The Organ Donation Breakthrough Collaboratives began in 2003 as one of the components of U.S. Department of Health and Human Services Gift of Life Donation Initiative.  The aim of these Collaboratives is to dramatically increase the availability of transplantable organs.  Since 2003, participant Organ Procurement Organizations and their partnering large hospitals, and now transplant centers, have been working to achieve a significantly higher conversion rate and increasing the number of organs transplanted per donor, results that will drive the future success of organ procurement.  The learning and knowledge that result from these Collaboratives will continue to be disseminated to the larger audience of organ transplant organizations, hospitals, and transplant centers for adoption and replication.

Defining the Problem
It is a fact that the United States is far from maximizing its supply of available organs from deceased donors.   Barring dramatic changes in organ transplantation technology, patients must continue to rely on human donors for life-saving organs.  In 2003, as this Collaborative was launched, organs were donated by only 6,455 of approximately 12,000 eligible organ donors. 

The principal point of interface between organ donors and patients awaiting transplantation is the organ procurement organization (OPO).  OPOs facilitate the organ donation process by developing effective relationships with acute care hospitals and transplant centers resulting in notification of every in-hospital death; assessment of each death for donation eligibility; consultation with families of eligible donors by trained professionals; and evaluation and placement of every medically suitable organ with a compatible transplant candidate.  Less than optimum performance of any of these processes results in denial of a grieving family’s opportunity to give the gift of life and the potential death of patients on the waiting list.

The measure of how effectively an OPO and hospital are collaborating to provide organ donation services is known as the conversion rate:  the ratio of the number of actual donations occurring at the hospital as compared to the number of eligible donors. According to data from the national Organ Procurement and Transplantation Network (OPTN), in 2003 25 of the 300 hospitals in the U.S. with the highest number of eligible donors had conversion rates in excess of 75%.  We have demonstrated that it is possible for every hospital to achieve this level of performance. This can be accomplished by understanding and adapting the organ donation best practices of high performing OPO/Hospital systems in collaborative efforts among OPOs and hospitals. 

Organ Donation &Transplantation Collaborative Mission and Goals
The U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Healthcare Systems Bureau (SPB), Division of Transplantation (DoT) working in partnership with the Institute for Healthcare Improvement (IHI), Quality Reality Checks (QRC), Inc. and teams of OPOs and their hospital and transplant center partners from across the country are participating in a series of Organ Donation Breakthrough Collaboratives. The focus of these efforts will be to improve organ donation conversion rates in hospitals with the more than eight eligible donors annually, building on the success of these Collaboratives.  The Collaboratives are designed to close the gap between the number of eligible donors and the number of actual donors.  New monthly donation - and now transplant - records have been consistently established over the 4 year experience with the collaboratives.  These data will be posted and regularly updated in the Transplant Growth and Management (TGMC) Virtual Office. 

Note: To access the Virtual Office you must hold membership in the TGMC group.  For more information on how to sign up as a website user and request group membership, please refer to the website FAQs.

The long-range goal of the Collaboratives is to create systems that will assure accurate and timely referral, screening, consent, organ recovery, and placement using organ donation and transplantation best practices. This is being achieved by implementing OPO, hospital, and transplant center-specific practices which focus on the needs and strengths of each institution with the understanding that success is achieved when grieving families find comfort in their decision to donate, and end-stage organ failure patients receive the life-sustaining organ they need. 

During the first two cycles of the Collaborative (2003-2005), HRSA and a Collaborative Faculty comprised of healthcare professionals from high performing organizations helped each participating organization achieve the Collaborative mission and goals:

• Assure OPO notification of all deaths or imminent deaths in a timely manner.
• Increase the consent rates in participating hospitals by 30%.
• Increase the conversion rates to 75% or greater.
• Notify OPOs of all instances of pending withdrawal of mechanical support from patients with non-survivable conditions.
• Increase the number of families who receive organ donation counseling from a trained and effective donation request team to 100%.
• Respond to all death notifications in less than 90 minutes.

The key measure of how effectively OPOs, transplant programs, and donor hospitals are collaborating to maximize transplantation is known as “organs transplanted per donor” (OTPD):  the ratio of the number of all organs transplanted over the number of actual organ donors.  The additional goal for the third cycle of the collaborative: The Organ Transplantation Collaborative, and the fourth, the Organ Donation & Transplantation Collaborative, launched in October 2006, was to achieve an average OTPD rate in excess of 3.75 organs transplanted from each donor. These last two Collaboratives have already demonstrated that this can be accomplished by understanding and adapting the organ donation best practices of high performing OPO/Transplant Program/Donor Hospital systems.  A final round of this Collaborative cycle, initiated in October 2007, The Transplant Growth & Management Collaborative, now focuses on increasing the capacity of transplant centers  to assure that every one of the increasing supply of viable organs is transplanted.

The Collaborative Model and Ideas to Drive Change

The model for this Collaborative combines an iterative, process improvement approach with fast-paced change brought about through system redesign.  The basic premise of this Collaborative’s model is that achieving outstanding organ procurement and placement rates requires a redesign of the core business and the use of existing knowledge and experience to guide such efforts.  Another distinctive feature of these Collaboratives is the focus on customer service as a driver of OPO, hospital, and transplant center change efforts.  This strategy assumes that participating organizations are not bound by the current system, that they can effect changes identified as useful, and that they desire a system that is efficient, effective, and rewarding for both donor families, transplant candidates and healthcare professionals.

A “Change Package” forms the substantive content for each of the Collaboratives. The Change Package details the practices that underlie high organ donation and transplantation rates.  It is based primarily on three key inputs: current scientific literature and recent studies of organ donation processes; three extensive reviews of OPOs and hospitals with high donation rates and transplant centers with significant growth, including hundreds of individual interviews, that were conducted in 2003, 2005 and 2007 by HRSA; and the input and expertise of an expert panel of leading practitioners, including prominent transplant clinicians.  To that knowledge base has been added the rich learning that was gained from multi-year Collaborative experience.  That experience assures an accelerated knowledge transfer process as we move forward.

The initial Collaborative Change Packages detailed the practices that underlie high organ donation consent and conversion rates, and have been updated throughout the past Collaborative years. The ODBC Change Package was distilled from the first two collaborative cycles.  To that learning has been added the Transplantation Collaborative Change Package (OTBC Change Package ; ODTBC Change Package), and the current Transplant Growth & Management Collaborative Change Package.

The Collaborative Measures of Success
For each of the Organ Donation & Transplantation Collaboratives, measurement strategies were developed to track success and allow teams to gauge their improvement in key process and outcome measures.  (Links: ODBC Measurement Strategy; OTBC Measurement Strategy; ODTBC Measurement Strategy; TGMC Measurement Strategy)

These measurement strategies have given rise to scorecards that provide ongoing assessments of hospital, DSA (donation service area) and regional progress toward achieving Collaborative goals.  To help track the effectiveness of spreading best practices to the Nation’s largest hospitals, the 8+ dataset tracks conversion rates and the number of organs transplanted per donor by hospital, DSA and region.  The help understand each DSAs overall effectiveness in meeting the goals, the Collaborative Scorecard provides a national dashboard of organ donation and transplantation performance.  These scorecards are available in the transplantation and organ donation virtual office, and are updated on a monthly basis.  For information on how to sign up as a website user and request group membership to access the TGMC Virtual Office, please refer to the website FAQs.