Widespread interest and adoption of normothermic regional perfusion (NRP) in the United States (USA) was somewhat slower than in many European countries. Following initial experiences by the Michigan ECMO donation after circulatory death (DCD) program in the early 2000s, NRP in the USA was largely abandoned until 2020. Renewed interest in NRP gained support as select thoracic transplant programs began to pursue thoracoabdominal-NRP (TA-NRP). Abdominal programs followed suit and now the use of NRP has become widespread in the USA. In addition, multiple Organ Procurement Organizations (OPOs) have now begun employing procurement surgeons and NRP services so that they can offer NRP recovery for all DCD donors. Initial results with NRP have been excellent, with numerous studies showing a significant reduction in ischemic cholangiopathy and increased organ utilization. All the published case series have described excellent graft and patient survival. Moving forward it will be important to firmly establish practice Standards for NRP organ recovery in the USA in addition to ensuring that data is collected and reviewed. In addition, developments such as Hospital-Based Donor Care Units (DCUs) and sequential NRP + ex situ perfusion may continue to expand the donor pool. The present chapter provides an overview of the development of NRP in the USA as well as current landscape and future directions.