Introduction In 2018, this U.S. OPO, located in the mid-Atlantic region with 2.7 million population serving 43 hospitals, had an authorization rate of only 42%, resulting in 54 donors with 133 organs transplanted. A decision was made to seek help to redesign their donor referral responses, authorization practices, and implement a standardized bi-weekly post donor case review. The OPO reached out to an international training center (ITC), affiliated with the U.S.’ leading OPO in organ donations and transplants for the past 15 years.

Methods The OPO and ITC examined current practices and challenges. The ITC made recommendations for 1) authorization standards of practice 2) training on referral response goals, expanded identification of donor potential, and 3) strategies to create and preserve BD and DCD organ donation opportunities.

Between 2018 and 2022, the ITC facilitated 6 team trainings. The team trainings were supplemented with 44 individual scenario-based family donation conversation (FDC) simulations and 45 enrollments in eLearning modules. Initial focus was on FDC fundamentals and maximizing donation potential of each referral. As staff skill and confidence improved, training transitioned to managing more challenging, complex situations. In 2021, the ITC clinical leader began facilitating bi-weekly case debriefs. Staff were engaged in new ways, including practices to examine referral response, identification of donor potential, and creation and preservation of BD and DCD opportunities. The forum created a distinct shift in the group’s critical thinking and problem-solving capabilities. Staff became open to receiving / providing constructive critique and increasingly took initiative to report using new strategies to successfully overcome donation challenges. This forum has proven to be pivotal in continued improvement and in 2022 OPO leadership assumed facilitation of the debriefs.

Results Over 5 years, the OPO increased family approaches by 36% and authorization rates increased by 33%. Overall, organ donors increased by 102% (54 to 109) with brain dead donors increasing by 110% and DCD donors by 82%, resulting in 105% (133 to 273) increase in organs transplanted.  

Conclusion In 5 years, with consultation from ITC, this OPO realized a 102% increase in organ donors, resulting in a 105% increase in organs transplanted. Having this OPO’s leadership commit to improving clinical practices by standardizing the response to donor referrals, recognizing expanded donor potential, improving FDC practices, and adopting strategies to create and preserve BD and DCD donation opportunities led to sustainable, improved donor and transplant outcomes.