Simultaneous Pancreas Kidney transplantation (SPK) or Pancreas Transplantation alone (PTA) are life saving procedures for patients with type 1 (juvenile) diabetes mellitus and impaired renal function. Although the waiting lists for SPK and PTA are increasing, the numbers of pancreas transplantations are declining in the Eurotransplant (ET) area (www.eurotransplant.nl). One major reason for this decline is the fact that a large number of pancreas allografts, potentially eligible for transplantation are excluded by the ET pancreas allocation system (EPAS). Those criteria include an organ-specific cut-off for donor age >50 years and/or BMI>30. This means that donors that are older than 50 years or donors with a BMI >30 are, at the moment, not considered for solid organ transplantation. The pancreas will be directly allocated for islet transplantation (Eurotransplant manual - version may 26, 2009).