AUTHOR=Miñambres Eduardo , Berman Marius , Antonini Marta Velia , Campo-Cañaveral De La Cruz Jose Luis , Croome Kristopher , Feltrin Giuseppe , Hessheimer Amelia , Jorns Carl , Messer Simon , Wall Anji , Domínguez-Gil Beatriz , Martin Dominique E., Oniscu Gabriel C., Cillo Umberto 
  
TITLE=Normothermic regional perfusion (NRP) use in controlled donation after circulatory determination of death (cDCDD): results of the European Society for Organ Transplantation Bucharest consensus conference
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.16391
  
DOI=10.3389/ti.2026.16391
  
ISSN=1432-2277
  
ABSTRACT=Normothermic Regional Perfusion (NRP) is emerging as a game-changer in enhancing outcomes for Donation after Circulatory Determination of Death (DCDD). NRP maintains physiological conditions through perfusion with oxygenated blood, outperforming conventional super-rapid recovery techniques significantly improving outcomes and organ utilization. Despite its clinical benefits, widespread adoption of NRP is impeded by heterogeneous organizational, legal, and ethical frameworks. At the ESOT Bucharest Consensus Conference, leading experts in transplantation achieved consensus on 130 relevant NRP-related open issues to facilitate its implementation and guide global practice. Key recommendations include criteria for adoption of NRP, minimal requirements, procedures to be adopted before and during NRP, donor organ evaluation criteria and sequence of organ harvesting. Consensus extends to procedural components (including the configuration of perfusion parameters and strategic team coordination), ethical integrity of NRP in the context of the dead donor rule and key unmet needs for future developments. While significant strides were made in unifying practice, unresolved issues regarding maximum warm ischemic time and variability in legal standards indicate avenues for future research. This consensus underscores the imperative for global standardization in NRP application, promising to elevate the success rates of organ transplants and establish NRP as a foundational element in the evolution of DCDD.