Accept or refuse? Factors influencing the decision-making of transplant surgeons who are offered a pancreas: results of a qualitative study

作者：Loss Julika^*; Drewitz Karl P; Schlitt Hans J; Loss Martin

来源：BMC Surgery, 2013, 13: 47.

DOI：10.1186/1471-2482-13-47

• Pancreas transplantation
• Under-utilization
• Allocation process
• Refusal

Background: Most offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon%26apos;s decision to select an offered pancreas. %26lt;br%26gt;Methods: Semi-standardized interviews were conducted with 14 highly qualified transplant surgeons from all 14 German transplant centers performing %26gt; 5 pancreas transplantations per year. The interviews focused on medical and non-medical criteria on which the individual accept/refuse decision depends. Interviews were recorded, transcribed and underwent content analysis. %26lt;br%26gt;Results: The interviewees agreed upon certain main selection criteria, e. g. donor age, lab results, ICU stay. However, there was no consistency in judging these parameters, and clear cut-offs did not exist. The pancreas macroscopy is a pivotal factor, as well as knowing (and trusting) the donor surgeon. 3/14 surgeons reported that they had occasionally refused a pancreas because of staff shortage. Some interviewees followed a restrictive acceptance policy, whereas others preferred to accept almost any pancreas and inspect it personally before deciding. %26lt;br%26gt;Conclusion: The assessment of medical donor characteristics is highly inconsistent. Both very cautious as well as very permissive acceptance policies may render the allocation process less efficient. A more standardized policy should be discussed. Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

• 出版日期2013-10-23