Challenges in Meeting UNOS Personnel Requirements for Pancreas Transplant Programs Amid Declining National Case Volumes

Pancreas transplantation remains a highly specialized and life-enhancing procedure for selected patients with insulin-dependent diabetes mellitus. As national transplant volumes have declined over the past decade, many U.S. transplant centers are finding it increasingly difficult to satisfy the personnel credentialing standards established by the Organ Procurement and Transplantation Network (OPTN). These standards, designed to ensure safety and competency, require documented case volumes and training experience that are difficult to achieve in today's landscape, where most programs perform fewer than 10 pancreas transplants annually, and training opportunities are limited. This growing mismatch between regulatory expectations and real-world practice highlights the need to reassess current personnel criteria and consider more flexible, competency-based approaches that maintain quality while supporting program viability and patient access.