The Ruffatti organ at the Cathedral of the Immaculate Conception in Kansas City, Missouri, was installed in the first quarter of 2003, as part of the massive restoration of the sanctuary space, which included restoring the arches and columns, and the stained glass windows. A new floor was added, using marble from Spain, Italy and India.

The main organ is located in the rear gallery, and is comprised of 47 ranks over a three-manual console. The remaining rank is in the front gallery, a horizontal Fanfare Trompette with the trademark Ruffatti bell-shaped flared brass resonators, which is mounted on either side of the rose window, which was also added as part of the restoration.

Recessed lighting in the mid- night-blue ceiling gives the appearance of stars in the night sky, and the effect is remarkable.