Life-saving breakthrough: How Normothermic Regional Perfusion (NRP) is revolutionizing organ donation

What is NRP? 

Normothermic Regional Perfusion (NRP) is a process that significantly improves the preservation and recovery of organs for transplantation. Typically, when organs are recovered from an organ donor after circulatory death (also called donation after cardiac death, or DCD) — those organs face the challenge of being in a state of oxygen deprivation. This is a significant hurdle because organs function best when they have access to oxygenated blood. 

NRP works to ensure that a donor’s gift is in the best possible condition for a successful transplant outcome for a recipient. NRP is a sophisticated procedure whereby oxygenated blood is circulated through the donor’s organs upon Donation After Circulatory Death (DCD). This blood flow helps restore the health of the organs before they are recovered and prepared for transplantation into the recipients. The impact of this is monumental; this advanced technique: 

• Improves the health of the organ(s) prior to transplantation;  

• Saves more lives by increasing the number of organs available for transplant; and 

• Allow organs to last longer for the recipients with fewer complications. 

“It is not possible to magically increase the number of donors due to multiple factors,” said LifeSource organ recovery surgeon Dr. Umar Farooq. “But, it is possible to refine our current practices to have a higher yield of organs from our current pool of donors, and NRP is one such innovation. It has statistically proven to increase the number and quality of organs available for the waiting recipients.” 

The life-saving impact of NRP 

The ability to restore oxygenated blood flow to organs before they are removed from the donor is nothing short of revolutionary. Organs such as hearts, lungs, kidneys and livers, which would typically begin to degrade in an oxygen-deprived state, can now be preserved in far better condition, after death is medically and legally declared. 

This advancement allows for more organs to be available for procurement and increases the chances of those organs functioning optimally once received. In particular, kidneys that undergo NRP show up to 35 percent less chance of experiencing delayed function, meaning recipients of these organs face fewer post-transplant complications and have a higher quality of life. In fact, studies have shown that NRP can increase the odds of procuring organs for transplant by up to threefold for abdominal organs, including the liver and pancreas. 

“For individuals and families who have made the selfless decision to donate their or their loved one’s organs as lifesaving gifts for others, this innovation offers the profound reassurance that more lives will be touched by their generosity,” said Farooq. “NRP maximizes the potential of each organ donation, ensuring that the donor’s legacy is carried on by helping not just one person, but many.” 

The future of organ donation: More lives, fewer barriers 

Beyond the immediate clinical benefits, the widespread adoption of NRP brings us closer to a broader mission: saving more lives through the gift of organ donation. Nationwide, there are over 100,000 people waiting for a life-saving organ transplant, and every 7.5 minutes that waiting list grows. Devastatingly, 16 people die each day while waiting for an organ transplant. But just one organ donor can heal and save up to 8 lives through organ donation, and more than 75 lives through tissue donation. 

Across the United States, NRP is making possible the industry-wide goal of reducing the transplant waiting list by recovering and transplanting 50,000 organs annually by 2026 — a target that would save thousands more lives each year.  

Hospitals, organ procurement organizations, and transplant centers are already embracing this technique, with over half of U.S. organ procurement organizations (OPOs) now implementing thoracoabdominal NRP (TA-NRP) for thoracic organs like the heart and lungs. There is ongoing training for healthcare teams to uphold the highest ethical standards, ensuring that NRP is conducted efficiently and with the utmost care. The continued evolution of NRP ensures that more organs are used, more lives are saved, and the overall impact of organ donation is maximized. 

In a world where the waiting list demand for life-saving organs far exceeds the number available, innovations like NRP offer a beacon of hope. They not only improve the lives of those waiting for organ transplants but also honor the generosity of those who choose to give the gift of life through donation. 

With NRP, the future of organ donation looks brighter than ever. Together, we’re taking a significant step forward in saving lives and offering hope to thousands of patients and families. 

Frequently Asked Questions 

When is NRP used? 

After circulatory death (DCD) is declared – which is determined by a medical provider who is not a part of the organ procurement team using accepted medical criteria and confirmed after a pre-defined hands-off period. The purpose of the hands-off period is to confirm that autoresuscitation does not occur, and that cessation of circulatory function is irreversible. Click here to learn more about how the organ donation process works.  

Does the NRP technique resuscitate the patient? 

No. Perfusion is not an act of resuscitation; the technique is isolated to the specific organ system deemed necessary for procurement. For example: 

• Thoracoabdominal NRP (TA-NRP): The aorta and right atrium are cannulated. Perfuses the thoracic and abdominal organs, including the heart and lungs.   

• Abdominal NRP (A-NRP): The femoral artery and femoral vein are cannulated. Perfuses the abdominal organs, including the liver, kidneys, pancreas and bowel.   

Is this procedure ethical? 

Yes. NRP follows the medical and legal determination of death donor rule and irreversibility, and as such, is not causing any additional death – it’s saving more lives. There is no difference in the process for determination of death in standard circulatory death (DCD) donation versus donation where NRP is used. There is also no impact on the legal framework for an anatomical gift. This technological advancement simply allows for greater efficacy in maximizing the gift given by the donor and/or their family once their authorization is obtained.  

What do the patients’ families think of the use of this technique? 

This technique allows the patient to donate more organs and save more lives – we find that families are typically hopeful about the possibilities for their loved one to help more people.  

Does this procedure improve the health of certain organs more than others? 

Thoracoabdominal NRP (TA-NRP) is used in the preservation and recovery of thoracic organs, including the heart and lungs. Abdominal NRP (A-NRP) is used in the preservation and recovery of abdominal organs including kidneys, liver, pancreas, and intestine. When adjusting for organ-specific donor risk profiles, the use of NRP: 

• Increased the odds of all abdominal organs being transplanted by threefold  
• Kidneys had a 35% lower chance of developing delayed graft function than non-NRP kidneys in recipients in the long-term