Evaluating Islet Cell Isolation and Transplantation From Donors Following Medical Assistance in Dying

Alessandro Parente; Kevin Verhoeff; Tatsuya Kin; Joshua Hefler; Braulio A Marfil-Garza; Norberto Sanchez-Fernandez; Anna Lam; James Lyon; Doug O'Gorman; Khaled Z Dajani; Blaire L Anderson; David L Bigam; Patrick E MacDonald; A M James Shapiro

doi:10.1097/TXD.0000000000001667

Evaluating Islet Cell Isolation and Transplantation From Donors Following Medical Assistance in Dying

Transplant Direct. 2024 Jun 20;10(7):e1667. doi: 10.1097/TXD.0000000000001667. eCollection 2024 Jul.

Authors

Alessandro Parente^{1

2

3}, Kevin Verhoeff^{1

2}, Tatsuya Kin^{1

2}, Joshua Hefler^{1

3}, Braulio A Marfil-Garza^{2

4}, Norberto Sanchez-Fernandez^{1

3}, Anna Lam^{1

2}, James Lyon², Doug O'Gorman^{1

2}, Khaled Z Dajani^{1

3}, Blaire L Anderson^{1

3}, David L Bigam^{1

3}, Patrick E MacDonald^{2

5}, A M James Shapiro^{1

2

3}

Affiliations

¹ Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada.
² Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada.
³ Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
⁴ Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, CP, Mexico.
⁵ Department of Pharmacology, University of Alberta, Edmonton, AB, Canada.

Abstract

Background: Limited information is available regarding outcomes of islet cell isolation (ICI) and transplantation (ITx) using medical assistance in dying (MAiD) donors. We aimed to assess the feasibility and outcomes of ICI and ITx in MAiD donors.

Methods: ICI and ITx from MAiD were compared with donation after circulatory death (DCD) type III between 2016 and 2023. Differences of isolated islet equivalents (IEQs), numeric viability and other quantitative in vitro metabolic measures were assessed.

Results: Overall, 81 ICIs were available of whom 34 (42%) and 47 (58%) from MAiD and DCD-III, respectively. There were no differences of pancreas and digested tissue weight and islets viability among the 2 groups; however, cold ischemic time was longer in MAiD (11.5 versus 9.1 h; P = 0.021). The IEQ (P < 0.001) and percent trapped (P < 0.001) were higher in the DCD-III; however, MAiD islets demonstrated a higher purity (P = 0.020). Overall, 15 ITx were performed of whom 3 (8.8%) and 12 (25.5%) from MAiD and DCD-III, respectively (P = 0.056). Patients had a median fasting C-peptide of 0.51 ng/mL (interquartile range, 0.30-0.76 nmol/L), with no differences between groups (MAiD = 0.52 versus DCD-III = 0.51; P = 0.718). The median HbA1c was 6.2% (interquartile range, 5.7%-7%) (MAiD = 6.3% versus DCD-III = 6.1%; P = 0.815) and BETA2 scores (MAiD = 7.4 versus DCD-III = 12.8; P = 0.229) did not differ.

Conclusions: ICI from MAiD donor pancreas may be successfully transplanted with comparable outcomes to DCD-III and may be used for research. These results justify additional efforts to consider MAiD as another valuable source of grafts for ITx. Further multicenter studies and larger clinical experience are needed to validate our findings.