This is one of those posts where I need to reiterate at the outset that I am not a doctor or medical practitioner and have absolutely no formal medical training. What I DO have, is 38 years of combined experience, private study and use of therapy for all things related to Type-1 Diabetes. In fact, if one were so inclined, one could easily believe that enough years have been spent and enough private study has been done to equivalate the knowledge of a doctor, if not the skill. But I’m not that vain… (wink, wink). Totally kidding, let’s move on…
Now that the disclaimer portion of our day has been completed, let’s move on to the actual subject of today’s post: pancreas transplantation. A pancreas transplant is one of those things that everyone with Diabetes has at least wondered about, at some point in their lives. It would make sense, right? If you have a faulty heart or kidney, you can try and have THOSE transplanted, provided you’re lucky enough to find a donor that matches you and all goes well. All sorts of other organs have been transplanted, including livers, lungs and even eyes! So what’s the problem with pancreas transplantation, and why isn’t it more of a thing?
To answer that, we need to start by doing the same thing I’ve done a dozen times since starting this blog page. We need to properly define the two mainstream types of Diabetes. Although there are a number of various types and sub-types, for the purposes of this post I will limit these definitions to Type-1 and Type-2.
In simplified terms, Type-1 Diabetes occurs when your body’s own immune system seems hell-bent on destroying your body’s insulin-producing cells, namely the ones in your pancreas. Once these cells are destroyed, your pancreas effectively stops producing insulin. In a normal body, insulin is a hormone that allows glucose to enter the bloodstream. If the amount of glucose gets too low, your body reduces or limits the amount of insulin it produces and the vice versa. Still with me? Good, moving on…
Type-2 Diabetes is a bit different on the sense that one’s body is either resistant to insulin and its effects, or one’s pancreas creates little to no insulin. This used to be referred to as an “adult-onset” Diabetes, much like Type-1 used to be referred to as “Juvenile Diabetes,” but some children have been shown to be diagnosed with Type-2 in recent decades, due a number of different factors I won’t bother getting into. Despite different treatment and dietary regiments, there is no cure for either type. No matter what you’ve read.
Now that we’re all caught up, let’s discuss the reasons behind why a pancreas transplant may not be the thing for you. First and foremost, like any organ transplant, you need a donor. Unlike liver transplantation where a portion of healthy liver can be taken from a living donor, there’s no way to replicate this with the pancreas. So simply put, you need an organ from a deceased person. There are a number of difficulties behind obtaining such an organ, including but not limited to making your way up a donor list, having the donor be a match for you and trying to determine if a transplant is right for you based on your specific set of Diabetes-related symptoms and complications.
So pancreas transplantation CAN be done, it just simply isn’t the norm. It also isn’t permanent. And apparently we live in opposite world because the worse your Diabetes may be and the harsher your complications, the better odds that you’d qualify for a transplant. This is because they usually look at the fact that your Diabetes can’t be treated with traditional therapy methods. So THAT’S weird, but Type-2 is more likely to be a fit for a transplant, since its cause is mostly the lack or reduced production of insulin in the pancreas, so replacing it would typically fix that.
So let’s say that the stars align, you pass all the tests and get a donor organ and are approved to go through with the transplant. You’ll need to undergo a rigorous regimen of anti-rejection medications. A lot of things will remain the same for you, including all the medications and constant medical check-ups to ensure your proper recovery and the acceptance of your new organ. The next issue is that the very same immune system that attacked the first pancreas will begin to attack the new one. Shortly, you’d be faced with the very same issue that caused your Diabetes in the first place.
This means that part of your new medication regimen will require immunosuppressants in order to limit your immune system so that it won’t attack the new organ. Limiting one’s immune system will lead to a greater risk of infection and you may need a whack of antiviral and antibacterial drugs. Then, one needs to consider all the complications related to the surgery and the after-care involved in any surgery, the side effects of the anti-rejection medications and the drugs you’ll need to take for the rest of your life, as well as the potential for rejection after all that pain and suffering. Are we still on the transplant gravy train or are we running scared yet?
I’m making it sound pretty horrific, but the reality is that a pancreas transplant CAN work for some individuals. It simply isn’t the standard therapy to deal with it. And even if a successful transplant will eliminate the immediate need for insulin therapy, it doesn’t actually CURE Diabetes. And if the transplant fails or one rejects the organ, one can simply go back on insulin therapy. No harm, no foul. Minus major surgery, that is.
The Mayo Clinic actually has a good article that outlines the specific procedure and the complications associated with a transplant, so give it a read. There is no cure for Diabetes. As much as I’d like to add the word “yet” to the end of that statement, I believe much as most Diabetics do, that a cure won’t be forthcoming in our lifetime. But therapies have come a long way, and if I compare being on an insulin pump, using CGM and the effectiveness of my insulin compared to 1982 when I had to guess my manual injections, carb counting wasn’t a thing and I carried a glucometer that was effectively the size of a brick, I’d say we’re pretty spoiled. ☯