Perhaps the most daring living-donor transplantation is segmental pancreatic transplantation. Clinicians at the University of Minnesota have performed about 100 distal pancreatectomies from living donors. According to Raja Kandaswamy, MD, Pancreas Transplant Fellow at the University of Minnesota, survival data in kidney-pancreas transplantation are superior to those of pancreas transplantation alone. In addition, he noted that episodes of rejection are identified earlier in patients who also receive a kidney because the rising creatinine provides an early marker of graft rejection. He described a rigorous screening program with glucose tolerance testing for donors the goal of which is to predict function of the residual pancreatic islet after donation.
Some surgeons now advocate laparoscopic donation.
Although this less invasive procedure has advantages to the donor, laparoscopy could put the graft at risk for increased surgical trauma. In the 19 January 1999 issue, the second part of this article will discuss the ethical considerations of organ transplantation. In an effort to facilitate living donation of kidneys, surgeons at the University of Maryland now rely exclusively on laparoscopic nephrectomy for graft harvest. The technique was pioneered at Johns Hopkins and refined by the group at Maryland. Th donor kidney is removed in a polyethylene bag that has passed in through the scope.