Introduction: US organ procurement organizations (OPOs) are mandated to maximize the number of organ donors and organs transplanted per donor. Normothermic regional perfusion (NRP) does this, with the additional benefit of higher quality livers and kidneys, from donation after circulatory determination of death (DCD) donors compared to direct procurement (DP). Our OPO provides all components of NRP for transplant centers receiving organs from donors in our service area, eliminating the need for them to travel to the donor hospital. We compared our NRP donation outcomes to those of a recent DP cohort to encourage expansion of OPO-based NRP.
Method: NRP became the default DCD recovery method 1-Jul-2024. All perfusion and cannulation services were coordinated/performed by our OPO. We compared NRP (1-Jul-2024 through 8-Jun-2025) to direct procurement (DP; 1-Jul-2022 through 30-Jun-2024) donors. Compared outcomes were liver utilization rate (livers transplanted/number of donors), kidney use rate (kidneys transplanted/kidneys recovered for transplant) and observed:expected (O:E) ratios for liver and kidney transplants.
Results: We had 427 DP donors and 255 NRP donors. Average NRP age was significantly older (50.6 vs. 44.4 years; p<0.001). Overall liver utilization was 53% (136/255) from NRP and 14% (61/427) from DP donors (p<0.001). For donors older than 50 years, NRP liver utilization was 49% (72/146) vs 9% (18/191) for DP (p<0.001); for donors older than 60 years, liver utilization was also higher from NRP donors (53% [47/89] vs. 6% [4/67]; p<0.001). Livers were transplanted at 29 different centers. Overall liver O:E improved from 0.81 (DP) to 5.19 (NRP); for donors over 50 years old, liver O:E improved from 0.99 to 8.59; for donors over 60 years old, liver O:E improved from 1.11 to 9.51. Overall kidney use rate was 72% from NRP and 73% from DP donors (p=NS); for donors older than 50 years, kidney use rate was 62% (NRP) vs. 63% (DP; p=NS); for donors older than 60 years, kidney use rate was 54% (NRP) vs 57% (DP; p=NS). The average NRP kidney donor risk index (KDRI) was significantly higher (1.32 vs 1.19; p<0.001), resulting in increased kidney transplant O:E for NRP overall (1.63 vs. 1.15); donors older than 50 years (2.28 vs. 1.26); and donors older than 60 years (2.83 vs. 1.29).
Conclusions: Despite a significantly older NRP cohort, NRP was associated with significantly increased liver utilization and liver transplant O:E from DCD donors compared to DP donors. Patients at multiple centers benefited from our OPO-based NRP model, promoting equitable access for patients listed at centers without NRP programs. Additionally, the significantly higher KDRI in the NRP cohort, yet similar kidney use rates, translated to more kidneys transplanted than expected. Expansion of OPO-based NRP would expectedly decrease waiting times and waitlist mortality for those on the liver and kidney waitlists in the US.