Purpose of Review <p>Normothermic regional perfusion (NRP) can help address the organ shortage by increasing transplantation from donation after circulatory death (DCD) donors. However, despite promising data, adoption has been limited in the United States. This review presents a structured framework for NRP adoption by reviewing the clinical need, evaluating the current evidence, and identifying potential barriers to implementation.</p> Recent Findings <p>NRP in DCD donors is associated with lower incidence of ischemic cholangiopathy and lower risk of graft failure, with outcomes approaching those of donation after brain death (DBD) donors. At our institution, NRP is utilized for all local DCD transplants and select fly-outs, and we found that our local Organ Procurement Organization transplants an average of 3.36 organs per NRP donor, compared to 1.91 for donors managed with static cold storage. These rates are comparable to those seen in DBD donors, and similar outcomes are seen at other sites that have adopted NRP.</p> Summary <p>NRP can significantly expand the donor pool, improve graft viability, and reduce complications associated with ischemic injury of DCD donors. Nonetheless, it has faced several barriers to implementation, including ethical concerns, logistical challenges, and a lack of standardized data tracking needed to refine and validate best practices. Achieving universal adoption of NRP will require addressing these barriers through a structured, iterative, and evidence-based process.</p>