Whole pancreas transplants have the same rejection problems as beta
cell implants, and also require major surgery. For these reasons, whole
pancreas transplants are only used 1) in desperate cases in medical
schools with exceptional capabilities, and 2) in conjunction with
kidney transplants.

Kidney transplants are (relatively) common in diabetics with advanced
complications. A kidney recipient is taking immunosuppressant drugs
anyway, and the same surgery that implants the kidney can stick in a
pancreas with little extra effort or trauma. As a result, the double
transplant is now recommended, at least for consideration, for any
diabetic patient who requires a kidney transplant.

The only disadvantage would seem to be that the pancreas donor must be
dead; whereas a living kidney donor is feasible. Even this is not
strictly true, as a kidney-plus-partial-pancreas transplant from a
living donor is possible, and the partial pancreas contains enough beta
cells to produce insulin for the recipient. However, this procedure is
seldom performed.

Combination kidney/pancreas transplants are listed in a different queue
than kidney-only. Since the number of people waiting for donor kidneys
is quite long (anywhere from a few months to seven or eight years), the
kidney/ pancreas list is often a quicker means of receiving a
transplant. For example, in January 1998 there were 38,380 people on
the UNOS [see below] registrations for a kidney transplant. There were
only 355 registrations for a pancreas transplant and 1604 registrations
for a kidney-pancreas transplant. [Based on UNOS Scientific Registry
data as of January 28, 1998.]

Kidney/pancreas transplants, while still considered experimental at some
institutions, have been approved by Blue Cross/Blue Shield in the
following centers: University of Iowa Hospitals and Clinics, Iowa City;
University of Minnesota Hospital and Clinic, Minneapolis; Ohio State
University Hospitals, Columbus; and University of Wisconsin Hospital
and Clinics, Madison. Though this is for BC/BS only, other insurance
companies may follow the BC/BS lead if pushed. [Information from January
2000. Check to see whether additional centers have been approved.]

UNOS (United Network of Organ Sharing) has a list of 124 transplant
centers that have pancreas transplant programs. For more information,
contact UNOS at (800)24-DONOR or see their web page at

   http://www.unos.org

(See the section on sources for additional contact info.)

The UNOS handles transplant registrations only in the USA, but can
provide contact information for organ-donation agencies around the
world. Organ allocation became a political football in the US in the
late 1990s, and the details of allocation and waiting lists may change.

The transplant mailing list is an excellent resource. See the section on
online resources: mailing lists.

(Thanks to Alexandra Bost for much of the information in this section.)