Background: From 2000 to 2013, 17% of all kidneys procured for transplantation from deceased organ donors in the United States were discarded. The high rate of discard is of concern given the acute shortage yet the factors contributing to discard remain poorly understood.

Methods: We reviewed kidney data from 2000 to 2013 obtained from the Scientific Registry of Transplant Recipients and determined the proportion and quality of kidneys discarded vs. transplanted for each day of the week. We used logistic regression to analyze the odds of discard for each day of the week, adjusting for kidney quality. Kidney quality was estimated using the Kidney Donor Risk Index (KDRI). A lower KDRI is associated with a lower quality kidney and worse transplant outcomes.

Results: The proportion of kidneys discarded increases each day of the week, peaking on Friday and Saturday, while the quality of kidneys discarded also increases (Figure 1). The odds of discard are significantly greater for kidneys recovered Wednesday through Sunday as compared to Monday, even after adjusting for kidney quality (KDRI), p<0.05. Kidneys recovered on Friday and Saturday have the highest adjusted odds of discard, around 1.2 times the odds of kidneys recovered on Monday.

Conclusions: The day of the week that a kidney is procured appears to influence its utilization for transplant. This demonstrates a need for systemic changes to improve utilization patterns of organs procured either just prior to or during the weekend.

Figure 1:

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