Introduction: Organ shortage is a major reason for the low number of organ transplant in India. An estimate four thousand people die in road traffic accidents in Kerala, about 70% of them could be declared brain dead and become potential donors. Due to the lack of professionals trained on deceased organ donation, all those potential donors are missing.
Although Kerala achieved the highest number of donors in 2015 with 75 donors/2,1 pmp, in 2016 there was an important decline due to legal implications on brain death (BD) certification. In November of 2018, the Family and Health Welfare Department sanctioned a government order to appoint an in-hospital transplant procurement manager to coordinate potential donors at intensive care units in government medical colleges. 
Materials and Methods: A Transplant Procurement Manager was designated to create the first hospital-based organ procurement unit (H-OPU) in a third level transplant hospital with a total of 560 beds and 60 ICU beds. The procurement manager became actively involved in the donor identification following GIFT protocol, supporting BD diagnosis and approaching donor’s families.
An educational approach based on the implementation of a specialized program for health professionals according to the TPM® DTI Foundation training model also started in 2019. On-site training in the different steps of the DP was performed, later two ICU physicians attended the Advance TPM® in Barcelona. The educational program was reinforced as well by setting an international internship and hospital visits allowing professionals from India to further increase the experience and competences exchange in the field. In addition, a team of DTI international experts visited Kerala hospitals to exchange best practices.
Results: Compared to 2018, in 2019 there was a smaller number of ICU admissions N=649 Vs N= 732 of which 112 patients presented a devastating brain injury (possible donors) and were referred to the TPM team (Vs N= 148 in 2018). 42.8 % were converted to potential donors in 2019 Vs 37.8% in 2018, an increase of 5% (N=45 Vs N=56). From the total potential donors declared, 25% were actual donors (N=12 Vs N=0), the rest of the cases were discarded primarily because family refused (religious barriers, inconsistencies among relatives, apathetic attitude towards the DP). The conversion rate increased from 0% in 2018 to 25 % in 2019.
Conclusion: The positive impact on the conversion rate is associated with the first operational H- OPU as part of the services provided by the hospital. The role of the transplant procurement manager provides a clinical leadership and raises the value of deceased organ donation. Committed medical team in addition to an efficient system can reestablish the family's trust to avoid the leakage of donors.
Organ donation specialized training and international collaboration alongside institutional and regulatory support from the government are essential elements for the reconstruction of the DP in Kerala.