The Transplant Procedure

When Called About Your Transplant
It is your responsibility to obtain either a cellular phone or pager so that we can contact you when you are not at home. We will try to call you at home first. If we cannot reach you, we will then try your alternate number. If a pager will not work in your area it is your responsibility to make other arrangements for us to be able to reach you. If your pager goes off you are to call the University of Alberta Hospital Switchboard and ask for the recipient transplant coordinator on call. The number is 1-780-407-8822.
Once you are contacted you will need to do the following:
  • Have nothing to eat or drink (discuss this with the coordinator if you are a long distance away).
  • Monitor glucose.
  • Activate friends and family and notify them that you may be having your transplant.
  • Go to the University of Alberta Hospital Admitting Department.
  • Take your pager and/or cell phone with you so that if the transplant is cancelled we can reach you while you are on your way to the hospital.
Unfortunately, isolation of the islet tissue may not yield enough islets to make the procedure beneficial and we will then have to cancel the transplant. Some patients have been in the Radiology Department when their transplants were cancelled.
Where do donor organs come from?
The pancreases come from the same donors that give heart, lung, liver and kidney organs. The donors and their families have decided previously that in the event of death the patients wish to donate their organs and give the gift of life.

Two separate transplant procedures are usually required for each recipient – this means that we need at least two donated organs for every recipient patient.

In Canada we have an organ procurement system which ensures that donated organs are transported to the location where patients require them. These dedicated teams across the country make arrangements for the removal, storage and transportation of all acceptable donated pancreases to our isolation lab.

It is important to remember to thank your donor family. Through the organ procurement system, you may send an anonymous thank you to your donor family. We will give you further information about how to thank the donor family after your transplant. 
Clinical Islet Laboratory

How is the islet tissue isolated from the pancreas?
Once the organ procurement team notifies our centre that a pancreas is available, our dedicated islet isolation team starts to prepare the lab for separating the islet tissue from the rest of the pancreas. This procedure takes eight to ten hours. The pancreas is first inspected and then a tube is placed in the pancreatic duct. An infusion of enzymes is flushed into the pancreas. It will start to break down the tissue so that the islet tissue will be freed from the rest of the pancreatic tissue. Once the pancreas is well flushed it is cut into little pieces and placed in a special container with steel marbles. This container is shaken, and the enzyme is flushed through the container. Samples are frequently taken. Once the islet tissue is seen to be separating from the rest of the tissue the infusion of enzyme is stopped. The tissue is then separated and the islet tissue is removed from the rest of the tissue and washed. The islets are checked and counted. If in this final count the number or quality of islets is not satisfactory, the transplant will have to be cancelled. The reason for this is that we want to be sure we provide you with the best possible islet transplant.

Preparation for the Transplant

 Once you arrive at the hospital, the Admitting Department staff will register you and assign a room to you. Our patients are admitted to a Transplant Unit that cares for many of our other transplant patients. Once you arrive on the unit, your nurse will do a brief history and start an intravenous line for medications. You will have blood drawn and have a chest X-ray. You will be asked to sign consent forms for the procedure. You will then wait for the call to go down to the Radiology Department where the procedure will take place. Medications will be administered while you wait and your blood sugars will be monitored and treated by the hospital staff. 

Islet transplantation is a procedure usually performed in the Radiology Department. Local anesthetic or freezing is injected around the site of the catheter placement on the right side of the abdomen where the liver is located. The X-ray doctor then places a catheter into the main vein in the liver called the portal vein using a special X-ray machine (fluoroscopy) and dye. Once the catheter is in place a solution containing the islet tissue is infused. This procedure can take thirty minutes to several hours

The catheter is then removed a small plug is placed to stop bleeding. You are then taken back to the nursing unit where you will stay in bed on your right side for four hours.

In some cases, usually when a patient is taking aspirin, the islets may be given through a simple surgical procedure in the operating room, rather than in radiology. If this is necessary, it will be discussed with you prior to transplant.


Back on the Nursing Unit
You will have your pulse, blood pressure and serum glucose levels monitored. You will have some blood drawn for testing and go for an ultrasound to ensure that there is no internal bleeding around the liver and that the blood is flowing well in the blood vessels of the liver. If the test results from the blood and ultrasound are satisfactory you will be discharged. Time in hospital varies, typically from one to three days
.


For more information contact the Clinical Islet Transplant Program in Edmonton:

Clinical Islet Transplant Program
2000 College Plaza
8215-112th Street Edmonton, Alberta, Canada T6G 2C8
780-407-1501(phone)
780-407-3850(fax)
Email: isletprogram@islet.ca