Organ Procurement Organization-Based Normothermic Regional Perfusion in the US: Current State and Future Direction

The 55 US organ procurement organizations (OPOs) play a central role in transplantation. OPOs are required to maximize quality and number of organs transplanted; normothermic regional perfusion (NRP) promotes these donation outcomes from donation after circulatory determination of death (DCD) donors. Most reports of NRP benefits have been from transplant centers; there is 1 recent OPO-based NRP publication, showing improved organ utilization in non-thoracic donors. A recent survey of OPOs’ experience showed 606 cases had been coordinated through 2023, predominantly at the request of a transplant center. Barely half of OPOs (53%) had a policy approved or pending approval. Large heterogeneity of practice/experience and the need for guidelines/standards were study highlights. We collectively performed 533 NRP recoveries in 2024. Benefits of OPO-based NRP and ideas for future direction, which requires more process standardization, are outlined. Expansion of OPO-based NRP is necessary to maximize DCD donation outcomes.