Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue affecting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population.

Multiinstitutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement.

The use of donation after circulatory death organs after normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This issue has led to variation in perception and use of normothermic regional perfusion, thus contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with an introduction to program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns.

Normothermic regional perfusion is relevant after donation after cardiac death in the pediatric population. Ethical and technical challenges remain, in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplantation, thereby reducing pediatric mortality.