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of the head of the pancreas requiring extensive dissection, this may preclude the pancreas for transplantation. The SMA is divided distal to the take-off of the replaced right hepatic artery preserving it intact on a short length of SMA with a carrel patch for the liver graft. Occasionally, there is a large inferior pancreati-coduodenal arterial branch vascularizing the head of the pancreas that originates proximal to the take-off of the replaced right hepatic artery. The inferior pancre-aticoduodenal vessels are critical to vascularization of the head of the pancreas because the gastroduodenal artery is routinely ligated during the process of hepatic artery immobilization for the liver transplant. Therefore, in the case of a very proximal take-off of the inferior pancreaticoduodenal artery dividing the SMA at the appropriate location for proper liver procurement would significantly impair vascularization of the head of the pancreas and preclude its use for transplantation. Evaluation of the arterial vascularity of the pancreaticoduodenal allograft can be tested on the backbench by several methods: i) injection of Renografin® into the superior mesenteric artery or Y-graft and obtaining an x-ray; ii) intraarterial injection of fluorescein visualization with a Wood's lamp; and iii) performing a methylene blue angiogram.

The use of marginal and non-heart-beating donors for pancreas transplantation has been reported. There is a higher rate of ruling out the pancreas for transplantation at the time of procurement than in stable conventional organ donors. If the pancreas is deemed suitable, there is the added consideration of the effect of delayed kidney graft function in a uremic SPK candidate. The use of marginal and non-heartbeating donors for pancreas alone transplantation is selective, made on a case-by-case basis.

The use of living related and unrelated pancreas donors has also been described. A distal pancreatectomy is performed for a segmental pancreas transplant. Anecdotal cases of combined live donor partial pancreatectomy and nephrectomy have also been reported. These procedures are not widely performed and are confined to one or two pancreas transplant programs.

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