NICE approves machine perfusion of livers for transplantation for use in the NHS

The National Institute for Health and Care Excellence has approved the use in the NHS of ex-vivo machine perfusion for preservation of livers donated for transplants

The NICE announcement noted that liver transplantation is a highly successful treatment for end-stage liver disease, which is responsible for the deaths of around 11,000 people a year in England.

Professor Kevin Harris of NICE said that the latest evidence reviewed by NICE concluded that the procedure worked well and was safe to be offered to patients. He added that use of the procedure could lead to more patients waiting for livers being offered transplants, thereby potentially extending their lives. Transplant surgeons have called the machine a ‘game changer’ for the way in which organs are stored for transplant.

One variation of the technique, normothermic machine perfusion, was developed by Department spinout OrganOx Ltd as a result of a cross-disciplinary collaboration between Professor Constantin Coussios (Institute of Biomedical Engineering) and Professor Peter Friend (Nuffield Department of Surgical Sciences).

The technique maintains donor livers at body temperature for up to 24 hours, supplying the organs with oxygenated blood, medications and nutrients, and also allows assessment of the viability of the donor liver during preservation. A randomized study of the procedure compared to conventional cold storage was carried out last year, with positive results, and was cited in the NICE report.

Professor Coussios says of the NICE approval, “Increasing utilization of the limited pool of donor organs is heavily predicated on the ability to ‘test-drive’ those grafts that are perceived as marginal, and to take full advantage of extended preservation to 24 hours to optimize donation and operating theatre logistics. Normothermic machine perfusion uniquely enables both of these to occur. This forward-looking NICE approval will now make it possible to assess the potential impact of this major technological advance on reducing waiting lists and NHS transplantation costs nationally.”

NICE announcement

Announcement of first liver transplant in India using normothermic machine perfusion (May 2018)