As awareness of the hospital's accountability and role in organ donation grows, the role of the healthcare executive also becomes more prominent. Without the leadership and attention that can only be provided at the senior level, the good intention of engagement to pursue donation are often realized only as missed opportunities. The following key elements serve to further clarify what needs to be in place to increase donation: 1. A senior leadership group to sponsor and visibly support the donation improvement team. 2. The development and implementation of an organizationwide donation education program focused on the fundamental of the organ donation process and best practices.