The Weekend Effect

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Introduction A US study suggested donation rates were poorer on weekends. We investigated the effect of day-of-week of donor referral on organ donation in Australia. We also investigated whether any weekend effect resulted in fewer referrals for donation on weekends compared to weekdays. Methods In Australia, potential donor referrals are made to a state-based Donation Service, who then simultaneously seek family consent for donation and assess the medical suitability of the referral for donation. Referrals do not proceed without family consent, or if deemed medically unsuitable. In Australia, organ retrieval occurs when utilisation is almost certain, hence discard rates are extremely low. We retrospectively reviewed all New South Wales referral logs from January 2010 to March 2016. Our outcomes were actual donation (when a referral proceeded to organ retrieval), family consent, and medical suitability. We used logistic regression with random effects adjusting for clustering of referral hospitals. We used mortality data from the Australian Institute of Health and Welfare to compare donation referrals to the background mortality rate by day of the week. We compared donor referrals to all-cause mortality, and specifically to motor vehicle accident (MVA) deaths, as these deaths more typically result in donor referrals. Results Of 2,832 potential donors referred for consideration, 603 (21%) became actual donors.Donation rates were higher for weekend compared to weekday referrals (24% vs. 20%), however this was not statistically significant (p=0.1). We found no evidence of reduced donation (adjusted OR: 1.10; 95% CI 0.88 – 1.38; p=0.4), consent (adjusted OR 1.14; 95% CI 0.88-1.48; p=0.3), or medical suitability (adjusted OR 1.26; 95% CI 0.98-1.62; p=0.07) among weekend referrals.While all-cause mortality was relatively uniform over the week, referrals appeared to drop on Saturdays and Sundays.MVA deaths were more common on weekends (Saturday and Sunday), while the number of referrals from MVA deaths was relatively stable over the week.Compared to all-cause mortality rates by day of the week, the rate of donor-referral on weekends was lower than during the week (p<0.001). We also found that MVA referrals were less common on weekends compared to all MVA deaths (24% vs. 35%; p=0.03). Conclusion There was no association between day-of-the-week or weekend referrals and actual donation, family consent, or medical suitability. Our study suggests the Australian organ donation process is operating consistently even during transient periods of diminished resource or higher caseload, typically experienced during the weekend. These results stand in contrast to the findings from the US. There was some indirect evidence that donor referrals may be more selective at weekends. Further research could explore different stages of the donation pathway (e.g. progression from donor-identification to referral, and progression from actual donation to transplantation)