Status:
Ready to upload
Record number:
1776
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Annually, in the United States, nearly 2700 kidneys procured for transplantation are subsequently discarded.
Time to detection:
NA
Alerting signals, symptoms, evidence of occurrence:
Weekends are classically associated with limitations on resource availability which may result in an increased reluctance, if not a complete inability, to accept organs for transplant during weekends. It is also important to note that currently no universal guidelines exist in the United States to recommend which kidneys should be utilized and which should be discarded. As a result, the authors hypothesize that there is a significant degree of transplant center-to-center variability, suggesting that factors external to the donor organ, or recipient, may contribute to transplant centers’ decisions not to transplant an organ.
Demonstration of imputability or root cause:
In the United States during a study period from 2000 to 2013, it was determined there is a dramatic adverse impact of weekends on the procurement of, and subsequent discard of, kidneys from deceased donors that were determined to be transplantable at the time of procurement, and analysis of utilization patterns reflect that, on weekends, they are utilized most often at large transplant centers. In addition, kidneys procured but not subsequently transplanted over the weekend appeared to be of higher quality than kidneys that were procured and similarly discarded during the weekday, suggesting that factors beyond the quality of the kidney were influencing the decision to accept/decline the offer of a deceased donor kidney. Data support that 80% of all kidneys transplanted on the weekend are procured on Friday or Saturday. The odds of kidney discard on Friday and Saturday remained significantly elevated in comparison to all other days of the week. The discard rate for kidneys procured on Saturday (18.4%) was the second highest for the week after kidneys procured on Friday (18.8%). The discard rate was lowest on Monday and increased over the course of the week to peak on Friday (P < 0.001).
Imputability grade:
2 Probable
Groups audience:
References:
Reference attachment:
Suggest references:
Mohan S et al. The weekend effect alters the procurement and discard rates of deceased donor kidneys in the United States. Kidney International (2016) 90, 157–163
Note:
This report does not refer to occurrence of incidents, but the disturbance in the donation system. Despite recognizing the potential effect for the donation activities and consequent reduction of treatment opportunities for patients, this occurrence is highly related with US donation system and cannot be evaluated as classic occurrence/event.
Expert comments for publication:
The study suggests that organizational and systemic factors that extend beyond the quality of the available organ appear to be contributing to the high rate of discard of kidneys from deceased donors in the United States. Further investigation into the short- and long-term outcomes of recipients transplanted at centers that are high weekend utilizers could potentially provide an opportunity for quality improvement efforts, as well as changes in policy, to improve organ utilization.