title: The weekend effect alters the procurement and discard rates of deceased donor kidneys in the United States.
abstract: Factors contributing to the high rate of discard among deceased donor kidneys remain poorly understood and the influence of resource limitations of weekends on kidney transplantation is unknown. To quantify this we used data from the Scientific Registry of Transplant Recipients and assembled a retrospective cohort of 181,799 deceased donor kidneys recovered for transplantation from 2000-2013. We identified the impact of the day of the week on the procurement and subsequent utilization or discard of deceased donor kidneys in the United States, as well as report the geographic variation of the impact of weekends on transplantation. Compared with weekday kidneys, organs procured on weekends were significantly more likely to be discarded than transplanted (odds ratio: 1.16; 95% confidence interval: 1.13-1.19), even after adjusting for organ quality (adjusted odds ratio: 1.13; 95% confidence interval: 1.10-1.17). Weekend discards were of a significantly higher quality than weekday discards (Kidney Donor Profile Index: 76.5% vs. 77.3%). Considerable geographic variation was noted in the proportion of transplants that occurred over the weekend. Kidneys available for transplant over the weekend were significantly more likely to be used at larger transplant centers, be shared without payback, and experienced shorter cold ischemia times. Thus, factors other than kidney quality are contributing to the discard of deceased donor kidneys, particularly during weekends. Policy prescriptions, administrative or organizational solutions within transplant programs may potentially mitigate against the recent increase in kidney discards.
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA. Electronic address: sm2206@cumc.columbia.edu.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Foley
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Chiles
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Dube
authors.affiliation: Department of Surgery, Division of Transplantation, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Department of Medicine, Renal Division, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Pastan
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
authors.forename: R John
authors.initials: RJ
authors.lastname: Crew
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Department of Surgery, Division of Transplantation, Columbia University Medical Center, New York, New York, USA.
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
mesh_terms: D064591:Allografts / Q000706:statistics & numerical data*; D046148:Donor Selection / Q000706:statistics & numerical data; D006801:Humans; D016030:Kidney Transplantation; D016017:Odds Ratio; D016134:Organizational Policy; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States
keywords: organ allocation; outcomes; renal transplantation