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However, the global number of pancreas transplants and utilisation of pancreas grafts is declining. We aimed to identify significant donor factors associated with pancreas non-use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Population-cohort study using United States (US) data from the Organ Procurement and Transplant Network (OPTN) registry (2010-2024). Multivariable regression models were constructed to assess associations between donor characteristics and pancreas utilisation. Restricted cubic splines were used to preserve non-linear relationships and interaction terms with donation date were performed, to capture evolving decision-making behaviours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identify 23 donor factors significantly associated with utilisation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914,612 transplants from 133,986 donors). The most important continuous donor factors are age, BMI and peak creatinine; all showing significant non-linear relationships with utilisation (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Donor type is the most important categorical variable, with donation after circulatory death (DCD) having 92% lower odds of utilisation (aOR=0.078, 95% CI\u2009=\u20090.070 to 0.087,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009&lt;\u20090.001). Interaction analyses reveal increasing reluctance to use DCD donors or older donors over the study period (both interaction\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Conversely, clinicians have become more comfortable transplanting pancreases from Hepatitis C positive donors and IV drug use (IVDU) donors over time (both interaction P\u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This large population cohort study demonstrates significant shifts in utilisation decision-making over time. Growing reluctance to use DCD, despite evidence of favourable outcomes, highlights a valuable area to focus US pancreas utilisation efforts. Meanwhile, previously underused groups such as Hepatitis C positive and IVDU donors show growing acceptance, supporting expansion of these donor populations globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s43856-026-01506-9","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T04:33:31Z","timestamp":1772858011000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modelling donor factors influencing pancreas transplant utilization and evolution of decision-making over time"],"prefix":"10.1038","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0349-4080","authenticated-orcid":false,"given":"Chahana","family":"Patel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Kourounis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"van Leeuwen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Holzner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram","family":"Wadhera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Zeeshan","family":"Akhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Florman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeles","family":"Maillo-Nieto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Tingle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"1506_CR1","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/j.amjmed.2016.02.011","volume":"129","author":"S Dholakia","year":"2016","unstructured":"Dholakia, S. et al. 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