Normothermic machine perfusion (NMP) and hypothermic machine perfusion (HMP) techniques are improving organ viability in transplantation. Recent studies highlight the efficacy of NMP in liver preservation from donation after circulatory death (DCD) donors and HMP in liver allograft viability. Additionally, central Y-Y ECMO systems have been successfully implemented in pediatric patients, representing further progress in surgical support technologies. These advances are critical for increasing organ utilization and improving postoperative outcomes.