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Spain has always been considered one of the world leaders in organ donation. However, there are regions in the world that outperform them. This study shows that 12 US OPOs out performed Spain in 2016 for donors PMP.This study is a retrospective analysis from US OPTN data for 2016, Donate Life America (for donor registry information) and IRODAT for 2015 Spain data. Various best practices are shared among U.S. OPOs in efforts to increase donation including: Donation after Circulatory Determination of Death (DCDD) –(majority are controlled), U.S donor registration of over 52% (132 million people) through opt-in 50 state driver’s license registries, authorization training of transplant coordinators, and ongoing systematic donor hospital development and education.The U.S. population is 322 million and the 58 U.S OPOs combined surpassed an average of 30.9 deceased donors PMP in 2016. However, the top 12 OPOs in the country exceeded 40 donors PMP with an average of 44 donors PMP with a range from 40 to 52 donors PMP in that group, exceeding Spain’s donors PMP published data for 2015. Deceased donor organs transplanted PMP in the US was 95 organs transplanted PMP which is comparable to Spain.Approximately 22% of the 58 OPOs in the U.S. increased the number of deceased organ donors and donors PMP rates to higher than Spain in 2016, by utilizing non-physician transplant coordinators who are not employed by the donor hospital, improved training programs for transplant coordinators, shared best practices: including increases in DCDs, increased professional education and partnerships with donor hospitals in identifying and managing potential donors, and an opt-in drivers’ license registries in all 50 states that has over 52% of the population registered.