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To optimize organ donation performance the nature and impact of complex factors need to be understood. Some factors are well known and might not be modifiable (contra-indications for transplant, age limit of organ donor, etc), but others (collaboration and relationships) that contribute to variations among similar hospitals in the same province, are poorly understood. Thus, the overall aim of this research is to understand the nature and impact of relationships within the organizational context of organ donation programs in Ontario.We will employ an exploratory, prospective, diagnostic study consisting of three approaches: (1) to describe the characteristics of social networks of health care professionals of the organ donation programs (Social Network Analysis) and (2) to describe the organizational attributes and processes of on organ donation programs (Multiple Case-Study), and (3) to compare the influence of social networks and organizational attributes on the performance of organ donation programs (Network Comparison). The study sites will include Ontario hospitals designated as type A based on trauma centre level (Public Hospitals Act classification); and hospitals partners of the Ontario’s Organ Procurement Organization. At least five sites will be purposely selected to capture the greatest variability of settings possible.Understanding the influences of informal networks on organ donation outcomes is essential to the development and informing of interventions to optimize performance. This research will increase organ donation rates in Ontario by providing to the scientific community a novel measure of organ donation programs’ performance and by identifying successful collaboration paths during organ donation processes. We will present the development process of the research as well as preliminary findings.