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AOPO Statement on Normothermic Regional Perfusion

Dec 15, 2022 | Advocates, AOPO, Donation, Healthcare Industry, News, Press Release, Transplant

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STATEMENT
Updated May 2026

Normothermic Regional Perfusion: An Emerging
Organ Recovery Procedure

Normothermic Regional Perfusion (NRP) is an evolving clinical technique used in organ recovery following donation after circulatory death (DCD). Organ procurement organizations (OPOs), which coordinate the donation process in partnership with hospitals and transplant centers, may support the use of NRP to help preserve organ function after death has been declared, with the goal of increasing the number of organs available for transplant and improving outcomes for patients waiting for a lifesaving transplant.

How NRP Works

NRP is initiated only after a patient has died. Death is determined by the patient’s treating medical team, independent of the organ donation process and separate from the role of the OPO, and in accordance with established medical, ethical, and legal standards. Following the recommended 5-minute observation period after the heart has stopped, NRP may be used to restore circulation to specific organs in the body to maintain their viability for transplantation.

Why NRP Is Used

Research and clinical experience suggest that NRP can:

      • Increase the number of transplantable organs from each donor
      • Evaluate the viability of organs for safe transplantation
      • Improve the function of transplanted organs
      • Expand access to transplantation for patients on the waiting list

As the need for organs continues to outpace availability, innovations like NRP can help honor more donation decisions and save more lives.

Safeguards and Ethical Standards

The use of NRP is guided by strict clinical and ethical safeguards to protect patients and maintain public trust:

      • Separation of care and donation decisions: Decisions about patient care, including withdrawal of life-sustaining treatment and the declaration of death, are made by the patient’s medical team and are completely independent of organ donation.
      • Respect for the donor and family: Care at the end of life remains focused on the patient’s comfort, dignity, and the needs of their loved ones.
      • No restoration of brain circulation: Clinical protocols require confirmed measures to prevent any blood flow to the brain after death has been declared.
      • Pause for concern: Clinical teams are expected to stop the process at any point if there are ethical or medical concerns.
      • Transparency and communication: Families are provided with clear, compassionate information and the opportunity to ask questions throughout the donation process.

AOPO Guidelines and Ongoing Work

The Association of Organ Procurement Organizations (AOPO) has developed DCD Guidelines and NRP Safeguards to support OPOs and their clinical partners in implementing consistent, ethical, and patient-centered practices across the country. These guidelines reflect input from clinical experts and align with broader recommendations from the transplant community.

NRP continues to evolve as more data and experience become available. AOPO remains committed to ongoing evaluation, collaboration with clinical and policy stakeholders, and supporting OPOs in implementing evidence-based practices to ensure that organ donation practices are safe, ethical, and worthy of the trust placed in them by donors and their families.