allografts appears to be decreasing. Data on pancreas outcomes suggest that even “nonideal” allografts can be safely used to expand the donor supply. The chapter reviews the outcomes with ideal and nonideal allografts such as those from donors who are older, had high body mass index, or donated after cardiac death. Pancreas outcome can be effectively and accurately predicted when using the Pancreas Donor Risk Index (P-DRI) which is based on preoperative variables including donor gender, age, race, BMI, height, cause of death, preservation time, DCD status, and serum creatinine. Although the P-DRI scoring system is highly reliable, the final assessment of the safety of transplant must be made by direct examination of the allograft after recovery by an experienced pancreas transplant surgeon.