LiveOnNY has also been hampered by uneven engagement with the region’s hospitals, which play a crucial role in any successful donation. Intensive-care units must flag potential donors well in advance of death so family consent can be secured, and then it’s up to hospital staff to maintain the viability of the organs until a transplant program is ready to recover them. But clinicians in New York say that local hospitals have not historically held organ procurement among their top priorities.

Dr. Raghu Loganathan, who directs critical care services at St. Barnabas Hospital in the Bronx, said that during his training two decades ago, clinicians viewed a potential donor who had been declared brain-dead as “an orphan patient,” the responsibility of the organ procurement organization rather than the hospital’s.

Increasing organ donation requires a fundamental shift in perspective. To illustrate, Dr. Loganathan recalled a night when a brain-dead patient went into cardiac arrest. He and a team of other clinicians spent an hour resuscitating the patient’s heart so that it would continue circulating blood to the other organs and they could be donated, the kind of intensive intervention that trainees might assume only a living patient merited.

“We used to focus on the patients where there is a ‘prognosis,’” he said. “And that culture has changed, but not necessarily across the board.”

The Greater New York Hospital Association acknowledges that some hospitals have been less supportive of donation than others. Lorraine Ryan, a senior vice president of the association who is also a member of LiveOnNY’s medical board, said that while New York has some of the country’s premier transplant programs, they have not always shown an equal commitment to procuring organs in their intensive-care units. “It was the community hospitals,” she said, “that were outperforming the transplant centers themselves.”

In October 2017, the association gathered participants from all the area’s large health systems for presentations, like one titled “The Current Crisis,” and has circulated data showing hospital leadership how their performance compares.

Whether this will be sufficient to keep LiveOnNY in business is up to federal regulators. If LiveOnNY loses its certification, a neighboring organ procurement organization, like Gift of Life, could apply for the contract. Leaders in the field say that while depressed organ donation rates in New York may stem from many factors, responsibility ultimately has to lie somewhere.