Exploring the current provision of pancreatic transplantations in low- and middle-income countries: Current landscape, challenges, future prospects

Table 1 Summary of current landscape of pancreatic transplants in low- and middle-income countries

Aspect	Summary
Health policies in low- and middle-income countries	Varied approaches in organ donor policies in low- and middle-income countries. Relaxation in eligibility criteria in certain nations is associated with increased transplantation activity. Stringent eligibility criteria and organ-transplantation priority policies in countries like Turkey pose challenges. Sociocultural factors, especially religious prohibitions, hinder organ donation in low- and middle-income countries, impacting organ availability
Region-specific analysis of pancreatic transplant provision	Significant progress in Latin America, particularly Brazil and Argentina. Russia has expanded pancreas transplant provision since 2005. Established programs in Asia face challenges such as treatment unavailability and regional disparities. South Africa remains the focal point for pancreas transplants in Africa, with limited activity in other regions. Heterogeneous landscape with variations in transplant numbers and challenges across different regions
Analysis of surgical techniques and patient outcomes	Surgeons in low- and middle-income countries, including China and Russia, have advanced pancreatic transplant surgical techniques. Reduction in complications and improved efficacy seen in innovative approaches. Promising survival rates in certain nations, like China, emphasize the impact of surgical advancements and immunosuppression. Persistent postoperative complications in low- and middle-income countries, including renal function deterioration and graft challenges, necessitate focused improvement efforts

Table 2 Summary of challenges impeding the provision of pancreatic transplant services in low- and middle-income countries

Challenges	Key points
Economic barriers to service expansion	Limited access in low- and middle-income countries due to facility shortages, lack of specialized personnel, and infrastructural deficiencies. Financial burden on patients in countries like India. Brain drain of healthcare workers from low- and middle-income countries
Challenges to organ procurement	Sociocultural factors, religious prohibitions, legislative barriers, and donor risk factors hinder organ procurement in low- and middle-income countries. Commercialization of organ procurement is discouraged, impacting availability. Varied waiting times and limited donor lists due to endemic factors
Post-operative care	Challenges in immunosuppression management, limited healthcare infrastructure, economic constraints, and complications like graft thrombosis, bleeding, and infections. Resource constraints in low- and middle-income countries affect post-transplant care and monitoring. Urgent need for enhanced healthcare infrastructure

Table 3 Summary of future prospects for improving pancreatic transplant provisions in low- and middle-income countries

Area	Summary
Advancements in surgical techniques	Continuous refinement of surgical methodologies is crucial for the evolution of pancreas transplantation. Initiatives focusing on minimally invasive surgical techniques show potential for enhancing donor organ retrieval, reducing complications, and improving outcomes
Enhanced focus on research	State-of-the-art technologies, including gene editing and regenerative medicine, have the potential to revolutionize pancreas transplantation. Advances in laparoscopic biopsies showcase safety and diagnostic efficacy, aiding research in identifying prognostic indicators and developing precision medicine
Telemedicine implementation	Telemedicine's extensive implementation is expected to augment post-operative care in low- and middle-income countries. Remote monitoring and consultations overcome geographical barriers, facilitating timely interventions and collaborative knowledge exchange among specialists
International collaborations	Fostering international collaborations is paramount for addressing healthcare infrastructure gaps and the shortage of skilled professionals. Shared expertise, knowledge transfer, and collaborative research initiatives can increase access to transplantation services in low- and middle-income countries
Robust funding network and policies	A robust funding network is essential for various aspects of pancreas transplantation, including equipment acquisition, skills enhancement, and technological upgrades. Comprehensive policies addressing unique challenges in low- and middle-income countries, including financial support mechanisms, streamlined organ procurement processes, and targeted specialist training programs, create a sustainable ecosystem
Increasing availability of pancreas organs	Strategies to increase the availability of pancreas organs for transplants should be incorporated into future plans. Efforts to overcome sociocultural and legislative obstacles, including community engagement and educational campaigns, are essential for cultivating a positive perception of organ donation
Legal frameworks and ethical considerations	Addressing legislative ambiguities surrounding organ extraction procedures is crucial for streamlining the donation process. Models like the "Iranian" government-sponsored living unrelated donor transplant program, while raising ethical concerns, demonstrate increased deceased donor transplants with proper legislation