Why offered pancreases are refused in the allocation process-a descriptive study using routine data from eurotransplant.

The majority of pancreases, offered in allocation, are discarded. This pancreas underutilization is not well understood yet. We analyzed the detailed allocation protocols of all Eurotransplant-registered German whole-pancreas donors (2005-2009; n=1758). Outcome measures included donor characteristics, number of refusals per organ, and proportion of different refusal reasons in the whole sample and subgroups. Thirty-seven percent of offered pancreases were transplanted; among these, 62% of pancreases were of potentially high quality (favorable donor age and pre-procurement pancreas allocation suitability score, no malignancy, n=290). A pancreas was placed after four offers (median) or withdrawn after eight offers (median). Seventy-five percent of refusal reasons were donor related (e.g., "lab results", "age", "macroscopy", and "long intensive care unit [ICU] stay"). Among pancreases refused for "diabetes" or "malignancy" at least once, the proportion of transplanted organs was less than 10%; pancreases refused due to "trauma", "age", or "resuscitation" were later transplanted in 48%, 32%, and 28%, respectively. The impact of donor age and ICU stay on organ refusal varied substantially: organs were refused due to length of ICU stay even if donors stayed 7 days or less; some organs were transplanted without ever being refused due to ICU stay in donors who stayed 8 days or more in ICU. There were no clinically significant disparities between donors of used and unused pancreases, except age (median, 31 vs. 42 years). The loss of several pancreases seems avoidable. Many refusal reasons are not plausible, because there is no evidence supporting the refusal and because many of these organs were transplanted by other centers. This increases inefficiency in the allocation system.