title: Accept or refuse? Factors influencing the decision-making of transplant surgeons who are offered a pancreas: results of a qualitative study.
abstract: BACKGROUND
  Most offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon's decision to select an offered pancreas.
  
  
  METHODS
  Semi-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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Medical Sociology, University of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg D-93053, Germany. julika.loss@ukr.de.
authors.forename: Julika
authors.initials: J
authors.lastname: Loss
authors.forename: Karl P
authors.initials: KP
authors.lastname: Drewitz
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Martin
authors.initials: M
authors.lastname: Loss
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D046148:Donor Selection / Q000379:methods* / Q000592:standards; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D016035:Pancreas Transplantation; D017410:Practice Guidelines as Topic; D036301:Qualitative Research