Russian transplantology is quite far from first place in the world. The post-Soviet mistrust to social and medical service resulted in dramatic reduction of transplantations in some regions of Russia during the last 10 years. The level of organ donation depends on public trust and a proper form of the donation process. The reasons for the organ donation crisis are well known. First, it is the so-called "command form of organ donation" inherited from the Soviet medical system. The longtime model of obtaining donor organs from deceased individuals caused negative public opinion. Organ donation was considered to be an activity that violated the dead and living rights. As a result, we need new forms of professional collaboration between transplantologists and intensive care unit specialists. The northwest Region of Russia created the first model of transplant coordination in 2006. There were regional transplant coordinators (as a part of a procurement center) and local (hospitals) coordinators. During 2006, this initiative was emotional and enthusiastic; after 2007, this initiative received financial support from the local government. As a result, there is an increasing number and changing quality of organ donations. In 2007, the total number of organ donors in Saint Petersburg now is 8.7 per million compared with 2.5 per million in 2005.