Methods
Sample
In Germany, 163 pancreases from donors after brain death were transplanted in the year 2010 (transplantation from donors after circulatory death is not allowed in Germany). These pancreas transplants were performed in 24 centers; the three hospitals with the highest volume transplanted 13, 14, and 16 pancreases per year, respectively. 14 of the centers transplanted more than five pancreases per year. In all of these 14 relative 'high volume' centers, experienced transplant surgeons are on call to decide upon the acceptance or refusal of whole organ donor pancreases when offered by Eurotransplant. In most centers, 2–3 surgeons are specialized in pancreas transplantation.
Semi-structured, face-to-face interviews were conducted with surgical consultants from all 14 'high volume' pancreas transplant centers between May and November 2011). The interview partners (n = 14) met the following inclusion criteria:
employment at a transplant center performing >5 pancreas transplantations per year (according to 2010 data)
minimum of three years of experience in pancreatic transplant surgery
routine responsibility for decisions on accepting or refusing offered donor pancreases
Purposive sampling was used to recruit the sample. Two transplant surgeons from transplant centers with less than five pancreas transplants per year were interviewed first in order to pre-test the interview guide; they provided comments on the questions (for the final interview guide see Table 1). These interviews were not included in the analysis. All participants agreed to being interviewed and recorded. The transcript, analysis and presentation of data did not enable identification of individual participants or their respective centers.
Data Collection
The interviews covered factors that influence the transplant surgeon's decision to accept or refuse a pancreas. If donor-related medical factors such as age, BMI or length of ICU stay were named by the interview partner, it was asked whether certain limits would apply for these variables, and what these limits were. If non-medical criteria were not mentioned spontaneously, e.g. staff shortage, these aspects were asked explicitly. One of the authors (KPD) conducted all the interviews, each of which was audio-taped and lasted for 20–70 minutes.
Analysis
Interview tapes were transcribed verbatim. The transcripts were de-identified and continuously numbered (Interview Partner = IP 01-IP 14), so none of the researchers, except the interviewer, could link the answers back to the interviewed transplant surgeon or the respective transplant center. The transcripts were examined using thematic content analysis. Key themes that spanned specific questions and topics were identified, and were used to organize the material. In the course of the data analysis, the initial categories, distinguishing between medical and non-medical factors influencing the decision, evolved into more sophisticated coding structures and additional categories, including e.g. concepts of trust, patient's prognosis, and strategic aspects. To enhance the validity of the findings, the interview transcripts were read and coded independently by two authors (KPD and JL); deviant cases and contradictory data were analyzed with particular attention.
Ethical Approval
No authorized ethical approval was needed as per the ethics committee of the University of Regensburg (reference number 11-160-0192).