The American Diabetes Association position statement suggests that indications for pancreas transplant (in the absence of kidney failure) are “frequent, acute and severe metabolic complications (hypoglycemia, hyperglycemia, and ketoacidosis) requiring medical attention” as well as “clinical and emotional problems with exogenous insulin therapy that are so severe as to be incapacitating; and consistent failure of insulin-based management to prevent acute complications” [4]. Here, INS is linked to kidney failure.