Opinion Review
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Nov 22, 2024; 15(6): 94590
Published online Nov 22, 2024. doi: 10.4291/wjgp.v15.i6.94590
Exploring the current provision of pancreatic transplantations in low- and middle-income countries: Current landscape, challenges, future prospects
Hareesha Rishab Bharadwaj, Joecelyn Kirani Tan, Syed Hasham Ali, Muhammad Hamza Shah, Aderinto Nicholas, Khabab Abbasher Hussien Mohamed Ahmed, Khansa Irfan, Priyal Dalal, Aashna Mehta, Wireko Andrew Awuah, Arkadeep Dhali
Hareesha Rishab Bharadwaj, Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom
Joecelyn Kirani Tan, Faculty of Medicine, University of St Andrews, St Andrews KY16 9AJ, United Kingdom
Syed Hasham Ali, Faculty of Medicine, Dow Medical College, Karachi 74200, Pakistan
Muhammad Hamza Shah, School of Medicine, Queen's University Belfast, Belfast BT7 1NN, United Kingdom
Aderinto Nicholas, Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomosho 210214, Oyo, Nigeria
Khabab Abbasher Hussien Mohamed Ahmed, Faculty of Medicine, University of Khartoum, Khartoum 0000, Sudan
Khansa Irfan, Priyal Dalal, School of Medicine, University of Central Lancashire, Preston PR2 1SG, United Kingdom
Aashna Mehta, Faculty of Medicine and Surgery, University of Debrecen, Debrecen 4032, Hungary
Wireko Andrew Awuah, Faculty of Medicine and Surgery, Sumy State University, Sumy 40007, Ukraine
Arkadeep Dhali, Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
Arkadeep Dhali, School of Medicine and Population Health, University of Sheffield, Sheffield S10 2HQ, United Kingdom
Arkadeep Dhali, Deanery of Clinical Sciences, The University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
Arkadeep Dhali, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LN, United Kingdom
Author contributions: Bharadwaj HR conceptualized and designed the research study, performed the literature review, and drafted the manuscript; Tan JK designed the research study and contributed to the manuscript; Ali SH performed the research and assisted with data analysis; Shah MH conducted the literature review and contributed to the manuscript; Nicholas A performed the research and assisted in data collection; Mohamed Ahmed KAH contributed to the research design and manuscript review; Irfan K assisted with data collection and manuscript editing; Dalal P, Mehta A contributed to data analysis and manuscript review; Awuah WA assisted with the literature review and manuscript editing; Dhali A provided oversight on the research design and reviewed the manuscript.
Conflict-of-interest statement: No conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arkadeep Dhali, MBBS, MPH, PGCert Clin Ed, FRSPH, NIHR Academic Clinical Fellow, Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom. arkadipdhali@gmail.com
Received: March 20, 2024
Revised: October 6, 2024
Accepted: October 22, 2024
Published online: November 22, 2024
Processing time: 243 Days and 11.3 Hours
Abstract

This comprehensive review addresses the global health challenge of disparities in pancreas transplant access, particularly in low- and middle-income countries (LMICs) compared to high-income countries. Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney, pancreas-after-kidney, and pancreas-transplant alone, LMICs face significant challenges, including limited infrastructure, financial constraints, and a shortage of skilled medical professionals. Donation after brain death remains constrained by sociocultural barriers. Region-specific analyses highlight progress in Latin America, Asia, Russia, and South Africa, showcasing the regional disparities in access and outcomes. Future prospects involve minimally invasive surgeries, telemedicine for enhanced post-operative care, international collaborations with organizations like the European Union of Medical Specialists, and robust funding networks to improve organ availability. In conclusion, the review underscores the importance of multifaceted strategies to address economic, sociocultural, and infrastructural barriers, aiming to improve accessibility, quality, and effectiveness of pancreas transplantation services in LMICs.

Keywords: Pancreatic transplantation; Diabetes mellitus; Global health; Low- and middle-income countries; Transplant surgery

Core Tip: This review explores the disparities in pancreas transplantation in low- and middle-income countries (LMICs) compared to high-income countries (HICs), emphasizing challenges like economic constraints, cultural beliefs, and limited healthcare infrastructure. Highlighting the importance of donation after brain death (DBD), as well as differences in outcomes of procedures such as simultaneous pancreas-kidney (SPK), pancreas-after-kidney (PAK), and pancreas-transplant alone (PTA) procedures between HICs and LMICs, it calls for increased research and collaboration to promote surgical equity. Collaborating with the European Union of Medical Specialists could support LMICs in establishing robust DBD programs, ultimately improving SPK, PAK, and PTA access and outcomes.