Specialist machines that keep donated livers functioning outside the human body should be made routinely available across the NHS, according to draft guidance published today by the National Institute for Health and Care Excellence (NICE).
The proposals, now out for consultation, aim to address a long‑standing postcode lottery in access to some of the most advanced transplant technologies currently available, with significant implications for patients waiting for life‑saving liver transplants.
Around 600 adults and children are currently on the active liver transplant waiting list in England. Across the UK, 874 liver transplants from deceased donors were carried out in 2024/25. Median waiting times stand at around five months for adults and six months for children and young people, with some patients not surviving long enough to receive a transplant.
A key challenge in liver transplantation is that donated organs can deteriorate during transport. At present, livers are typically moved using static cold storage, where the organ is flushed with a cold preservation solution, sealed in a sterile bag and packed in ice. While effective, this method limits safe preservation to between eight and twelve hours and does not allow clinicians to assess how well the liver is functioning before transplantation.
If transport times are prolonged or delays occur, the liver may no longer be safe to use. Surgeons are often required to make complex judgement calls based on limited information, including visual inspection alone.
NICE’s medical technologies advisory committee reviewed the evidence and concluded that four devices should be supported for use in NHS hospitals:
- Liver Assist (XVIVO BV)
- metra (OrganOx Ltd)
- PerLife Pro (Aferetica Srl)
- VitaSmart Hypothermic Oxygenated Perfusion System (Bridge to Life Ltd)
Rather than simply chilling the organ, these machines actively pump a specially formulated solution through the liver’s blood vessels, helping to protect it from damage and deterioration. Some devices operate at near‑normal body temperature, enabling clinicians to monitor liver function in real time before transplantation.
This approach allows livers from older donors or those donated after circulatory death, which may previously have been declined due to uncertainty over quality, to be properly assessed and potentially used, increasing the number of viable transplants and improving patient outcomes.
Patient experience also featured strongly in NICE’s assessment. A survey of 121 people, including those currently on the waiting list, transplant recipients and family members, highlighted the profound impact that liver disease and prolonged uncertainty can have on daily life.
Until now, access to these machines has depended heavily on geography. Some transplant centres have secured equipment through local charitable funding, while others have not, resulting in unequal access for patients. NICE’s draft guidance recommends that any of the four approved devices can be funded through core NHS budgets, removing reliance on local fundraising and ensuring more consistent national access.
Economic analysis presented to NICE’s independent committee showed that all four devices represent good value for money, with cost‑effectiveness well within the range NICE would typically consider acceptable.
Dr Anastasia Chalkidou, HealthTech Programme Director at NICE, commented:
“Too many people are waiting too long for a liver transplant, and where you live should not determine whether you can access the best available care.
“Most transplant centres already use these machines, but funding has come from local charities, and access has varied. This guidance gives the NHS a clear, evidence-based foundation to ensure these devices are available consistently and fairly across the country.
“Reducing health inequalities is central to everything NICE does, and this guidance is a practical example of that commitment.”
The consultation on the draft guidance is now open, with patients, families, clinicians, commissioners, charities and members of the public invited to comment. The consultation closes on 10 June 2026, with a second committee meeting scheduled for 25 June 2026. Final guidance is expected to be published in August 2026.
Image credit: iStock
