Thursday, August 18, 2016
Why are kidneys more likely to discarded on weekends?
New study shows that usable kidneys are discarded at 29% higher rates on Friday and at 25% higher rates on Saturday, holding kidney quality constant. Furthermore the discarded kidneys were of higher quality than those discarded during the week.
Since 5000 people die waiting for kidneys each year, it is probably not due to lack of demand.
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I would look at the types of deaths that occur on a given day. People die in car wrecks all the time, but they are more likely to be driving drunk on a Friday/Saturday. Perhaps those two days have more severe crashes which leave the organ unusable for some reason, or perhaps surgeons are leery at transplanting a less-than-rosey pickled kidney into an already sick patient.ReplyDelete
"kidneys available for transplant over the weekend were more likely to be used at larger transplant centers"
I think it's a safe assumption that "larger transplant centers" are going to be in urban areas. Urban people have more transportation options available, and don't have to drive nearly as far. Maybe the urban hospitals are getting their usual mix of organs, whereas the rural hospitals are seeing deaths due to Billy Bob wrapping his pickup around a telephone pole at 90 mph, and not leaving a viable organ.
There is a short supply of doctors and nurses to handle the number of kidneys coming in on weekend days. -Adelyn OrtliebReplyDelete
Follow up- My oversimplified solution would be to focus on hiring on new staff for weekends that are not accustomed to avoiding those days. When scheduling, it is difficult to convince someone to work on the weekends if they have had a good schedule and cherry picked days in the past. The hospitals could focus on ensuring weekends are staffed appropriately by analyzing the current allocation of workers throughout the week and adjusting. - AdelynDelete
I had the exact same thought. I toot think it has to do with supply and demand of those who are doing the procedure. To go one step further, are they lacking the proper incentive to come in on the weekends to do this?ReplyDelete
I think the comments re: supply and demand are on the right track.ReplyDelete
Keeping in mind the 12/12/2015 post about discarded donated kidneys, we know physicians do not have an incentive to perform risky surgeries as they will be put on a watch list if successful outcomes fall below 50%. "This incentive encourages physicians to reject all but the best organs for transplant." This is a way for them to reduce risk.
Building on that, the rise in discarded kidneys during weekends may be another risk mitigation technique used by surgeons. There is a finding called the "weekend effect" which has used empirical evidence to prove morality rates increase as the week progresses with the largest impact seen Friday-Sunday and during so-called "Bank Holidays". This could be related to less experienced physicians and nurses in acute care recovery units as the death rate is typically higher within two days after admission/surgery on weekends when compared to weekdays.
While the hiring of new staff may help fill the floor with bodies, providing an incentive for more experienced physicians and nurses to work weekends may help combat the "weekend effect" making it more likely that organ transplants have successful outcomes.
As a health care provider I think there is an important aspect of the article that should be recognized.ReplyDelete
"A better understanding of which components of health care delivery are driving the decision to discard kidneys is needed to determine where intensification of resources is warranted," commented Sunita K. Singh, MD, MSc, and S. Joseph Kim, MD, PhD, MHS, of the Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, noted experts in the field.
Transplants are done at very few hospitals across the country and the staff that is needed to both harvest and transplant an organ are not readily available everywhere. They can travel to a hospital under special circumstances.
Maybe a better study would be to see how many transplant teams are not working on a Friday or Saturday, and then increase the number since the need is obviously there? Just a thought. - Sarah
On weekends people practice more risky behaviors, such as drinking and driving or use of drugs. This would increase the amount of deaths to occur during the weekends. The is also a higher risk of stroke on weekends and holidays due to over indulging in alcohol and food, causing the death rate to rise.ReplyDelete
My facility has only one on call team and an on call surgery for each type of surgery during the weekends and holidays therefore there are fewer resources available during the weekends. Yes, if the patient has progressed to brain death, possibly you can maintain the organs by maintaining the body functions, i.e., ventilator and medication, however, your chance to harvest grows less with each hour. Alabama Organ Center has a team, but not enough resources to get all the organs if multiple deaths occur. In summary, the resources are less during weekends because it is difficult to get staff the weekends and due to more people out of work and homes there are more deaths during weekends.
The best data I could quickly find on death by day of the week is here: http://www.cdc.gov/nchs/nvss/mortality/gmwk14.htmReplyDelete
If we look at total deaths by day, it would counter the argument that there are more deaths on the weekends.
However, if motor vehicle accidents are the primary source for kidney donations, perhaps this data supports the argument. That said, Sunday has the 2nd highest volume of deaths by motor accident but one of the lower discard rates.
This paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149736/) also highlights "2) an increase in deceased donors, primarily by an expansion in utilization of less ideal donors with chronic cardiovascular and cerebrovascular disease versus acute trauma victims; 3) increased use of more elderly and obese donors and a dramatic increase in DCD and marginal donors. These changes in practice have been associated with a reduction in the number of organs recovered and transplanted per donor, organs likely to have poorer function (ECD, DCD) and an increase in the discard rates"