*Purpose: Normothermic perfusion (NMP) is a new technique that has been introduced into transplantation expanding capacity for organ utilization. NMP has been shown to be an effective method of organ preservation specifically in potential donors after cardiac death by providing the opportunity for interventions in suboptimal organs. We hypothesized that outcomes were improved after using NMP versus standard cold storage.

*Methods: A systematic review of the literature on normothermic machine perfusion was conducted up until December 2021. We input key words like normothermic perfusion technique, organ transplantation, organ preservation, and static cold storage (SCS) in PubMed as our search strategy and found a total of four papers reviewed without exclusions. Outcomes including graft survival, AST, hospital stay length, and graft injury were examined.

*Results: All four studies examined graft survival, with some heterogeneity in results, although one observational trial supported improved outcomes from NMP. It also showed lower post-transplant aspartate aminotransferase (AST) levels for the NMP organs (417 vs 907) and longer graft survival. Another study examined was a randomized controlled trial (RCT) which showed 50% decrease in graft injury and 50% decrease in organ discard using NMP, although mean graft survival was in favor of SCS. This RCT also reported lower AST levels post-transplant favoring the NMP organs. In an additional observational study, NMP has also been shown to allow for potential enhancement of suboptimal organs prior to transplantation.

*Conclusions: NMP provides a promising future in organ preservation due to its efficacy and organ optimization opportunities. The data is limited, but improved graft survival and AST are noted.

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