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Questions and answers for transplant candidates about pancreas, pancreas-kidney, & islet allocation

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Welcome to our question and answer page for pancreas, pancreas-kidney, and islet cell allocation.

We addressed below the most common information requested by people seeking a transplant for themselves or a loved one, as well as for transplant recipients or their caregivers who want to know more about their treatment. If you have a more general interest in transplantation, we hope you find it helpful as well.

If you have other questions or comments, contact the Organ Procurement and Transplantation Network (OPTN) Patient Services line at (888) 894-6361 or submit them here.

What does a pancreas do?

Your pancreas has two main functions:

  • an exocrine function
  • an endocrine function

The exocrine glands in your pancreas make chemicals that allow your body to digest food and absorb the nutrients from that food. The endocrine glands in your pancreas make insulin. Insulin is the hormone that regulates the level of sugar in your blood.

If you have type 1 diabetes, your pancreas cannot create insulin. You must take insulin on a regular basis.

If you have type 2 diabetes, your pancreas makes insulin, but your body does not respond to it correctly.

Separately from diabetes, your pancreas may not produce enough of the chemicals to digest food properly. This is called exocrine pancreatic insufficiency.

What are the types of pancreas transplants?

  • Pancreas-alone: a transplant where you just receive a pancreas
  • Simultaneous pancreas-kidney: a transplant where you receive a kidney and a pancreas at the same time
  • Pancreas after kidney: a transplant where you receive a pancreas by itself after you have already had a kidney transplant, usually from a living donor
  • Islet cell transplant: injection of pancreatic islet cells in your liver so that you can begin to make insulin on your own

Why would I need a pancreas transplant?

If you have diabetes, your pancreas is not working as it should. Over time, diabetes can cause problems. You might not be able to tell when your blood sugar is low, which can lead to fainting or seizures. Even if you are following your doctor’s advice to take your medication, exercise, and keep a healthy weight, you might still be unable to control your blood sugar levels. When your diabetes becomes this severe, a pancreas transplant could greatly improve your quality of life.

However, receiving a pancreas is a big operation. A transplant would require you to take drugs for the rest of your life to keep your immune system from rejecting it. These drugs may have serious side effects. For these reasons, even if you have diabetes, a pancreas transplant might not be right for you. However, if your diabetes causes your kidney to fail, you may need a kidney transplant as well.

In addition, since you would already be taking immunosuppressive drugs for a transplanted kidney, adding a pancreas would be less of a risk. Your diabetes also might cause enough medical problems that having a pancreas-alone transplant may help, even if you have not already received a kidney.

Some diabetic patients might also benefit from transplantation of islet cells. Islet cells are the cells within the pancreas that produce insulin. In an islet transplant the whole pancreas is not transplanted. A medical professional injects pancreatic islet cells into your body so that, in time, it can produce insulin on its own. It often takes two or more islet transplants for your body to make enough insulin to better control your diabetes. Some patients may still need to take insulin after the islet cell transplants, but they will have fewer dangerously low blood sugar episodes.

In rare cases, pancreas transplants are done for people with exocrine pancreatic insufficiency, which means you are unable to digest food properly. This would only be in cases where it cannot be treated in other ways, such as dietary supplements.

Once I am on the waitlist, how do they determine who receives an organ?

When an organ becomes available for transplant, the OPTN computer matching system compares information on that organ with all patients around the country who may be a match.

Blood type and the amount of time someone has spent waiting are the first items considered. The closer you match with a particular organ and the longer you have been waiting, the more likely it is that your transplant team will receive an organ offer for you.

Because organs can only be preserved for a short time from donation to transplant, the computer matching system also considers the distance from the donor hospital to the transplant hospital where a patient is listed. A shorter distance means a shorter amount of time the organ must be preserved. This makes it more likely the transplant will be a success.

If you are waiting for both a kidney and a pancreas, matching your genetic immune system markers with those of the donor will help predict the long-term success of your transplant. If the immune system markers on your organ are an exact match with the markers on one of the donor organs, you will receive priority on the waitlist.

Some people waiting for kidneys have developed immune system responses that make it very hard to find a kidney that their body will not reject. This may occur from having:

  • a prior transplant
  • blood transfusions
  • a pregnancy

Those difficult to match, “highly sensitized,” individuals will also get priority for a donor organ that appears to be a good match.

What do I need to do to get on the waitlist?

The details vary depending on the specific organ you need. You will find basic requirements and general information below. Keep in mind that you may have to meet other criteria set in place by your transplant hospital. Your transplant team will evaluate if a transplant is a good option for you.

Pancreas-alone transplant

How can I be listed for a pancreas transplant?

Most patients in need of a pancreas transplant have:

  • diabetes that requires you take insulin, as well as complications that cannot be well managed with standard therapy
  • rarely, severe digestive disorders after surgery to remove your pancreas

Once I'm registered, what else do I have to do?

Once you have met the initial medical qualifications, you may remain on the list without having to requalify. You might have to return to the transplant hospital for follow-up evaluations.

When do I begin getting credit for waiting time?

As soon as you are placed on the list, you begin to accumulate waiting time. If for some reason your medical condition changes and you are unable to receive a transplant for a period of time, your transplant team might make you inactive on the waitlist. Whether your status is active or inactive, you will continue to gain waiting time. However, you will not receive organ offers while you are on the inactive list.

Simultaneous pancreas-kidney transplants

How do I qualify to be listed for a simultaneous pancreas-kidney transplant?

You must have kidney failure, which means you are on dialysis or you meet a medical standard of kidney failure (see below, under kidney waiting time criteria). You also must have either diabetes or pancreatic exocrine insufficiency.

Once I'm registered, what else do I need to do?

Once you meet the qualifications and are listed, you will remain on the waitlist as long as nothing changes to disqualify you for a transplant.

When do I begin getting credit for waiting time?

If you are under 18, you begin earning waiting time from the first day you are added to the list.

If you are 18 or older, you begin earning waiting time as soon as you meet the following criteria:

  • You are listed for a kidney-pancreas transplant.
  • You are on insulin.
  • You meet the criteria to accrue kidney waiting time. This would mean that you have met at least one of the following:
    • Your kidney function, as measured with a glomerular filtration rate (GFR) or creatinine clearance rate (CrCl), is 20 mL/minute or lower.
    • You have begun dialysis on a regular basis.

Islet transplant

How can I be listed with an active status for islet transplants?

You must either:

  • depend on insulin injections, or
  • have a hemoglobin A1c (HbA1c) value greater than 6.5%

Once I'm registered, what else do I need to do?

Once you have met the initial qualifications, you may remain on the list without having to requalify, as long as nothing changes to disqualify you for a transplant.

When do I begin getting credit for waiting time?

As soon as you are listed, you begin earning waiting time. Patients typically require two or more islet transplants before they can begin making enough insulin to either lower or stop the need for insulin injections. You can continue to earn waiting time up to the third islet transplant you receive. After the third transplant, your waiting time will begin again at zero.

What if I have more questions?

You should contact your transplant team if you have questions or concerns. You also can read the entire pancreas allocation policy in the Policy section of the OPTN website.

Acronyms and terms

C-peptide – A substance made in the pancreas, along with insulin. A C-peptide test shows how much insulin your body is making.

Digestive enzymes – Substances secreted by cells lining the pancreas which break down the food you eat.

Genetic markers – A gene or short sequence of DNA used to identify a chromosome or to locate other genes on a genetic map.

Hemoglobin – A red blood cell protein responsible for carrying oxygen from the lungs to organs and tissues in the body.

Immunosuppression drugs – A class of drugs that reduce the strength of the body’s immune system, making it less likely to reject a transplanted organ.

Insulin – A hormone produced in the pancreas which regulates the amount of glucose in the blood. The lack of insulin causes a form of diabetes.