By current standards only a very few patients will ever consider be considered for a pancreas or islet cell transplant. There is a shortage of donor organs for transplantation as there is with all other types of organ transplants. In most cases a Local Transplant Team will organize all that is necessary as regards eligibility and entry into a program. Professional transplant organizations will have to comply with the laws and ethics of their respective medical and national bodies. This provides necessary protection for patients because safety standards can not only be upheld but can also be transparently assessed.

At the moment a very small percentage of Type 1 patients who present with disabling hypoglycaemia and/or renal failure requiring transplant will be considered eligible. Some Type 2 patients will be eligible for the same reasons. Some patients with chronic pancreatitis will be eligible for an autotransplant of their own islets harvested from their own pancreas. Even with this possibility patients will require an experienced transplant team and center in order to carry out and monitor the success and complications of the transplant.

The stumbling blocks for more widespread use of the technique include the lack of availability of donor organs and the lack of transplant centers with suitable resources. In terms of risk-benefit assessments we all have to bear in mind the safety of insulin in treating diabetes and the relative risk of taking anti-rejection drugs for years after a transplant. Anti-rejection drugs makes patients immunocompromised and this leaves patients open to a higher risk of some infections and tumours.

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