NRP Black Book 2026: The clinical manual for DCD & TA-NRP Organ Recovery
A field-tested operational manual for running normothermic regional perfusion safely, defensibly, and in alignment with current ASTS and OPTN standards.
Built for perfusionists, DCD coordinators, and transplant surgery teams that cannot afford failure during organ recovery.
What this prevents:
— Failed procurement due to unrecognized warm ischemia thresholds
— Regulatory exposure from incomplete cerebral exclusion documentation
— Misinterpretation of lactate trends during the run (“metabolic mirage”)
— Inconsistent team communication during high-risk TA-NRP cardiac recovery
— Compliance gaps following the November 2025 OPTN/HRSA Safety Communication
What’s inside — 57 pages, 57+ verified citations, updated through March 2026:
— A-NRP and TA-NRP protocol overview and circuit management
— Warm ischemia thresholds by organ — including the AWIT ≥10 min cardiac hard stop (HR 8.87, 30-day mortality)
— Agonal phase quality metric: why diastolic BP <40 mmHg matters more than total agonal duration
— Biliary protection matrix with metabolic velocity management and discordance guardrails
— DCD cardiac recovery strategy comparison — TA-NRP vs. DPP/OCS vs. REUP — including the 2026 paradigm shift argument from Vanderbilt
— DO2i framework: the first perfusionist-controlled variable linked to DCD cardiac outcomes
— OPTN/HRSA November 2025 cerebral exclusion requirements — transection standard explained
— ASTS/AST Joint Statement 2026 — where it agrees and where it conflicts with OPTN
— Cold storage transition, premortem heparin, troubleshooting, and run sheet guidance
— Pediatric NRP circuit considerations
— Full OPTN regulatory timeline through March 2026 including Project 1483
Includes at no extra cost:
— 60-Second Viability Audit: laminate-ready bedside checklist with every threshold cited
— NRP Program Compliance Checklist 2026: for OPO medical directors and program administrators
Based on: ASTS Standards 2024 — ASTS/ISHLT/STS/AATS TA-NRP Technical Standards 2024 — ASTS NRP Ethical Consensus 2024 — OPTN/HRSA Safety Communication Nov 2025 — ASTS Position Statement Sept 2025 — UK NHSBT NRP Protocol v1.13 (2025) — ELSO 2024 — Peer-reviewed literature through March 2026
For: Certified Clinical Perfusionists — ECMO Specialists — Transplant Surgery Teams — DCD Coordinators — OPO Medical Directors
For educational reference only. Clinical decisions must follow institutional protocols and physician oversight.