New machines that keep donor livers alive outside the body could help hundreds
A consultation has begun on draft guidance recommending four specialist liver preservation machines for routine NHS use, which could help more of the 600 people in England waiting for a life-saving transplant.
Specialist machines that keep donated livers functioning outside the human body should be made routinely available on the NHS, NICE has said in draft guidance published today.
A consultation has begun on draft guidance that could help address a postcode lottery in access to some of the most advanced transplant technology available.
Around 600 adults and children are currently on the active waiting list for a liver transplant in England. Across the UK, 874 liver transplants from deceased donors took place in 2024/25.
The median waiting time is approximately 5 months for adults and 6 months for children and young people. Some people do not survive long enough to receive a transplant.
Sometimes a donated liver cannot be used because its condition has deteriorated during transit. Cold storage limits how long a liver can safely be preserved, typically to between 8 and 12 hours. If the journey takes too long, or logistical delays occur, the organ may no longer be safe to transplant. Because it is also not possible to assess how well a liver is functioning during cold storage, surgeons sometimes have to make difficult decisions about whether to proceed, based on a number of factors including how the organ looks.
What do these machines do?
NICE's medical technologies advisory committee reviewed the evidence and recommended 4 devices can be used in NHS hospitals:
Liver Assist (XVIVO BV)
metra (OrganOx Ltd)
PerLife Pro (Aferetica Srl)
VitaSmart Hypothermic Oxygenated Perfusion System (Bridge to Life Ltd)
When a liver is donated, it needs to be moved quickly from donor to recipient. This is done using "static cold storage": the liver is flushed with a cold preservation solution, placed in a sterile bag and packed in ice for transport.
While effective, this method does not allow doctors to check whether the liver is working properly before the transplant takes place. It can also cause damage to the organ over time.
Instead of simply chilling the organ, these machines, used in NHS hospitals, actively pump a specially formulated solution through the liver's blood vessels. This helps protect the organ from deteriorating.
Some devices operate at near-normal body temperature, which allows surgeons to check whether the liver is working properly before the transplant takes place. This means that livers from older donors, or those donated after circulatory death, which might previously have been declined due to uncertainty about their quality, can now be properly assessed and potentially used, giving more patients a chance of a transplant.
What difference could this make to patients?
A survey of 121 people carried out as part of NICE's assessment, including people on the waiting list, those who have received a transplant, and family members, described the profound impact that liver disease and waiting for a transplant can have on daily life.
Monica Walsh and Charlotte Vockins gave evidence to the NICE committee as people with direct personal experience of liver transplantation. Their evidence helped the committee understand the real-life impact of waiting for a transplant and the difference these machines can make.
I had my liver transplant nine and a half years ago, and it gave me a second chance at life I will never take for granted. Since then, as a mentor to others waiting for transplants, I have seen at first hand how distressing it is when someone is called to hospital only to be told the donated liver is not suitable. I've spoken to people who have been called multiple times and even had it said to me on occasion that they simply could not got through it again.
Monica added, "These machines mean that by the time a patient is called, the donated organ has already been assessed, and we know it is viable. That certainty makes an enormous difference. It also means fewer donated organs go unused, which matters deeply to donor families.
"When Charlotte and I gave evidence to the NICE committee, we wanted them to understand the immense emotional toll of waiting. Knowing that our experiences helped inform this draft guidance means a great deal to me and to the community I represent.”
I was living with a rare liver condition since childhood, and waiting two and a half years for a transplant. Every day felt like living under a black cloud. My only option was a split liver transplant, and without the machine perfusion technology, that operation simply could not have happened. The liver would have been outside the body for too long.
Charlotte added, “I was living with a rare liver condition since childhood, and waiting two and a half years for a transplant. Every day felt like living under a black cloud. My only option was a split liver transplant, and without the machine perfusion technology, that operation simply could not have happened. The liver would have been outside the body for too long.
“What struck me afterwards was that my hospital had to scramble for charity funding to access the machine at the last minute. Meanwhile, other hospitals have machines available all the time. That cannot be right. When I heard that NICE was assessing these devices, I knew straight away that this was my story. I got involved because I want every patient to have the same chance I had.
“These machines make more transplants possible and mean fewer people die waiting. NICE's draft guidance recommending routine NHS funding for these devices is exactly the kind of change that is needed. That has to be the standard across the NHS, not a postcode lottery.”
Addressing unequal access
Until now, access to these machines has depended heavily on where a patient is treated. Some transplant centres have secured funding through local charities. The draft guidance recommends that any of the 4 devices can be paid for using core NHS funding and will result in access no longer depending on whether a local centre happens to have charitable support.
Economic analysis presented to NICE’s independent committee showed all 4 devices represent good value for the NHS. Cost-effectiveness are well within the range NICE would typically consider acceptable.
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.
Dr Chalkidou added, “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.”
What happens next?
A consultation has begun on this draft guidance and NICE is inviting comments from patients, families, clinicians, commissioners, charities and the public. The consultation closes on 10 June 2026. A second committee meeting is planned for 25 June 2026. Final guidance is expected in August 2026.