Purpose: Evaluate the impact of a systematic, disciplined approach to increasing kidney transplantation, including clear goals, measurement system, integration of organ procurement organization (OPO) with large donor hospitals and transplant programs, and singular focus on results. Methods: Key strategies for increasing organ donation and kidney transplantation were identified and implemented starting in January 2010, and progress was monitored and shared transparently. All kidney recovery surgeries (n=565) were performed by two staff members. Each recovered approximately 50% of the total kidneys. Specific goals included increasing overall organ donors, increasing donors after circulatory death (DCD), ensuring DCD donors are converted to brain dead donors to the maximum extent possible, and increasing kidneys transplanted. Results: Total organ donors per month from this OPO increased 47% from 2009 to 2012. DCD donors per month more than tripled. Total kidneys transplanted increased 32%, from 18.2 to 23.9 per month. Kidneys transplanted from brain dead donors increased 10.5%. Kidneys transplanted from DCD donors increased 300%.

Over this study period there were 37 cases that started as DCD donors but were successfully converted to brain dead donors. Mean DCD donor age in years for 2009, 2010, 2011, and 2012 was 31.5, 31.4, 41.1, and 37.7 respectively. Mean brain dead donor age in years for 2009, 2010, 2011, and 2012 was 35.7, 36.5, 39.6, and 34.1, respectively. Conclusion: A systematic approach to increasing kidney transplantation can generate continuous growth. A robust approach to increasing DCD donation contributes to an increase in the supply of kidneys, without reducing the pool of brain dead kidneys. Careful attention to ensuring potential brain dead donors are not lost to the DCD pathway enables successful conversion of these cases whenever clinically possible. Integration of the OPO, the donor hospitals and the affiliated kidney transplant programs is an effective strategy for increasing kidney transplantation.

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