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In collaboration with the Québec Hospital Association, Transplant Québec published the Organizational Framework for Organ Donation and Tissue Donation Services as a reference to provide hospitals a structured approach to develop more effective organ donation and tissue donation services. Administrators, physicians and health professionals, supported by the ODO, are the key stakeholders able to improve the culture of organ and tissue donation in an institution. Improved performance will better meet the needs of patients waiting for a transplant.The Framework and tools were created in phases over 5 years: a Standardized Organ Donation Procedure (SODP); an Audit System based on International Classification of Deceases (version 10) implemented with the help of hospital archivists and Transplant Québec donor coordinators (4 indicators); all linked to hospital accreditation (Accreditation Canada), quality processes and online educational materials. The key components of the Framework will be presented and modelling of the approach will be discussed in relation to improving the number of donors and number of organs. Commitment, defined roles and responsibilities, specific procedures for organ donation and tissue donation, and the education of clinical teams are essential elements.Beginning in 2012, donor referrals increased by 34 % and family refusals decreased by 30 %. During this period, the number of donors increased from 120 to 172 a year, while the total number of transplants rose by 50%. Additionally, the number of DCD donors increased by 400%.Over 5 000 health professionals (mostly critical care) completed online education on the SODP. The number of hospitals using the Audit system increased from 12 to 35. Future gains and next steps will be considered. The role of the ODO in sustaining and moving change forward is crucial to these improved results.There remains untapped potential to improve organ donation from the administrative and clinical perspectives at both the hospital and system levels. Our approach demonstrates the effectiveness of providing standardized guidance for hospital administrators combined with educational resources for health care professionals and an audit system in improving performances. The 5-year trend of these improvements highlights the sustainability of the interventions for improvement of a stronger organ donation culture in institutions.Association québécoise des établissements de santé et de services sociaux.