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To the Editor: Dr Hering and colleagues¹ describe their experience with single-donor marginal-dose islet transplantation in patients with type 1 diabetes. I believe that there are flaws in their premises and that the results are subject to a different interpretation. It is not clear that restoration of insulin independence must be achieved with a single donor "for islet transplants to become a widespread clinical reality." The authors state that a single-donor transplant will reduce the risks of transplantation, but the basis of the lowered risk lies in the single transplant procedure, not the number of donors. Transplanting islets pooled from multiple donors in a single transplant procedure entails minimal, if any, added risk compared with a single-donor transplant.

In addition, the authors assert that using single donors will reduce costs and increase availability of islet transplantation. However, 18 consecutive donor pancreases were procured from cadaver donors for use in this . . . [Full Text of this Article]

Craig V. Smith, MD
crsmith@coh.org
Department of Diabetes, Endocrinology, and Metabolism
City of Hope National Medical Center
Duarte, Calif

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