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Donor family members cite feel their loved one’s legacy is honored as a key factor in their satisfaction. Knowing the outcome of their loved ones’ gifts of organ donation is an important factor in their feeling positive about donation. Receiving a note of thanks and hearing how the recipients are doing helps to achieve this.The OPO implemented a program to support the anonymous exchange of letters between donor family members and transplant recipients. The program included development of printed materials to share with recipients post donation, guidance for writing, and a process for anonymous exchange of letters. The OPO reached out to partner transplant centers to share the importance of the process and develop best practices for managing the program. Transplant center social workers guide their recipients about writing to donor families. This process is managed by donor family advocates who are employed by the OPO and are trained and experienced bereavement professionals.The process and support resulted in a positive number of letters exchanged over a three-year period. In 2014, 147 donor families wrote to organ recipients and 388 organ recipients write to donor families. In 2015, 149 donor families wrote to organ recipients and 327 organ recipients wrote to donor families. In 2016, 216 donor families wrote to organ recipients and 332 organ recipients wrote to donor families. On occasion the exchange of letters leads to donor families and recipients choosing to meet and with consent of both parties they are provided the names and contact information. This occurred 12 times in 2014, 18 times in 2015, and 20 times in 2016. Surveys are sent to each donor family member 13 months post donation and include the statement “through donation, you feel your loved one is remembered and legacy honored.” The percent of respondents who answered positively to that question increased over a three-year period from 85% in 2013 to 87% in 2014 and 92% in 2015.Providing opportunities for donor family members and recipients to communicate with each other provides important support for donro families. The number of letters exchanged suggest it is a positive experience for transplant recipients. A well-established system including process guidelines and resources managed by professional staff is important for the success of a writing program.