**4.3. Pancreas allocation**

Solid organ allocation protocols are the major influence on patients' waiting-list vintage. In the UK, the introduction of a new nationwide allocation system in December 2010 significantly reduced the number of long-lasting patients and increased the number of islet transplants [11]. These protocols must comply with national legislations and logistic constraints. Several factors must be taken into account, such as donor demographics, donor center, geographical proximity to transplant center, and recipient priority indexes. In the UK protocol, weighting factors included expected organ travel time, recipient sensitization, dialysis vintage, waiting-list time, HLA mismatching, and donor BMI (differential weighting for islet or whole-organ transplantation). Other allocation protocols, such as the US and the Eurtotransplant, also include in their weighting factors donor, recipient and center characteristics.

that DCD donors are a suitable source of organs for pancreas and islet transplantation in selected donors [17]. Age limit acceptance is usually lower for DBD donors (<45 years), and both warm and cold ischemia times should be strictly respected, at the risk of increased surgi-

**Table 5** describes the acceptance criteria for both DBD and DCD donors at our center. In sum-

nases and pancreatic enzymes <3× normal values are accepted for transplantation, regardless

≤8 h (>8 h evaluate individually)

• Functional (FWIT): <30

prior to donation: <60

• History of pancreatitis

• Arterial HT • Smoking • Alcoholism

• Hemodynamic instability (SBP <60 mmHg)

William Kelly and Richard Lillehei performed the first pancreas transplant at the University of Minnesota on December 17, 1966 [18]. In the last decades, the progress in immunosuppressive treatment has been parallel to a decrease in postoperative complications, to an improvement in the surgical technique, and ultimately to a better survival of both the graft and the

The correct evaluation of the viability of the pancreas at the time of extraction in the donor is one of the basic pillars to obtain good results in the recipient. This must invariably be accompanied by a correct surgical technique during the extraction and implantation of the

, and transami-

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http://dx.doi.org/10.5772/intechopen.76667

mary, all donors under 45 years without other risk factors, with BMI ≤30 kg/m<sup>2</sup>

**Characteristic DBD donors DCD donors**

) ≤30 ≤30

Warm ischaemia (minutes) — • Total (TWIT): <60

• History of pancreatitis

• Smoking • Alcoholism

≤12 h (>12 h evaluate individually)

Donor age (years) ≤45 (46–55 evaluate individually) ≤45

of being DBD or DCD. Beyond those criteria, individual evaluations are performed.

<3×s <3×s

<3×s <3×s

cal complications.

Donor BMI (kg/m2

time (h)

Expected cold ischaemia

Hepatic transaminases (times above normal value)

Pancreatic enzymes (times above normal value)

**6. Surgical techniques**

Clinical risk factors • Arterial HT

**Table 5.** Hospital clinic pancreas donor acceptance criteria.

patient.

organ.
