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Anthony D'Alessandro, MD, is no stranger to the successes of a solid organ transplant program. As a transplant surgeon at the University of Wisconsin Hospital (UW), D'Alessandro has performed more than a thousand transplants in his sixteen year tenure. In fact, last year was UW's biggest year ever." Our transplant center and OPO had a record year with 133 deceased donors in 2004 from 115 the year prior. We had 618 organs transplanted in 514 patients," says D'Alessandro.

The success of the Donation Breakthrough Collaborative has conversion rates rising across the country. On the heels of this success is the soon to be launched Transplantation Breakthrough Collaborative, which will focus on the number of transplanted organs.

D'Alessandro was asked to co-chair this transplant initiative. The initiative targets transplant centers, surgeons, OPO CEOs and hospital administrators and how their institutions can increase the number of organs recovered and transplanted, with a goal of 3.75 organs per donor. The new phase will launch at the First Annual Organ Donation National Learning Congress in May.

Results from the "Best Practices" hospitals and OPOs produced five areas of concentration for the new Organ Transplant Breakthrough Collaborative:

• Intent: having the attitude of "every organ, every donor, every time."
• Relationships: the need for real-time high level assistance during donation cases.
• Donor management: seeing donor management as the simultaneous care of seven potential recipients; have ICU intensivists view the patient as caring for the potential recipients.
• Push: finding creative ways to place every organ. How do you maximize the utilization 
• Pull strategy: how to foster attitude of a "rule in"; instead of "rule out." Every organ is transplantable until you've exhausted all means.

The potential of the third phase of the Collaborative is tremendous. "If you combine the 75 percent conversion rate goal with the transplant collaborative goal of 3.75 organs per donor, this could increase the number of transplants to 36,000 per year-but only if you achieve both of these goals," says D'Alessandro.

Even though all hospitals and transplant centers are not currently involved in the Collaborative, the model was designed to allow others to join in with ease. "The first two collaborative phases were highly successful in increasing conversion rates in hospitals and this model is what I believe to be the new model for those not involved in the collaborative," says D'Alessandro. "The Collaborative's knowledge management system (KMS) will provide access to all learning session presentations, testing and key concept changes, for implementation. Many of these changes have been proven effective in increasing donation and will hopefully spread to non collaborative hospitals."

As D'Alessandro's transplant center has seen notable changes from last year due to the Collaborative efforts, he looks forward to implementing the yield strategy. It's going to be great to have all transplant centers, hospitals and OPOs collaborate in an interactive way, there's never been anything like this before."