Novel life-saving liver procedure recommended, potentially enabling hundreds more transplants
A procedure that keeps donor livers supplied with oxygen inside the body before removal has been recommended for NHS use and could help more people on the transplant waiting list.
It’s the first time a NICE committee has reviewed the evidence behind the procedure which preserves the donor liver by pumping oxygenated blood through it using a machine for around two hours. This allows the liver to recover from damage while it is still in the donor's body. Doctors can also run tests during this time to check how well the liver is working before it is removed.
An independent NICE committee has recommended in the draft guidance that in-situ abdominal normothermic regional perfusion (NRP) can be used as an option to preserve donor livers during retrieval after the donor's heart has stopped.
Currently, most donor livers are preserved by immediately flushing them with cold fluid and packing them in ice for transport, a method known as static cold storage. However this can result in the liver being damaged as it has stopped receiving blood and oxygen.
In a separate appraisal, NICE has recommended specialist liver preservation machines in draft guidance that preserve donated livers outside the human body. 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.
Between April 2024 and March 2025, 727 livers were donated after circulatory death in the UK. Of these, only 309 were transplanted. That means 58% of donated livers were not used, largely because of concerns about damage caused by interrupted blood flow.
At the end of March 2025, 584 adults were on the active liver transplant waiting list across the UK.
NHS Blood and Transplant estimates that wider use of NRP could enable around 150 additional liver transplants each year.
Dr Anastasia Chalkidou, NICE's HealthTech programme director, said: “Too many donated livers are currently going unused, and too many people are dying while waiting for a transplant."
The evidence shows this procedure works as well as, or better than, existing methods and has a good safety record. This is the first time NICE has evaluated this procedure for any organ, and our draft guidance gives the NHS a clear, evidence-based foundation to make it available consistently and fairly across the country.
Professor Rick Body, chair of NICE's interventional procedures advisory committee, said: “The committee reviewed consistent evidence from multiple observational studies, and the findings point in the same direction."
This procedure works as well as, or better than, standard cold storage, with no safety concerns identified. Importantly, it allows transplant teams to assess liver function objectively before retrieval, which should help reduce variation in clinical decision-making and give more patients a fair chance of receiving a suitable organ.
Jim Kilpatrick, 66, from Donaghadee in Northern Ireland, is a liver transplant recipient and is Chair of the Royal Victoria Hospital Liver Support Group. He said: "Knowing that there is another opportunity for a liver which might previously have been deemed unusable is a huge step forward. Some patients are on the list for several years, becoming a little exasperated at not having received the call. If there are more livers out there which are usable, that is exactly what they need to hear."
Anything in the way of technological advances that can bring into play livers that might otherwise have been unusable – is exactly what needs to be pursued so more people have the opportunity I have been given.
Vanessa Hebditch, director of policy and communications at the British Liver Trust, said: “Too many people with advanced liver disease spend months living with uncertainty while waiting for a suitable donor liver, and sadly every year people die whilst waiting for a life-saving transplant."
This is encouraging because it supports an innovative approach that could help make more donated livers be viable and available for transplantation. We know that every additional transplant represents a life saved and a family given hope for the future. We welcome the opportunity to see innovations like this benefiting more patients across the UK.
At present, NRP is available at 8 of the 10 organ retrieval centres in the UK, but is only used in regular practice in around 3. This means that whether a patient benefits from the technique can depend on where in the country their donor is treated.
NICE's guidance notes that the procedure enables transplant teams to assess liver function objectively before removal, reducing variation in clinical practice and potentially improving fairness of access to donor livers.
NHS Blood and Transplant announced in November 2025 that NRP will be introduced as routine practice across the UK, funded from April 2026 by the Department of Health and Social Care and the health departments of Scotland, Wales and Northern Ireland. All 10 abdominal retrieval centres are expected to offer the procedure by 2027.
The draft guidance is open for consultation. NICE is inviting comments from patients, families, clinicians, commissioners, charities and the public. The consultation closes on 27 July 2026. A second committee meeting will take place on 10 September 2026 if needed, before final guidance is published later this year.