The pancreas is a long, thin organ that lies behind the stomach in the back of the upper abdomen. It has two functions carried out by different types of cells: to produce enzymes aiding in digestion, and to produce insulin to help the body move sugar into the cells for nutrition.
Pancreas transplantation is offered only to persons with severe pancreatic failure.
Generally, individuals with type I diabetes ranging in age from childhood to age 50 are possible candidates, though occasionally a person older than 50 may be considered for pancreas transplantation. However, many of them have had diabetes so long that other complications make pancreas transplant surgery too risky.
A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a pancreas transplant. This team includes surgeons, kidney specialists known as nephrologists, social workers, nurses, and transplant coordinators.
A few conditions would disqualify a person from receiving a pancreas transplant. These include: cancer within the past five yearscertain infections, such as tuberculosis or osteomyelitis, a bone infectionsevere lung, liver, or kidney problems or complications from diabetes that would make the operation too risky
A candidate for a pancreas transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new pancreas because it is something foreign. Immunosuppressants are medications that keep the immune system from attacking the new pancreas. These medications need to be taken for as long as the new pancreas functions.
The person will also need lifelong follow-up by healthcare professionals. If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a pancreas from a donor. There are currently about 3,000 people in the US waiting for a pancreas or a combined pancreas-kidney transplant.
Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain dead donor. Two or three teams may operate on the donor at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.
The pancreas can be preserved safely for about 12 to 15 hours. The transplant surgery needs to take place within this timeframe. The pancreas transplant recipient is given general anesthesia. This means that the person is put to sleep with medications and feels no pain. The person is put on a ventilator, an artificial breathing machine, during the surgery.
For a pancreas transplant alone or "pancreas after kidney" transplant, a curved incision is made in the lower part of the abdomen off to one side or the other. The pancreas can be placed on the left or the right side. If a kidney transplant has already been done, the pancreas is placed on the opposite side. If a combined pancreas-kidney transplant is to be done, the pancreas is usually placed on the right side and the kidney on the left.
The pancreas is usually implanted first, followed by the kidney. A major artery and a major vein are connected to restore blood flow to the new pancreas. Then the section of duodenum (the beginning of the small intestine) which came along with the donor pancreas is connected to the recipient's intestine or bladder. Once all of the connections are complete, the incision is closed and the recipient is taken to the intensive care unit for recovery.