Excellent medical care and readily accessible insulin preparations serve to require a very high quality of deceased donor pancreas organs accepted for transplantation. Improving, prevailing outcomes for individuals with diabetes require that only the very highest quality organs are utilized. As an organ procurement organization (OPO) whose outcome measure is organs transplanted per donor (OTPD), we are motivated to pursue pancreas donation/transplantation from every potentially suitable donor. Through our QAPI program, we have retrospectively assessed the importance of a replaced right hepatic artery (originating from the superior mesenteric artery instead of the celiac access) in practically limiting the surgical judgment to recover this organ.

A simple scoring system agreed upon by all local pancreas transplant program directors was implemented for the anatomic assessment of deceased donor organs. The anatomic recovery surgeon was asked to assign this score. The liver surgeon was asked to indicate the presence of a replaced right hepatic artery, independent of the pancreas gland score.

Overall, 18% of donors for whom there was an intent to transplant the pancreas upon entry to the operating room, were found to have a replaced right hepatic artery emanating from the superior mesenteric artery. During the time frame under study, 58% of these organs were "A", 25% were "B" and 19% were "C". Despite being grossly suitable for transplantation, only 44% of anatomically excellent "A" pancreata in the presence of a replaced right hepatic artery were clinically transplanted.

Despite the clear establishment of technical protocols to approach the surgical procurement of a pancreas when a liver is also being recovered and the right hepatic artery is replaced, most pancreas allografts are sacrificed. Development of consensus and surgical comfort in simultaneous organ recovery in this context, is likely to significantly increase the availability of deceased donor pancreata for clinical transplantation.

CITATION INFORMATION: Friedman A., Bagavan P., Delli Carpini K. To Score a Pancreas, Stars Must Be Aligned Am J Transplant. 2017;17 (suppl 3).

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