The Asian Experience

The concept of organ donation after a brain or circulatory death has not gained the same acceptance in Asian as opposed to Western countries. For that reason, many Asian countries, including South Korea and Japan, rely heavily on the willingness of living donors to provide solid organs for the purpose of transplantation in order to meet the high demand for life-saving and life-improving transplants. This explains why the number of pancreas transplants from living donors has increased over time in South Korea and Japan, whereas in Western countries, which provide much easier access to deceased donor organs, the number has declined. Living donor pancreas transplantation (LDPT) has several advantages over deceased donor pancreas transplantation (DDPT), as shown by Gruessner et al. (Transplantion of the Pancreas. Springer, New York, 2004): better human leukocyte antigen (HLA) matching, shorter ischemic time, shorter waiting time, and application in sensitized patients and in patients with ABO blood type or HLA mismatches (MMs). However, the pancreas is an unpaired organ with a complex parenchymal structure and, unlike the liver, does not regenerate in volume after distal donor pancreatectomy. In LDPT, voluntary motivation, physical and emotional suitability, and stringent legal and ethical guidelines are important considerations preoperatively. Sound donor and recipient relationships are key to proceeding with LDPT. Any form of coercion, exploitation, and commercialism must be ruled out. As with all types of living donor organ transplants, donor safety is crucial. After all, a healthy volunteer is exposed to the risk of surgery solely for the benefit of another individual. Early surgical complications and late complications, such as the development of diabetes, remain worrisome concerns associated with LDPT. The development of donation-related diabetes mellitus must be prevented. Increasingly sophisticated preoperative evaluation of donor endocrine pancreatic function is crucial for successful donation. Hence, after extensive medical and metabolic donor evaluation, the final decision for donation should rest with the endocrinologist(s) involved in the evaluation process. In Korea, 739 pancreas transplants were performed from October 1992 to December 2019 (Park et al., Transplant Proc 47(4):1096-1098, 2015). Of those, 23 (3.1%) were LDPTs. There were 6 (28.6%) cases of pancreas transplant alone (PTA) and 17 (71.4%) simultaneous pancreas and kidney (SPK) transplants. The patient survival rate was 95%; the 1- and 5-year graft survival rates were 78.2 and 63.6%. For SPK only, the 1- and 5-year graft survival rates were 88.2 and 71.4%. In Japan, 437 pancreas transplants were performed from April 2000 to December 2019. Of those, 27 (6.1%) were LDPTs. There were 21 SPK, 5 PTA, and 1 pancreas after kidney (PAK) transplants. Patient, pancreas, and kidney graft survival rates were 96.3, 81.5, and 88.9% at 5 years and 86.6, 68.0, and 61.6% at 10 years after transplant. Of the 27 donors, 2 (7.4%) developed diabetes at 7 and 11 years after donation. Recipients undergoing LDPT, specifically in the SPK transplant category, reported improvement in their quality of life. In summary, a total of 50 LDPTs have been performed in South Korea and Japan with excellent long-term results. LDPT is an important treatment option in Asia for diabetic patients who cannot undergo DDPT.