Accept or refuse? Factors influencing the decision-making of transplant surgeons who are offered a pancreas: results of a qualitative study

Abstract

BackgroundMost offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon’s decision to select an offered pancreas.MethodsSemi-standardized interviews were conducted with 14 highly qualified transplant surgeons from all 14 German transplant centers performing > 5 pancreas transplantations per year. The interviews focused on medical and non-medical criteria on which the individual accept/refuse decision depends. Interviews were recorded, transcribed and underwent content analysis.ResultsThe interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay. However, there was no consistency in judging these parameters, and clear cut-offs did not exist. The pancreas macroscopy is a pivotal factor, as well as knowing (and trusting) the donor surgeon. 3/14 surgeons reported that they had occasionally refused a pancreas because of staff shortage. Some interviewees followed a restrictive acceptance policy, whereas others preferred to accept almost any pancreas and inspect it personally before deciding.ConclusionThe assessment of medical donor characteristics is highly inconsistent. Both very cautious as well as very permissive acceptance policies may render the allocation process less efficient. A more standardized policy should be discussed. Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

“…However, subjective selection bias because of trust issues towards the recovering surgeon can not entirely be ruled out. This is also shown to be the case in other reports [2,8]. Nevertheless, we tried to limit this by including recovering surgeons from other pancreas transplant centres in our analysis.…”

“…There remains a reticence on accepting less than perfect pancreas allografts for transplantation among many transplantation surgeons. This is because of the potentially high complication rate associated with pancreas transplantation and the misconception of absent survival benefit [1][2][3]. However, it is always on the back table where the final decision has to be made by the transplant surgeon whether or not to proceed with the transplantation.…”

“…It was suggested that more training in pancreas recovery with annual feedback was needed to achieve a drop in refusal rate [8]. Similarly, a qualitative study from Germany conducted over 14 transplant centres performing more than five pancreas transplantation per year showed that transplant surgeons were more inclined to refuse pancreas grafts from a surgeon who has limited experience in pancreas transplantation [2]. During the third WHO Global Consultation on Organ Donation and Transplantation in 2010, it was urged to standardize best common practise in organ recovery.…”

Improving pancreas graft utilization through importation

“…Despite these benefits, there has been a 30% decline in the number of pancreas transplants performed in United States since reaching a peak in 2004, when 1484 pancreas transplants were performed . Fewer transplant referrals, improvement in patient‐centered diabetes management, a proportional rise in donor after cardiac death (DCD) donation, and increased discard rates may all be factors in declining pancreas transplant activity …”

High alcohol intake in deceased donors has no effect on pancreas graft survival: a registry analysis

“…There is also some evidence which suggests that high alcohol intake is associated with an increased risk of pancreatic adenocarcinoma . Therefore, it is understandable that transplant surgeons are reluctant to implant pancreases from donors with a history of high alcohol consumption . However, outcomes of pancreases transplanted from donors with high alcohol intake have been poorly described.…”