Generating Strategies for a National Comeback in Pancreas Transplantation: A Delphi Survey and U.S. Conference Report

In the United States, potential transplant candidates with insulin-dependent diabetes mellitus are inconsistently offered pancreas transplantation, contributing to a dramatic decline in pancreas allograft utilization over the past two decades. The American Society of Transplantation (AST) organized a workshop to identify barriers inhibiting pancreas transplantation and to develop strategies for a national comeback. The two-day workshop focused on four main topics: (1) referral/candidate selection, (2) organ recovery/utilization, (3) program performance/patient outcomes, (4) enhanced education/research. Topics were explored through expert presentations, patient testimonials, breakout sessions, and strategic planning, including identification of tasks for immediate focus. Additionally, a modified Delphi survey was conducted among workshop members to develop and rate the importance of barriers, and the impact and feasibility of workgroup-identified improvement strategies. The panelists identified 16 barriers to progress and 44 strategies for consideration. The steps for a national comeback in pancreas transplantation involve greater emphasis on efficient referral and candidate selection, better donor pancreas utilization practices, eliminating financial barriers to procurement and transplant, improving collaboration between transplant and diabetes societies and professionals, and increasing focus on pancreas transplantation training, education, and research. Partnership between national societies, patient advocacy groups, and professionals will be essential to realizing this critical agenda.