Donation following the confirmation of death based on circulatory criteria has proven to be a valuable strategy for increasing the availability of organs for transplantation. However, the standard super-rapid extraction technique with ex situ static cold storage yields poor outcomes, particularly for livers. Normothermic regional perfusion, based on in situ perfusion with extracorporeal membrane oxygenation (ECMO), has emerged as a promising alternative to improve donor performance. Pioneered in Spain, this practice has become commonplace in many countries, improving effectiveness and post-transplant outcomes. Spain has established mobile units with highly qualified teams to support centers lacking ECMO technology or experience.

In this article, we detail the normothermic regional perfusion technique, both abdominal and thoracoabdominal, the benefits in post-transplant outcomes, as well as the logistical requirements and ethical considerations that support its use.