National Trends in Liver Discards: The Weekend Effect.
1Surgery, Columbia University Medical Center, New York City, NY
2Medicine, Division of Nephrology, Columbia University Medical Center, New York City, NY
3Department of Surgery, Division of Transplantation, Weill Cornell Medical Center, New York City, NY
4Department of Surgery, Division of Transplantation, Columbia University Medical Center, New York City, NY
5Department of Medicine, Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York City, NY.
Meeting: 2016 American Transplant Congress
Abstract number: C59
Keywords: Allocation, Cadaveric organs, Donation, Resource utilization
Session Information
Date: Monday, June 13, 2016
Session Name: Poster Session C: Economics, Public Policy, Allocation, Ethics
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Overall organ discard rates have increased over the last decade. Given the current organ shortage, understanding factors that contribute to the discard of livers is urgently needed to improve organ utilization.
Utilizing data from the Scientific Registry of Transplant Recipients, we studied trends in deceased donor liver discards in the U.S. from 2000-2013, including organ specific and system-wide factors (at the center, OPO, and regional level) that may potentially contribute to the liver discard rates.
From 2000-2013 there were 88,143 livers recovered, of which 8,755 (9.9%) were ultimately discarded. Discard rates ranged from a low of 7.35% in 2003, just at the beginning of the MELD era, to a peak of 11.37% in 2007, and have been stable at ~10% in more recent years. Discarded livers were of predictably worse quality: more likely to be from older (38.6 vs 47.8 yrs), heavier (26.3 vs 29 kg/m2), HCV+ (2.7% vs 7.9%), ECD (23% vs 39%), and DCD donors (3.8% vs 15.1%) (all p<0.0001). However, in addition to differences in organ quality there is a nearly 4-fold geographic variation in the discard rate between UNOS regions (4.8% to 18.2%) as well as significant variation in the percentage of livers discarded over the weekend in comparison to weekdays. Discard rates were lowest on Monday, and increased each subsequent day of the week, ultimately peaking on Saturday. In multivariable analysis, the odds of a liver being discarded on the weekend was nearly 10% higher, even after adjustment for organ quality (OR= 1.09; p=0.001). This statistically significant increase occurs for livers procured from ~5pm on Friday night to 5pm on Sunday, which account for 92% of all livers transplanted on Saturday and Sunday.
This analysis suggests that while discarded livers frequently have unfavorable donor characteristics, there are also systemic and operational factors, including the day of the week a liver becomes available that impact the chance of discard.
CITATION INFORMATION: Carpenter D, Mohan S, Halazun K, Verna E, Chiles M, Charak G, Ratner L. National Trends in Liver Discards: The Weekend Effect. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Carpenter D, Mohan S, Halazun K, Verna E, Chiles M, Charak G, Ratner L. National Trends in Liver Discards: The Weekend Effect. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/national-trends-in-liver-discards-the-weekend-effect/. Accessed July 7, 2020.« Back to 2016 American Transplant Congress