Purpose of Review <p>Lower organ-offer acceptance rates over weekends and holidays have been demonstrated among kidney, liver, and heart transplant centers. It has been suggested that low-volume centers are the primary drivers of these trends, resulting in geographical disparities in access to transplantation and the unnecessary discard of otherwise-transplantable organs. To investigate these assertions, we provide this review of landmark studies and recent publications on the topic.</p> Recent Findings <p>After adjusting for organ quality, higher rates of organ discards on weekends and holidays exist among kidney (13% increased rate), liver (14% increased rate), and heart transplant offers (12% increased rate). Despite this, there appears to be no difference in patient or graft outcomes among weekend or holiday transplants. In some cases, outcomes might be better among weekend or holiday transplants. Center volume is weakly associated with improved utilization of weekend and holiday organ offers. For instance, whereas low-volume kidney transplant centers performed 658 less transplants nationally per day on weekends, high-volume centers performed 421 less transplants nationally per day on weekends. Geographical disparities in access to transplantation are likely among low performers of weekend and holiday transplants but remain to be studied.</p> Summary <p>Lower organ-offer acceptance rates on weekends and holidays exist throughout the field of solid-organ transplantation despite no significant differences in patient outcomes. These differences appear to be only partially attenuated among high-volume centers, implying that additional resources alone do not solve the problem. Further research to characterize the high-performer center phenotype among weekend and holiday transplants and define best practices is necessary.</p>