Introduction: Normothermic regional perfusion (NRP) is a technique in donation after circulatory death (DCD) that holds promise for expanding the pool of transplantable organs. Despite its potential, the adoption of NRP across the 55 federally designated U.S. organ procurement organizations (OPOs) remains variable, and key ethical and operational challenges persist. Gaining insight into how OPOs perceive and implement NRP is essential to inform policy development, promote best practices, and identify priorities for future research.
Methods: We conducted semi-structured qualitative interviews with executives from 20 OPOs on their experiences collaborating with hospital partners, communicating with donor families, and training staff during and in preparation of NRP cases. Qualitative themes were elicited through deductive thematic analysis.  
Results: Twenty interviews were conducted with staff from U.S. organ procurement organizations (OPOs). Analysis revealed five key themes: (1) comfort with permitting NRP procedures varied both across and within donor hospitals and recipient transplant centers; (2) most OPOs lacked standardized protocols for case management and data collection specific to NRP; (3) there was considerable variation in how OPO staff described NRP to donor families during authorization conversations; (4) many OPOs engaged in proactive educational outreach to partner hospitals in anticipation of future NRP cases; and (5) OPOs reported active collaboration with donor hospitals and transplant centers during and following NRP cases.
Conclusions: While NRP may improve DCD transplant outcomes, there exists variation in practice across OPOs and individual hospitals, including differences in training protocols and communication with donor families about the procurement technique. This variation represents unresolved ethical concerns about lack of standardized NRP policies, which also affect donor hospital staff comfort levels with this type of procurement technique.