Purpose of review: The present review investigates donor qualities that impact pancreas and islet transplantation, with a focus on donors that have been historically underutilized, including those of extreme age, extreme size, and donors after cardiac death.
Recent findings: The increasing waiting time caused by the shortage of available pancreata and the growing number of patients with uncontrolled diabetes has led to the expansion of acceptance criteria for transplantable pancreata. The possible increased perioperative risks and/or foreshortened graft survival associated with the use of 'extreme' donors should be weighed against the mortality of uremic diabetics on the waiting list and the risk of dying from a hypoglycemic-unawareness episode. Current data have shown that pediatric pancreas donors are associated with excellent outcomes. Selected donors up to 50 years of age are suitable for both islet and pancreas transplantation. Obese donors are more appropriate as islet donors, and donors after cardiac death provide an underutilized source of pancreata for transplantation, with clinical results that are identical to those observed from ideal donors.
Summary: Donor selection in pancreas transplantation significantly impacts outcome, yet the use of extended criteria donors can provide results comparable with those of ideal donors.