As the average age for a post mortal organ donor in the ET area is now 58 years, there is a severe donor selection by age leading to organ shortage. In Germany in 2008 the total number of organ donors was 1.198. However, only 510 donors had an age between 3 and 50 years and thus were potentially eligible for pancreas donation. Out of the 510 donors only 183 pancreases (36% of all potential, age restricted pancreas donors) were retrieved and 127 (25%) were transplanted (DSO, Deutsche Stiftung für Organtransplantation e.V.). Altogether, 676 donors were not even screened for pancreas donation due to age, regardless to all other medical conditions. In addition, approximately 13% were not eligible for pancreas donation only due to BMI. Moreover, in the ET-area pancreases are allocated without local priority leading to longer ischemic times due to transport ways. However, there are data from other allocation areas throughout the world (UNOS or UK) showing that a good overall outcome after PTx can be achieved with donors exceeding the defined allocation criteria defined by ET (older than 50 or BMI>30), if the cold ischemic time is kept short. In Great Britain, a local retrieval and allocation system was installed in 2000 resulting in a steep increase in pancreas transplantation. Moreover, within this new allocation system the currently worldwide largest and most successful pancreas transplant program was initiated in Oxford in 2004 with an extensive use of extended pancreas donors leading to excellent results. These extended criteria avoided donor BMI restriction, and accepted donors with an age between 8 and 68 years. Meanwhile 350 SPK and PTA were transplanted with an excellent one year pancreas survival of 91%, kidney survival 95% and a patient survival of 96%.