Consensus Statement of the National Consortium on Normothermic Regional Perfusion for Organ Donation after Circulatory Determination of Death in India

Background: India ranked third globally in organ transplants in 2023, yet over majority of its 18,378 transplants were from living donors, with deceased donor numbers remaining critically low. To address this disparity, organ donation after circulatory determination of death (DCDD) offers a viable and ethically sound path to expand the donor pool. Normothermic regional perfusion (NRP), a technique adopted in the West, has been shown to improve DCDD graft viability and outcomes by restoring perfusion in situ, therefore allowing for functional assessment of the allografts and reducing ischemic injury. Methods: This consensus statement was developed by a multidisciplinary panel of experts in organ transplantation and organ donation. Contributions from all authors were compiled, edited, and refined through multiple rounds of virtual discussions and consultations, culminating in a national summit held on October 4–5, 2024, in Pune, Maharashtra. Conclusion: In light of the 2023 Supreme Court ruling simplifying the withdrawal of life-sustaining therapy (WLST), this consensus statement outlines practical protocols for implementing NRP in India. It addresses three core scenarios: WLST in the operating room (OR), WLST in the recovery area with transfer to the OR, and WLST initiated in the intensive care unit with portable NRP and transport.