Nationally, there are over 3,000 patients waiting for a pancreas, pancreas islet cell, or pancreas-kidney transplant.

Policy 3.8 Organ Distribution

3.8 Pancreas Allocation. The following policies shall apply to the allocation of pancreata.

3.8.1 Pancreas Organ Allocation. For local pancreas allocation, recipients may be selected from candidates awaiting an isolated pancreas, kidney-pancreas combination, or a combined solid organ-islet transplant from the same donor, unless there is a patient on the UNOS Patient Waiting List who meets the requirements of Policy 3.5.3 or Policy 3.8.1.6 and for whom there is a zero antigen mismatch with the donor. Within each Patient Waiting List, length of time waiting shall be considered for the selection of organ recipients. For combined kidney-pancreas candidates, blood type O kidneys must be transplanted into blood type O recipients as specified in Policy 3.5.1, unless there is a zero antigen mismatch between the candidate and donor and the candidate is highly sensitized as defined in Policy 3.5.3. If the pancreas is not placed locally for an isolated or combined whole organ transplant, a combined solid organ-islet transplant, a zero antigen mismatch patient or pursuant to Policy 3.5.3, the pancreas shall be allocated regionally and then nationally, or for patients listed for facilitated pancreas placement as described in Policy 3.8.1.3, in the following sequence:

NOTE: The amendments to Policy 3.8.1 (Pancreas Organ Allocation) shall be implemented pending programming on the UNOS computer system.

3.8.1.1 Regional Whole Pancreas Allocation. Within each of the following categories, allocation shall be based on the transplant candidate's length of time waiting.

Isolated pancreas candidates with 1 A, B, DR antigen mismatches; Isolated pancreas candidates with 2 A, B, DR antigen mismatches; Isolated pancreas candidates with 3 A, B, DR antigen mismatches; Combined kidney-pancreas candidates if the kidney is available. Blood type O kidneys must be transplanted into blood type O recipients as specified in Policy 3.5.1, and the kidney must be paid back as specified in Policy 3.5.7; and Isolated pancreas candidates with 3 4 or more A, B, DR antigen mismatches.

3.8.1.2 National Whole Pancreas Allocation. Within each of the following categories, allocation shall be based on the transplant candidate's length of time waiting.

Isolated pancreas candidates with 1 A, B, DR antigen mismatches; Isolated pancreas candidates with 2 A, B, DR antigen mismatches; Isolated pancreas candidates with 3 A, B, DR antigen mismatches; Combined kidney-pancreas candidates if the kidney is available. Blood type O kidneys must be transplanted into blood type O recipients as specified in Policy 3.5.1, and the kidney must be paid back as specified in Policy 3.5.7; and Isolated pancreas candidates with 4 or more A, B, DR antigen mismatches. 3.8.1.3 Facilitated Pancreas Allocation. In the event that the UNOS Organ Center has attempted, but has been unable, to place the pancreas for a period of at least five (5) hours, or upon notice to the Organ Center that organ retrieval is anticipated within one (1) hour, then irrespective of whether the entire regional and/or national Waiting List of patients has by that time been exhausted, the pancreas shall be offered through the UNOS Organ Center for patients listed with those transplant centers that have recorded in writing their desire, to participate in the UNOS system of facilitated pancreas allocation. A pancreas offered by this facilitated method shall be offered to patients who have not previously received an offer for that pancreas. If tissue typing is not available at the time of the offer, the offer shall be based upon length of waiting time alone. If tissue typing is available, then the pancreas shall be offered, in the following sequence, based on the transplant candidate's length of waiting time within each enumerated category below:

Isolated pancreas candidates with 1 A, B, DR antigen mismatches; Isolated pancreas candidates with 2 A, B, DR antigen mismatches; Isolated pancreas candidates with 3 A, B, DR antigen mismatches; Combined kidney-pancreas candidates if the kidney is voluntarily being offered. Blood type O kidneys must be transplanted into blood type O recipients as specified in Policy 3.5.1, and the kidney must be paid back as specified in Policy 3.5.4; and Isolated pancreas candidates with 4 or more A, B, DR antigen mismatches. Any transplant center desiring to participate in this system shall be allowed to do so provided that it (a) agrees to accept offers for pancreata that have been procured by institutions located outside of its OPO (b) agrees to accept offers for pancreata on a conditional basis pending tissue typing information and redistribution of the organs pursuant to UNOS Policy 3.8.1.6 in the event there is a patient on the Waiting List for whom there is a zero antigen mismatch with the donor, and (c) documents this agreement and its desire to participate in the system to UNOS in writing.

3.8.1.4 Islet Transplantation. If a suitable recipient is not identified by the allocation criteria specified in Policies 3.8.1, 3.8.1.1, 3.8.1.2, or 3.8.1.3, then the Host OPO shall offer the pancreas locally for clinical islet transplantation. If the organ is not used locally, the Host OPO shall offer the pancreas regionally and then nationally for clinical islet transplantation. If the organ is not used for transplantation, then the Host OPO should offer the pancreas for research.

3.8.1.5 Islet Allocation Protocol. Two active status codes will be used, Status 1 (Urgent) and Status 2 (Non-Urgent). At the regional and national level islet allocation shall be as follows:

Matching 0 HLA Mismatch 3 points 1 HLA Mismatch 2 points 2 HLA Mismatch 1 point 3-6 HLA Mismatch 0 points Status 1 A patient that receives a clinical islet transplant becomes a Status 1 for a three week period. (Recipients need islets from four or more donors within three weeks). Status 1 islet candidates shall have priority over Status 2 candidates at each level of allocation, (i.e., local, regional, then national). Status 2 All patients on the clinical islet transplant list who do not meet the Status 1 criteria. Waiting Time Waiting time shall begin when a patient is placed on the UNOS Patient Waiting List (See Policy 3.2.5 regarding accrual of waiting time while a patient is listed as inactive). Waiting time as a Status 1 begins when the patient becomes a Status 1 and continues until they are no longer a Status 1. If a patient returns to a Status 2, their entire waiting time continues. One point will be assigned to the patient waiting for the longest period with fractions of points assigned proportionately to all other patients, according to their relative waiting time. For example, if there are 75 patients waiting for islets, the patient waiting the longest would receive 1 point (75/75 x 1 = 1). A person with the 60th longest time of waiting would be assigned 0.2 points (75-60)/75 x 1 = 0.2). The calculation of points is conducted separately for each geographic (local, regional and national) level of islet allocation. The local points calculation includes only patients on the local Patient Waiting List. The regional points calculation includes only patients on the regional list, without the local patients. The national points calculation includes all patients on the national list excluding all patients listed on the Host OPO's local or regional waiting list.