A 30-year multidisciplinary framework for assessment and consent in total pancreatectomy with islet autotransplantation

Backgrounds/Aims: Total pancreatectomy with islet autotransplantation (TPIAT) is an irreversible intervention for selected patients with chronic pancreatitis, associated with significant morbidity and lifelong metabolic consequences. Given the benign nature of the disease, robust assessment, governance, and consent processes are ethically essential. Despite increasing global adoption, there is limited description of how centres implement assessment and consent in routine practice. Methods: We describe a structured assessment and consent pathway for TPIAT developed over 30 years at a single UK hepatopancreatobiliary centre. The pathway is coordinated by a dedicated clinical nurse specialist (CNS) and delivered through a multidisciplinary team including surgery, gastroenterology, endocrinology, pain management, and psychology. A descriptive review of routinely collected clinical data and non-validated patient feedback obtained during standard care was performed to characterise key components of the pathway. Results: Between 1994 and 2025, 97 patients entered the assessment pathway. Four did not complete assessment, and eight were deemed unsuitable following multidisciplinary review due to concerns regarding clinical appropriateness, metabolic reserve, or psychosocial readiness. Eighty-five patients proceeded to TPIAT. Progression through the pathway was iterative and consensus-driven, allowing any team member to pause evaluation. Key features included CNS-led continuity, repeated consultations, structured peer support, and multidisciplinary reassessment. Patient feedback suggested these elements improved understanding of procedural risks and long-term implications. Conclusions: This established, patient-centred assessment and consent framework represents a reproducible governance model for TPIAT in benign pancreatic disease and provides a practical reference for centres developing or refining TPIAT services.