Abstract Although organ preservation has relied upon hypothermia throughout the history of clinical transplantation, increasing reliance on suboptimal organs has recently focused attention on novel techniques that avoid the cumulative effects of preexisting organ damage and cold preservation. Normothermic preservation provides oxygen delivery at physiologic or near-physiologic temperature and allows maintenance of normal cellular metabolism. There is increasing evidence, mainly from experimental models, that this technique reduces preservation-related organ damage and that it has potential application particularly in the transplantation of marginal donor organs. The technical challenges and logistic constraints of what is an intrinsically more complex method have prevented introduction of normothermic preservation other than very limited clinical trials. However, the potential advantages of this technique are considerable, and it is likely that the technical problems will be overcome, allowing more widespread application into clinical practice.