There are three parts to this step.

First, you will visit a transplant center.
You, your doctor, a nurse, or a social worker can schedule this  visit. Your doctor’s office will send your medical records to the transplant center before your appointment. Your records should show that you are taking your medicine properly and are on a restricted diet. Your records will also confirm that you have no medical conditions that can keep you from receiving a transplant.

You will have a physical health evaluation.
A transplant doctor and transplant nurse coordinator will evaluate your medical condition. They will decide if you are healthy enough for surgery. They will need to know your medical history. They will need to evaluate how well you control your diabetes and how old you were when you were told you had it. They will talk with you about insulin and any problems you are having because of your diabetes.

Other tests you may have:

• Blood tests
• Chest x-ray
• Mammogram or prostate exam
• Colon exam
• EKG (electrocardiogram) and other heart tests
• You may have a stress test and a cardiac catheterization to look at your heart’s blood supply. This is done by inserting a catheter into an artery in your leg. Doctors may also test the blood supply to your legs.
• Your dentist may need to check your teeth and gums.
• Women will need an OB-GYN exam and Pap smear test.
• If you smoke, you will need to stop.
• You will need to stop any substance use.
• You may need to lose some weight. This is important because if you are overweight, you might go from having type 1 diabetes before transplant to having type 2 diabetes after your transplant. Your transplant team will tell you how much weight you need to lose.

You will have a mental health evaluation.
You may need to see a social worker or psychologist to make sure you are not addicted to alcohol or drugs. It is also important to make sure you have no emotional problems that can interfere with your health.

This step involves finding a pancreas for you. This can sometimes take a long time.

Your transplant center may give you some handouts to read about your operation. This information will help you get ready for surgery. It will also tell you about your care after the operation.

While you are waiting for your pancreas transplant, it is important that you keep in touch with your transplant center. If your health condition changes, be sure to let the transplant center know. If you change medical insurance, you also need to call the center. It is very important that you notify your center immediately if you have an address or phone number change. The transplant center always needs to know how to contact you when an organ becomes available.

It is very important to stay healthy while you wait for your new pancreas.

• If you smoke, please quit. If you need help quitting, talk to your regular doctor. Patients who smoke after a pancreas transplant do worse than those who do not smoke and many transplant centers will not perform pancreas transplants on people who continue to smoke.
• If you need to lose weight, ask your regular doctor to help you with a weight loss plan.
• Keep all your appointments.
• Do your best to control your blood sugar.

During this surgery, a healthy pancreas (and kidney if you are getting them together) is placed inside your body. Surgeons will connect the pancreas to your own blood vessels. They will also connect the pancreas to either your own small intestine or your bladder so the pancreatic juices can drain. The operation will last three to six hours, depending on whether you are getting one or two organs. 

Your own kidneys and pancreas will stay in your body. You will have a tube (catheter) inserted into your bladder. You will also have an IV (intravenous line) inserted into a vein in your arm and/or neck.  You might also have a tube in your nose that drains to your stomach. 

You will stay in the hospital until your doctor feels you are ready to go home. How long you stay in the hospital will depend on your health and how well the new organ(s) is working. It will also depend on how quickly you learn to take care of your new organ/s. The average stay in the hospital is seven to 12 days.

Transplant Medicines

After your operation, you will take strong medicines every day to help your body accept the new transplant. Your body is smart and can detect that the organ comes from another person. These medicines will keep your body from rejecting the new pancreas. These medicines are called antirejection medicines. You will need to take these every day for as long as the transplanted organ is in your body. These medications are also called  immunosuppressive medicines. If you stop taking these medicines, even for a short period of time, your body will destroy your new pancreas. You must tell your transplant center if you miss or run out of your medicines. 

Some Tests You Might Need to Have

Transplant ultrasound: With an ultrasound, doctors can see your pancreas, kidney, and blood supply on a screen. This shows them if there are any problems.

Transplant biopsy: Your doctors will biopsy your new organ. They use a needle to remove a tiny piece of kidney or pancreas. This piece is then looked at under a microscope. By looking at the cells, your doctors can find problems like rejection. This test also provides important information that will help the transplant team decide the best treatment for you.

CT Scan or Magnetic Resonance Scan: This test is used to see if you have a leak of digestive juices or an infection after a pancreas transplant. It can also be used to check the blood vessels going to your new pancreas.

The most important part of the pancreas transplant is staying healthy after the operation. 

Here is what you will need to do after you leave the hospital:

• Visit the transplant center often and keep all your appointments.
• Take your medicines properly. This is very important. Also, do not take any other medicines (prescription or over-the-counter) or supplements of any kind without checking with your transplant team.
• Have your blood drawn and directed by your transplant center.
• Tell the staff at the transplant center about any problems you are having. Be sure to let them know if you have trouble keeping an appointment or taking your medicines. Call immediately if you are having trouble getting or taking your medicines (payment troubles, side effects). Your transplant center can help!
• Call your transplant center if you have any of these symptoms:
  • Fever or chills
  • Stomach pain
  • Burning when you urinate
  • High or low blood sugar
  • Trouble breathing
  • Bad cough
  • Trouble taking your medicines
  • High blood pressure
  • Diarrhea, nausea, vomiting, or constipation
  • Weight loss or weight gain

Your Appointments

If your body begins to reject your new pancreas, you may not know it. Some patients may have signs, but most do not recognize them. If your body is rejecting the new pancreas or kidney, your doctors and nurses will know it. This is why it is so important to go to all your medical appointments. Your health care providers watch closely for signs of rejection and side effects from the medicines. 

Your doctors will only be able to tell if you are rejecting the new organ by examining you. The doctor can detect rejection through blood tests or a biopsy. Your doctor and transplant staff will be watching for the following:

1. Rejection
   The risk of rejection never goes away. You will always need to take anti-rejection drugs. Your doctor may lower the dosage, but you should never skip or stop taking the drugs.
2. Infections
   Immunosuppressant drugs can increase the chance of getting infections. These infections can be treated. However, you need to tell your doctor if you have a fever, unusual pain, or any other new feelings. The risk of infection will go down when your doctor lowers the dosage.
3. High Blood Pressure
   High blood pressure is a common problem after transplant. It can damage your kidneys. It can also cause strokes and heart attacks.
4. High Cholesterol
   You may develop high cholesterol blood levels after transplant. This can put you at risk for a heart attack or stroke. Your health history and diet may contribute to this as well as some of your antirejection medicines. There are some medications called statins that control cholesterol and help prevent rejection because they also control inflammation.
5. Cancer
   Transplant patients are at a greater risk for skin cancer. The anti-rejection medications can add to these chances. It is important that you use sunscreen lotions and wear clothing to protect your skin from the sun. It is also important for you to do other cancer screening such as pap smears and mammograms for women, and prostate screening for men. All patients should have their colon checked as recommended by your primary care physician.
6. Other health issues 
   Be sure to see your eye doctor for regular check-ups. You will need to also see other specialists on a regular basis. For example, doctors who specialize in feet, the brain and nerve system, and the endocrine system. Also, be sure to see your primary care doctor on a regular basis.
7. Pregnancy 
   It is possible to get pregnant after transplant, but you must talk with your transplant team to find out if pregnancy is safe for you. If you want to get pregnant, tell the transplant team before you stop using birth control. This is because some of your antirejection drugs may need to be changed before you get pregnant. If you find out you are pregnant, tell the transplant team right away. If your pancreas drains into your bladder, and you use a store-bought urine pregnancy test, it may test negative even if it is positive. Therefore, you need a blood test to be sure.

By following directions given to you and taking your medicines, the pancreas transplant will allow you to enjoy a life free from diabetes.  Patients report a better quality of life as well.