Quality of most procured pancreata is considered acceptable or good by surgeons, but remains difficult to ascertain. Little is known on how often pancreata are refused for transplantation during back-table inspection. Purpose of this study was to determine the frequency and type of problems responsible for refusal during back-table inspection and to identify possible risk factors. All 134 pancreata accepted and procured for whole-organ transplantation and transported to the Leiden University Medical Center in the period February 2002 until May 2008 were included. These were retrospectively analyzed on donor characteristics, procurement characteristics, and (non-)critical problems. A total of 111 (82.8%) pancreata were transplanted while 23 (17.2%) were refused for transplantation during back-table inspection, regardless of procurement region (χ ²=0.16 p=0.93). Fourteen pancreata (13.4%) were refused solely because of surgical injuries. In refused pancreata, on average 2.7 critical problems per pancreas were found and 0.6 non-critical problems (vs. 0.3 in transplanted pancreata, t=1.83 p=0.08). Chances of refusal increased in pancreata from older donors (odds ratio 1.08 [1.02-1.14]) procured in centers not performing pancreas transplantations (odds ratio 7.95 [2.43-25.97]). We conclude that pancreatic allografts are frequently refused during back-table inspection, partly because of the surgical injuries suggesting that quality of procurement may be improved.