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Non-heart-beating organ donors: a potential source of islets for transplantation?
H A Clayton1, S M Swift, J M Turner
1Department of Surgery, University of Leicester, Leicester Royal Infirmary, United Kingdom.
Background:
The shortage of organ donors relative to the number of patients on transplant waiting lists has led to a renewed interest in the use of non-heart-beating (NHB) organ donors in many centers. The lack of donors is also a problem for islet transplantation. The disparity between donor organs and potential recipients is further exacerbated by the requirement to transplant a large number of islets to increase the chance of success and the high level of variability in islet isolation yield. Non-heart-beating (NHB) donors have not previously been assessed as a source of islets for transplantation, and it is unknown what affects the additional factor of warm ischemic injury associated with NHB organs may have on the success of islet isolation.
Methods:
This study assesses the yield and function of islets from NHB donors and compares the results with islets obtained from heart-beating brain-dead (HB) donors.
Results:
There were no differences in the yield of islets per gram of pancreas, 1788 (0-4620) NHB vs. 1580 (26-2544) HB (median, range). The secretory function was also similar in both groups, with stimulation indices of 0.71-3.49 for NHB vs. 0.30-3.57 for HB (overall range). There was no correlation between islet yield and warm ischemia time in the NHB donor group.
Conclusions:
In conclusion, the study has demonstrated that it is possible to isolate large numbers of islets from NHB donor pancreata and that, where NHB donor programs exist, these could provide a significant addition to the number of potentially transplantable islets.
Insights
Non-heart-beating (NHB) donors can provide a significant number of islets for transplantation, comparable to heart-beating donors. Islet yield and function are not negatively impacted by warm ischemia time in NHB organ donors.
Area of Science:
- Transplantation immunology
- Organ donation science
- Endocrinology
Background:
- Organ donor shortage impacts transplant waiting lists, including islet transplantation.
- Non-heart-beating (NHB) donors are increasingly considered for organ donation.
- The impact of warm ischemic injury on NHB donor islets is not well understood.
Purpose of the Study:
- To assess islet yield and function from NHB donors.
- To compare NHB donor islets with those from heart-beating (HB) donors.
Main Methods:
- Islet isolation from NHB and HB donor pancreata.
- Quantification of islet yield per gram of pancreas.
- Assessment of islet secretory function via stimulation indices.
Main Results:
- No significant difference in islet yield between NHB and HB donors.
- Similar islet secretory function observed in both donor groups.
- No correlation found between islet yield and warm ischemia time in NHB donors.
Conclusions:
- NHB donor pancreata yield a substantial number of islets.
- NHB donors represent a valuable source to increase the pool of transplantable islets.
- NHB donor islet isolation is feasible and effective.