Introduction: Pancreas utilisation from organ donors remains low for both solid organ and islet cell transplantation.  A significant number of pancreata are accepted for solid organ transplant and the subsequently declined on inspection, mainly due to damage or fatty infiltration.  These organs are potentially suitable for islet cell transplant and are offered through the UK FAST TRACK scheme.  However, as cold ischaemia time is critical to islet cell transplantation outcome, very few are subsequently used for islet cell transplant.  Most islet centres in the UK will not accept pancreata if the cold ischaemia time is greater than 8 hours (in our centre we will accept up to 12 hours).  A recent NHSBT review of pancreata offered through the FAST TACK scheme demonstrated that in a 9 month period, out of 97 pancreata offered, only one was used for islet cell isolation and subsequent transplant. We reviewed our utilisation of pancreata declined for solid organ transplantation and then isolated for islet cell transplantation. 
Results: The Scottish Islet Transplant Programme was established in 2009 and we have performed 70 transplants in 39 recipients. Only 4 islet cell transplants out of 70 were performed on pancreata previously declined for solid organ transplant.   All pancreata were from DBD donors, 2 were declined because they were fatty, and 2 were declined due to organ damage.  The average cold ischaemia time for these donors (mean+/-SEM) was longer than pancreata originally accepted for islet cell transplant (11 +/- 0.7 hours). However yields were high (mean 688,750 +/- 260,000) with a viability of 92% (+/- 2) and purity of 88.3% (+/- 3.8).  The mean age of the donors was 28 (+/- 6.9), and BMI was 31.6 (+/-2.5). All 4 islet transplants were associated with good outcomes and in two of these donors , who were both aged under 20 years, very high yields were gained (750,000 and 1.4 million) and the recipients were insulin independent with a single islet cell transplant.
Conclusions: Utilisation of pancreata declined for solid organ transplant remains low.  The main reason for these organs not being used for islet cell isolation is cold ischaemia time.  Our limited experience of using declined pancreases demonstrates that excellent outcomes can be achieved and that longer cold-ischaemia times can be tolerated, especially if the donors are young. With greater communication between solid organ centres and islet cell centres, and widening of the acceptance criteria for cold ischaemia time, we could significantly increase the number of pancreata available for islet cells transplants.