Advancements in organ transplantation focus on improving graft viability and outcomes. Normothermic regional perfusion (NRP) gains traction as a transformative technique in donation after circulatory death, enhancing organ preservation. Investigations into pre-transplant kidney biopsy standardization provide critical frameworks for increasing transplant success rates. Pioneering use of central Y–Y ECMO in pediatrics marks a milestone in mechanical circulatory support. These innovations collectively aim to optimize transplant efficacy and patient prognosis.