Pancreas Alone Grafts from Cardiac Death Donors; is Procurement Damage an Issue?

Abstract

Aims: In order to minimize damage to DCD (deceased cardiac donors) pancreatic grafts the donor surgery has to proceed as quickly as possible. Because of this previous studies have suggested that organs procured (liver and kidney) from DCD donors have higher discard rates. The aim of this study was to establish whether DCD pancreatic grafts were more likely to be damaged and discarded when compared to conventional DBD (deceased brainstem) pancreatic grafts. Methods: Data was collected retrospectively from pancreatic alone organ offers to our single centre over a 12 month period and analyzed, Simultaneous kidney pancreas (SPK) grafts were excluded. Results: Of 33 pancreas alone offers 15 were DCD’s and 18 were DBD’s. There was no difference in leading cause of death between DCD or DBD donations of which intracranial hemorrhage was the most frequent and Hypoxic brain injury [joint with cardiovascular accidents (CVA) for DBD donations] the next most frequent cause. There was also no difference in BMI between the two groups. For DCD’s the mean donor age was 45.5 years compared with 42.6 years for DBD organs. 6% of all organs were discarded (n=2) because of procurement damage and all were from DBD donors. Of the remaining 31 organs only 6 were transplanted (DBD n=5 to DCD n=1). The leading cause of decline for the remaining 27 organs was donor history for both groups followed by prolonged cold ischemia for DBD’s and other logistical reasons for DCD’s. Procurement damage was the third most common cause of decline for DBD pancreas alone grafts. Conclusions: Although there did not appear to be a higher incidence of pancreatic graft damage when the organ was retrieved from a DCD donor in comparison to DBD donors, there are still organs being discarded because of procurement damage. Enhanced training techniques/supervision during the retrieval process still need to be optimised to reduce organ discard rates even further so no organs are ever wasted because of procurement damage.