What is NRP?

After a patient’s heart and lungs stop, blood flow and oxygen stop, causing rapid organ deterioration. In NRP, a machine mimics normal circulation by pumping oxygenated blood at normal body temperature to selected organs in the donor’s body.

This process:

• Restores near-normal conditions to the perfused organs, preventing ischemic damage.
• Maintains organ function by reducing cellular injury, which is especially important in Donation After Circulatory Death (DCD) cases https://epiccardiovascularservices.com/solutions/nrp-and-dcd-services/ 
• Extends preservation time, giving transplant teams more flexibility for coordination https://epiccardiovascularservices.com/solutions/nrp-and-dcd-services/

Two main types of NRP are used:

• Abdominal NRP (A-NRP): perfuses abdominal organs only.
• Thoracoabdominal NRP (TA-NRP): perfuses both thoracic and abdominal organs, sometimes even restoring cardiac activity

1. Improved organ viability: Keeps organs “alive” in a functional state until transplant, rather than relying solely on cold storage https://aopo.org/statement-on-normothermic-regional-perfusion/
2. Better recipient outcomes: Lower rates of complications, improved graft survival, and reduced ischemia-reperfusion injury Outcomes of DCD Liver Transplant Using Sequential Normothermic Regional Perfusion and Normothermic Machine Perfusion or NRP Alone Versus Static Cold Storage – Mayo Clinic
3. Expanded donor pool: Increases the number of viable organs from DCD donors, addressing the organ shortage crisis Thoracoabdominal Normothermic Regional Perfusion: Real-World Experience and Outcomes of DCD Liver Transplantation – International Perfusion Association
4. Higher utilization rates: More organs can be successfully transplanted, including from livers, kidneys, hearts, and lungs Thoracoabdominal Normothermic Regional Perfusion: Real-World Experience and Outcomes of DCD Liver Transplantation – International Perfusion Association

1. Improved Organ Viability: By minimizing warm ischemic time, NRP preserves cellular function, making organs more suitable for both transplantation and experimental studies. https://aopo.org/statement-on-normothermic-regional-perfusion/
2. Expanded Donor Pool: NRP allows more organs to be recovered from Donation After Circulatory Death (DCD) donors, which is critical for research that requires large or rare organ samples Thoracoabdominal Normothermic Regional Perfusion: Real-World Experience and Outcomes of DCD Liver Transplantation – International Perfusion Association
3. Better Research Outcomes. Studies using NRP-perfused organs have shown:

• • Improved early function in livers and kidneys https://aopo.org/statement-on-normothermic-regional-perfusion/
  • Reduced complications like cholangiopathy and delayed graft function In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival – American Journal of Transplantation
  • Higher rates of organ utilization in transplantation research
    https://www.amjtransplant.org/article/S1600-6135%2825%2900176-5/fulltext
  • Longer Preservation Time: Organs can be kept viable longer, giving researchers more time to perform experiments before transplantation epiccardiovascularservices.com.
    https://www.hrsa.gov/optn/policies-bylaws/policy-issues/normothermic-regional-perfusion-nrp
  • Allows testing on organ function parameters while in the body under normothermic regional perfusion or while on a normothermic pump device.

Given the advantages of NRP and NMP in organs for transplant, and thus organs for researcher, further research is warranted.  Can organs for medical research be improved allowing for broader acceptance criteria by researchers while also providing time for organs to recover after procurement?

Given the current outcomes, we can expect to see only growth in the use of normothermic technology for organs used in transplant and research.