Kidneys from deceased donors tend to be discarded more often over the weekend than on weekdays, a new study shows.
A deceased donor kidney procured on Friday or Saturday was 20 percent more likely to be discarded than if it became available on other days, said study author Dr. Sumit Mohan, a kidney expert and an assistant professor at Columbia University Department of Medicine, in New York City.
With donor organs always in short supply, this waste may cause some transplant candidates to miss valuable opportunities for a new kidney, Mohan said.
“We’ve gotten to a point where we’re discarding 17 percent of kidneys in the United States. That’s almost one in five,” he said. “We could increase the transplantation rate just by removing the bottlenecks in our process, without the public stepping up and increasing the donation rate.”
Mohan was to present his findings Saturday at the American Society of Nephrology’s annual meeting, in San Diego. Research presented at medical meetings is typically considered preliminary, because it is not subject to the same scrutiny as that in published journals.
For this study, Mohan and his team examined data from the Scientific Registry of Transplant Recipients.
About 80 percent of kidneys from deceased donors are transplanted over the weekend and are procured either Friday or Saturday. Given that, the researchers compared the use of deceased donor kidneys procured on those days to the organs procured for weekday use.
They found that about 18.6 percent of deceased donor kidneys that come in on Friday and Saturday are discarded, compared with a discard rate of 16.4 percent the rest of the week.
The issue does not seem to be the quality of the donated organs. While kidneys procured on Friday and Saturday did tend to be slightly older and of slightly lower quality, the researchers found that kidneys discarded over the weekend were of higher quality than those discarded during the rest of the week.
Mohan says the “weekend effect” may come down to the way hospitals allocate resources on Saturdays and Sundays.
Hospitals around the world tend to operate with less staff on weekends. “Usually what happens, the only things that happen on the weekends are emergencies,” Mohan said. “Elective procedures are never scheduled for Saturday or Sunday. Because we have a skeletal staff on the weekends, it gets much harder to do things and it takes longer to do things, in general.”
Transplant hospitals are required to be ready to take a donated organ every day of the week, but it can be difficult to assemble the required team to procure an organ or implant it, he said.
“If you have fewer resources on the weekends, if the operating rooms are closed and you have to get an entire team to come in, the hurdle is much higher to accept a kidney and get everything up and running,” Mohan said.
Dr. David Klassen, chief medical officer of the United Network for Organ Sharing, said the new study raises interesting points. But he is skeptical of Mohan’s staffing theory and noted there wasn’t a huge difference in discard rates between the weekend and weekdays.
“I wouldn’t say this is any sort of definitive analysis of that concept,” he said.
The study also found lower kidney procurement on Friday and Saturday, but it was only 89.5 percent compared with 90.2 percent on weekdays, Klassen pointed out.
However, Klassen said UNOS is concerned about the percentage of donated organs that are discarded, and is trying to find ways to minimize the discard rate.
He said one way might be to change how transplant centers are monitored and rated, so they might be more likely to try transplanting organs of good-but-not-sterling quality.
Older transplant candidates might be willing to take a donated organ that isn’t expected to function for decades longer, Klassen said.
Mohan said regulators also could limit weekend waste by allowing transplant centers to place themselves on bypass for short periods, when their resources are stretched. That way, an organ could be forwarded to a center that is actually ready to use it, rather than languishing in the process.
To learn more about organ donation, visit the U.S. National Institutes of Health.
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