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It was recognized that many local hospital donation processes required organized oversight and lacked application of donation best practices, this translated into lost donation opportunities. A call to action was required to better serve our community and develop a culture of donation. One donor hospital, in close collaboration with the organ procurement organization (OPO), implemented donation best practices and became a local process leader. The intensivist then realized there were opportunities to improve donation practice across the six affiliated hospitals and a program was developed to support this initiative.A regional organ, eye and tissue donation council with membership from six alliance hospitals and the OPO was formed, with endorsement by the senior regional hospital administrators. The goal was to share and achieve equivalent donation best practice across the regional hospitals. Central to the initiative was a donation council at each local hospital working to achieve donation best practice, collaboration at the regional level and reporting through the performance improvement system.The following has been implemented at each hospital:Donation councils have been formedCouncil information is electronic and centralizedStructured reporting through the performance improvement system to both the local and regional councilsReview of physician practice pre OPO management with a structured donation debrief processAn electronic note for physician documentation of death by neurologic criteria is available with goals of mandatory use and timely completion of two notes by six hoursBiannual reporting to the alliance hospital administrative leadership that has led to enhanced donation practice oversight at each hospitalCollaboration for community activities and donor recognition eventsCurrent work includes the development of a common procedure document for donation processes based on national guidelinesApplication of donation collaborative best practices at a regional level and shared best practice has resulted in enhanced donation practice at each hospital. Oversight by the regional hospital leadership through the performance improvement system ensures program maintenance. The six alliance hospital donation council is a unique venture in the county and OPO region, providing a model for other hospital systems to emulate.