Comments

Region 1 | 08/29/2024

One attendee commented that part of the reason their program no longer does pancreas transplants was because their pancreas surgeon felt that oftentimes, how the liver was recovered resulted in damage the pancreas anatomy, so it is highly important to consider issues related to pancreas recovery. Another member said that only efficiency and patient matching should be considered for pancreas continuous distribution, and that the only time a pancreas is transported should be if the list of local candidates is exhausted.

During the meeting, attendees participated in group discussions and provided the following feedback:

· The group agreed there’s need for improved training and dedicated pancreas directors, but ultimately questioned whether it should be a goal to increase the number of pancreas transplants. 

UAMS Medical Center | 08/28/2024

After reviewing the Summer 2024 update to the continuous distribution of pancreata proposal, we appreciate the additional information provided and offer the following feedback. We believe that it is important to standardize the distribution process for simultaneous Kidney/Pancreas transplants. Creating a standardized process will allow all centers/OPOs to communicate effectively during organ allocation. We feel that multiple patient attributes should be evaluated simultaneously, and a composite allocation score should be created to remove the barriers with categorized scoring.

Region 8 | 08/27/2024

During the meeting, attendees participated in group discussions and provided feedback in-person and online, on the following questions:

· For innovative strategies that could be implemented to enhance fellowship training and cultivate greater interest in pancreas transplantation among medical professionals and what range of skills and experiences might contribute to a professional's readiness to participate in organ procurement procedures – attendees suggested the following:

o  Volume, experience, and exposure to pancreas transplants are really important

o  More funding to promote training in pancreas transplants

o  Train at centers that do the procedure

o  Personal mentorship by experienced surgeon

o  Focus on comprehensive skill development, including advanced surgical and blood conservation techniques crucial for patients like Jehovah's Witnesses. (This aligns with the OPTN Ethics Committee's 2021 White Paper encouraging unbiased evaluation.) Fellows should rotate through related specialties, participate in research on bloodless surgery techniques, and engage in simulation-based training for complex scenarios. Cultural competence training should emphasize consistent, transparent criteria application to avoid discrimination. Mentorship programs with surgeons experienced in bloodless transplantation and interdisciplinary collaboration can advance innovative techniques. These strategies ensure a well-rounded skill set addressing diverse patient needs and could increase overall transplant numbers.

· For encouraging OPOs to have procurement teams for all abdominal organs, including pancreas, impact procurement, attendees suggested the following:

o  Make it more efficient and economical

o  If the surgeons are highly skilled, it would be positive; if not, it would have negative impact

o  Noted support for OPOs having procurement teams

· For encouraging programs to have dedicated pancreas directors, separate from kidney, influence outcomes and growth of the programs, attendees provided the following feedback?

o  A dedicated person that can focus on increasing pancreas transplant would be ideal.

o  There could be a decrease in volume since pancreas transplant is a specialized field. 

Region 4 | 08/19/2024

One attendee strongly advocated for giving priority to prior living donors noting that over the past 25 years, the number of prior living donors who are listed for transplant is very low but has a high impact on promoting trust in the system and is important for how the transplant community connects with the community at large. 

Virtual attendees also provided feedback that education of diabetic specialists could cultivate greater interest in pancreas transplants among medical specialists. Attendees also commented that having dedicated pancreas program directors could improve outcomes and increase transplant. Some attendees commented that encouraging OPOs to have procurement teams for pancreas would be helpful for quicker coordination of procurement with family and donor hospital OR availability.  It would also reduce the risk of flying for the transplant team.  

Region 2 | 08/16/2024

Feedback submitted online emphasized the importance of setting standards to improve the chances of successful transplant outcomes. An attendee, who is a simultaneous kidney and pancreas transplant recipient, expressed a wish that they had been given the option for a pancreas transplant 25 years earlier. This could have potentially prevented complications from Type 1 Diabetes and preserved their kidneys. There was also agreement on the value of metrics and modeling in the Continuous Distribution update. 

During the meeting, attendees participated in group discussions and provided feedback on the following questions: 

• What innovative strategies could be implemented to enhance fellowship training and cultivate greater interest in pancreas transplantation among medical professionals? What range of skills and experiences might contribute to a professional's readiness to participate in organ procurement procedures? 
• The discussion highlighted the rarity of pediatric pancreas transplants, particularly for adolescents who often face challenges in accessing adult programs due to the specialized skills required for pancreas surgeries. The need for adult programs to gain expertise in treating younger patients was emphasized, especially as advancements in diabetes care, such as Dexcom and insulin pumps, are transforming treatment options. Concerns were raised about the future of training for pancreas transplant surgeons, including the potential reduction of required surgical fellowship years and the removal of mandatory transplant rotations, which could impact the quality of training. The idea of utilizing simulation labs to enhance surgical practice and better prepare fellows and donor surgeons for pancreas transplants was proposed. Additionally, it was noted that, with limited pancreas donor resources, it is essential to ensure that all transplant surgeons are adequately trained and qualified. There was some uncertainty expressed about the relevance of pancreas transplants given the advancements in insulin technology, indicating a need for ongoing discussion in the transplant community about these issues. 
• How might encouraging OPOs to have procurement teams for all abdominal organs, including pancreas, impact procurement? 
• The discussion focused on the potential benefits of moving towards local recovery of pancreata from an OPO perspective. Local recovery could improve the training of procurement staff and ensure that centers are more inclined to utilize pancreata, as they would have the capability to procure them directly. This approach aims to control the recovery narrative and reduce declines attributed to inadequate recovery staff or the challenges of traveling long distances for pancreas retrieval. Overall, enhancing local recovery practices could increase the number of available pancreata for transplantation. 
• In what ways might encouraging programs to have dedicated pancreas directors, separate from kidney, influence outcomes and growth of the programs? 
• While there was some skepticism about whether simply appointing a pancreas director would lead to significant improvements, it was noted that having someone solely focused on pancreas transplants could enhance interest and outcomes. Dedicated pancreas directors may not be influenced by the demands of kidney or liver transplants, allowing for a more concentrated effort in this area. It was acknowledged that having specialized staff could improve outcomes, although there are questions about the overall demand for pancreas transplants, especially regarding the inclusion of type 2 diabetics. The conversation also highlighted the high costs associated with pancreas transplantation, raising concerns about the financial feasibility of expanding programs focused solely on pancreas transplants. 

Luke Preczewski | 08/02/2024

I am generally supportive of these efforts, especially resolution of issues related to SPK. Will need to see an actual proposal for this, but the direction is right.
One note: the discussion needs to take into account much more significantly logistic and financial consequences of allocation changes. Past changes have led to a system in which far too many unnecessary flights occur. This has dramatically increased logistic challenges and costs for transplant centers. This trend is not financially or logistically sustainable, and any future changes need to take this seriously.