Organ Donation Breakthrough Collaborative

Health Resources and Services Administration, Division of Transplantation
Rockville, Maryland, USA

The Health Resources and Services Administration's (HRSA) Division of Transplantation has built on IHI's Breakthrough Series Collaborative Model to reform organ donation in the United States.

The aim of the Organ Donation Breakthrough Collaborative is to save or enhance thousands of lives a year by spreading known best practices to the nation's largest hospitals to achieve organ donation rates of 75 percent or higher in these hospitals. It was established and announced in April 2003, by former Department of Health and Human Services Secretary, Tommy Thompson, and key leaders and practitioners from the organ donation/transplantation and hospital communities, including IHI Board Chair Vinod Sahney.

  • Conversion rate (percentage of eligible donors that become donors)
  • Monthly number of donors (number of donors per month across the US)
  • Referral rate
  • Medical examiner denials
  • Timely notification
  • Appropriate requestor


The change package (or, ideas for change and improvement) for this Collaborative was made up of four strategies and about 30 key concepts, all profiling the practices used by Organ Procurement Organizations (OPO) and large hospitals which already had organ donation conversion rates in the arena of 75 percent or more. 

Change Package Strategies:
  • Unrelenting focus on change, improvement, and results
  • Rapid early referral and linkage
  • Integrated donation process measurement
  • Aggressive pursuit of every donation opportunity
The change package was rapidly evolved by the faculty and HRSA team during the Collaborative, as teams refined and added to the original menu of effective practices. By the conclusion of the first of the two Collaboratives, the change package included eight “First Things First Changes” necessary for achieving baseline donation rates at the national average, and a set of six “High-Leverage Changes” associated with getting to donation rates of 75 percent or more. HRSA served as a facilitator to the cultural and process changes they were advocating and thought early and often about spreading what they learned from the hospital/OPO teams.
High-Leverage Changes:
  • Leadership for Spread
    • HRSA provided strong leadership themselves and engaged the leadership of key stakeholder organizations (AMA, AHA, JCAHO, and many others).
  • Better Ideas
    • HRSA invested in a thorough investigation of the systems with the best results and worked (with IHI) to package these in an effective way for the hospital/OPO teams to act on.
  • Set-up for Spread
  • Communication
    • HRSA invested in building a website to support communication.
  • Strengthening the Social System
  • Knowledge Management
  • Measurement and Feedback System


Summary of Results / Lessons Learned / Next Steps
There is a new, higher-performing organ donation system in the United States. This new system was created by bold national implementation of two formal Breakthrough Series Collaboratives and many focused spread activities. Organ donation increased by a record 10.8 percent in 2004; 2005 numbers through the first nine months of the year are another 7 percent higher than the prior year. These back-to-back increases are unprecedented in the history of the field, and have already resulted in an estimated 3,000 additional life-saving and life-enhancing transplants.


A team of IHI content experts has reviewed this report and determined that it is a compelling example of current results from organizations working with IHI.


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