title: The UK Pancreas Allocation Scheme for Whole Organ and Islet Transplantation.
abstract: In order to develop a national allocation scheme for donor pancreases, factors affecting waiting time and transplant outcomes in the United States (US) and United Kingdom (UK) were analyzed and compared. Blood group, sensitization, dialysis requirement, and whether the patient was waiting for a kidney and pancreas or pancreas alone affected waiting time in both countries; ethnicity and body mass index (BMI) also affected waiting time in the US. Ninety-day pancreas survival was similar in the UK and US, and was poorer for patients receiving a pancreas alone, with older donors, higher BMI and longer duration of ischemia in both countries. Factors affecting outcome, together with published data on factors affecting islet transplantation, informed the development of a points based allocation scheme for deceased donor pancreases in the UK providing equitable access for both whole organ and islet recipients through a single waiting list. Analysis of the allocation scheme 3 years after its introduction in December 2010 showed that the results were broadly as simulated, with a significant reduction in the number of long waiting patients and an increase in the number of islet transplants. There remains a surplus of highly sensitized patients in the waiting list, which the scheme should address in time.
authors.affiliation: Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England.
authors.forename: A
authors.initials: A
authors.lastname: Hudson
authors.affiliation: Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England.
authors.forename: L
authors.initials: L
authors.lastname: Bradbury
authors.affiliation: Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England.
authors.forename: R
authors.initials: R
authors.lastname: Johnson
authors.affiliation: Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England.|The Oxford Transplant Center, Churchill Hospital, Headington, Oxford, England.
authors.forename: S V
authors.initials: SV
authors.lastname: Fuggle
authors.affiliation: Institute of Cellular Medicine (Diabetes), The Medical School, Newcastle-upon-Tyne, England.
authors.forename: J A M
authors.initials: JA
authors.lastname: Shaw
authors.affiliation: Scottish Islet Transplant Unit, The Royal Infirmary, Edinburgh, Scotland.
authors.forename: J J
authors.initials: JJ
authors.lastname: Casey
authors.affiliation: The Oxford Transplant Center, Churchill Hospital, Headington, Oxford, England.
authors.forename: P J
authors.initials: PJ
authors.lastname: Friend
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge and the NIHR Cambridge Biomedical Research Center, England.
authors.forename: C J E
authors.initials: CJ
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D017408:Guidelines as Topic; D015276:Health Care Rationing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D010182:Pancreatic Diseases / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D006113:United Kingdom; D014850:Waiting Lists; D055815:Young Adult
keywords: Clinical research; islet transplantation; islets of Langerhans; organ allocation; organ procurement and allocation; pancreas; pancreas-kidney transplantation; practice; registry analysis; simultaneous registry