*Purpose: As a condition of participation, CMS requires the referral to an organ procurement organization (OPO) of patients with death or imminent death by every acute care facility. Oversight of the adequacy and efficiency of the donor hospital referral process is limited and without consequence for poor compliance. Such referrals serve as the first step in the pathway to organ and/or tissue donation from decedents.

*Methods: A review of referrals of patients on or off ventilators from1/1/16 to 09/30/21 to one OPO using available internal records was undertaken. ANOVA testing was conducted to test for statistical significance between documented instances for each day of the week while considering the individual change from one year to another. Major factors like age groups, time between referral and cross clamp as well as time from brain death declaration day to cross clamp were investigated.

*Results: A total of 289,271 referrals were analyzed; 29,891 on ventilators + 259,380 off ventilators. The two graphs demonstrate decreases in both referral categories on Saturday + Sunday versus Monday – Friday, with the pattern in ventilated patients reaching high significance (P = 0.0002). A similar pattern of brain death declaration is also identified (P = 0.0001).

*Conclusions: Within the designated service area of our large OPO, hospital referrals of dead + imminently dying patients differs on weekends vs. weekdays. Similarly, brain death declaration is significantly more likely to occur on weekdays than weekends. We hypothesize that resource limitations are responsible for these differences. The ultimate impact of the associated delays on the availability and suitability of organ and tissue donors merits further investigation.

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