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1 Recommendation

1.1

Four ex-situ machine perfusion devices can be used in the NHS as options to preserve livers from deceased donors for people who need a liver transplant. The technologies are:

  • Liver Assist

  • metra

  • PerLife Pro

  • VitaSmart Hypothermic Oxygenated Perfusion System.

PerLife Pro can only be used as long as it has the appropriate regulatory approval.

What this means in practice

There is enough evidence to show that ex-situ machine perfusion devices to preserve livers from deceased donors for people who need a liver transplant provide benefits and value for money. So, they should be routinely available across the NHS and paid for using core NHS funding.

Why the committee made these recommendations

There is a shortage of high-quality donor livers in the UK, and many available donor livers do not proceed to transplantation. This can substantially affect quality of life and increase the risk of death for people who are waiting for a liver transplant.

Static cold storage is traditionally used to preserve livers between organ retrieval and transplantation. This minimises damage to the organ caused by a lack of blood supply during transport and preparation for surgery. Ex-situ machine perfusion devices pump a specially formulated solution through the donor organ's blood vessels. In the UK, they are used at the hospital where the liver transplant will take place. They aim to improve organ preservation compared with static cold storage alone, particularly for higher-risk transplants.

Most UK liver transplant centres already use ex-situ machine perfusion devices. But practice differs across centres and funding often comes from local charitable sources rather than core NHS funding. This has resulted in regional variation in access to ex-situ machine perfusion devices.

Evidence suggests that, compared with static cold storage alone, ex-situ machine perfusion devices improve clinical outcomes for people who have a liver transplant. The devices may also increase the number of donor livers that can be transplanted safely.

Results from economic modelling show that these technologies are likely to be cost effective. So, they can be used in the NHS.