Ling J1,2, Polkinghorne K1,2,3, Kanellis J1,2
1Monash Medical Centre, Clayton, Australia, 2Department of Medicine, Monash University, Clayton, Australia, 3Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
Aim: To examine reasons underlying non-retrieval and non-utilisation of donor pancreata for solid pancreas transplantation in Australia and New Zealand (ANZ) and identify potentially useable organs from this cohort.
Background: Deceased donor pancreas non-utilisation has increased in Australia, UK and the USA. Pancreas non-retrieval has increased in Australia and is high in New Zealand. We hypothesised that deceased donor pancreata in ANZ were not being optimally identified, retrieved or utilised.
Methods: Deceased donors from 2007 to 2016 from the Australian and New Zealand Organ Donor (ANZOD) registry were analysed for reasons underlying non-authorisation of pancreas donation, and for pancreas non-retrieval or non-utilisation. These groups were then screened using Transplantation Society of Australia and New Zealand (TSANZ) deceased-donor criteria to identify potentially suitable solid-organ pancreas donors. Their characteristics were then compared to actual donors.
Results: 2998 donors had authorisation requested for pancreas donation during the study period. Donor medical unsuitability (37%) was the commonest reason for non-retrieval followed by donor age (25%) and logistics (14%). Several potential solid-organ pancreas donors (n=222) comprising 18/71 non-authorised (25%), 197/1765 non-retrieved (11%), and 7/131 non-utilised pancreata (5%) were identified. When compared to actual donors, only donor region of origin, history of hypertension and cause of death were significantly different. Increasing donor upper-age limit to 50 years old resulted in an additional 62/1967 (3%) potential solid-organ pancreas donors.
Conclusions: Potential additional solid-organ pancreas donors exist within the non-authorised, non-retrieved and non-utilised pancreas donor groups in ANZ. Further research into increasing solid-organ pancreas donor upper-age limits, and minimising logistical barriers to pancreas retrieval are necessary to minimise non-retrieval and non-utilisation of potentially transplantable donor pancreata.
Jonathan Ling is a nephrologist at Monash Medical Centre (VIC) with an interest in management of chronic kidney disease and transplant nephrology. He obtained his medical degree from the University of Liverpool (UK) before migrating to Australia. He attained his FRACP in 2017 after undertaking specialist physician training at the Royal Hobart Hospital, Alfred Hospital and Monash Medical Centre. He is completing a PhD (Monash University) examining eligibility criteria, potential barriers to transplant and factors affecting outcomes of solid pancreas transplantation in Australia and New Zealand.