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Abstract: TH-PO898

Understanding Barriers and Strategies to Increase Pancreas Transplantation: A Delphi Survey of US Transplant Professionals

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
  • Maher, Kennan Ryan, Saint Louis University, Saint Louis, Missouri, United States
  • Woodside, Kenneth J., Gift of Life, Ann Arbor, Michigan, United States
  • Parsons, Ronald, Emory University, Atlanta, Georgia, United States
  • Cooper, Matthew, Froedtert Hospital, Milwaukee, Wisconsin, United States
  • Dadhania, Darshana M., Cornell University, Ithaca, New York, United States
  • Doshi, Mona D., University of Michigan, Ann Arbor, Michigan, United States
  • Forbes, Rachel C., Vanderbilt University, Nashville, Tennessee, United States
  • Pavlakis, Martha, Beth Israel Lahey Health, Cambridge, Massachusetts, United States
  • Singh, Neeraj, Willis-Knighton Health System, Shreveport, Louisiana, United States
  • Sawinski, Deirdre L., Cornell University, Ithaca, New York, United States
  • Axelrod, David, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

To better understand barriers to expanding U.S. pancreas transplantation (PTx) practice, and the anticipated impact and feasibility of potential strategies to address, we conducted a modified Delphi survey of professional and patient stakeholders.


An electronic survey was distributed to 53 stakeholders, including surgeons, nephrologists, endocrinologists, OPO professionals, and patients, who participated in a national workshop in Boston, MA (distrubution: 6/25/22-8/14/22) Participants ranked the importance of 16 barriers to PTx, and the anticipated feasibility and impact of associated strategies, using 9-point Likert scales.Consensus was defined a priori as when <30% responded outside an item's Interquartile Range (IQR).


Of 16 analyzed barriers, 8 met consensus as ‘very important’, incl.: candidate medical and psychosocial complexity, inadequacy of available tools to assess and transmit quality information, allocation delays, financial barriers, inadequate provider and patient education, and insufficient number of trained surgeons. While no strategy met consensus as ‘very feasible’, 15 strategies met consensus as ‘very impactful’ (Table: Highest Impact X Feasibility subset). 1 strategy was ranked as both ‘very important’ and ‘very feasible’: OPOs should provide real-time access to allograft imaging to improve acceptance decisions.


While stakeholders generally agree on barriers to PTx utilization, a diversity of strategies may be impactful and feasible, including focus on improving organ assessment, logistics of the organ recovery operation and allocation, and mitigation of financial disincentives for organ utilization.


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