title: Why offered pancreases are refused in the allocation process-a descriptive study using routine data from eurotransplant.
abstract: BACKGROUND
  The majority of pancreases, offered in allocation, are discarded. This pancreas underutilization is not well understood yet.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 A pancreas was placed after four offers (median) or withdrawn after eight offers (median).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).
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
authors: Martin
authors: M
authors: Loss
authors: Karl P
authors: KP
authors: Drewitz
authors: Christian J
authors: CJ
authors: Apfelbacher
authors: Marieke D
authors: MD
authors: van Rosmalen
authors: Axel
authors: A
authors: Rahmel
authors: Hans J
authors: HJ
authors: Schlitt
authors: Julika
authors: J
authors: Loss
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D014019:Tissue Donors; D009927:Tissue and Organ Procurement