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The ultimate goal of beta cell transplantation is to improve the quality of life and to prevent the severe acute and the devastating chronic complications of diabetes, by utilizing isolated allogeneic human or xenogeneic porcine islets early in the course of type 1 diabetes. An additional aim is to minimize the use of long-term immunosuppression that is currently needed to prevent islet rejection and autoimmune recurrence of diabetes [1–3]. Several increasingly complex steps will have to be taken to reach this final objective and it is evident that the immunological obstacles, particularly those involved in pig-to-man islet xenotransplantation [4], are formidable and can only be overcome by continued research efforts directed towards the problems peculiar to isolated islets.

Living related donors (LRDs) were first used for kidney transplantation [1]. The consistently high patient and graft survival rates of LRD kidney transplants have led to their increasing popularity in the United States, accounting for up to 50% of all kidney transplants at some centers. The pancreas was the first extrarenal solid organ in which successful LRD transplants were done [2]. Over the last 5 years, the use of LRDs has received increasing attention for liver [3], lung [4], and intestinal [5] transplantation

The role of pediatric cadaver donors for transplantation of kidneys is controversial; some reports of outcome following pediatric donor transplantation have shown results similar to those with adult donors (1, 2, 3), while others have shown worse results (4, 5). Pediatric donor kidneys can be transplanted singly to two recipients, or both kidneys can be transplanted to a single recipient (16). Single kidney transplants make optimum use of the donor pool; double transplants provide increased renal mass and therefore more functional reserve in the early post-transplant period.

The International Pancreas Transplant Registry was founded at a meeting held in Lyon, France in 1980 [1]. The American College of Surgeons/National Institutes of Health (ACS/NIH) Organ Transplant Registry forwarded information on 57 on pancreas transplants performed between 1966 and June 30, 1977 to the new Registry [2]. Information on all other cases known to have been performed up to that time, including 3 from 1976 (one primary and two secondary) that had not been reported to the ACS/NIH Registry, were also incorporated into the new Registry [1]. Since 1980, all institutions performing pancreas transplants have submitted data to the Registry on age of the recipient, duration of diabetes, HLA typing, technique of transplantation, duration of preservation, type of immunosuppressive regimen, duration of graft function, and causes of graft failure.

Interest in the application of clinical pancreas transplantation has increased dramatically recently, as evidenced by the fact that nearly as many pancreas transplants have been performed in the last two years (1981–1982) as in the preceding 14 years following the first pancreas transplantation in 1966 (14). The potential of pancreas and islet transplantation as treatments for Type I diabetes approximates that of kidney transplantation for treatment of end stage renal disease.