The demise of islet allotransplantation in the United States: A call for an urgent regulatory update

for The “Islets for US” Collaborative

Research output: Contribution to journalArticlepeer-review

Abstract

Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and “more than minimally manipulated” human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as “minimally manipulated tissue” and not regulated as a drug, which has led to islet allotransplantation (allo-ITx) becoming a standard-of-care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo-ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States.

Original languageEnglish (US)
Pages (from-to)1365-1375
Number of pages11
JournalAmerican Journal of Transplantation
Volume21
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • clinical research/practice
  • ethics and public policy
  • islet transplantation
  • islets of Langerhans
  • law/legislation
  • quality of care/care delivery

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'The demise of islet allotransplantation in the United States: A call for an urgent regulatory update'. Together they form a unique fingerprint.

Cite this