A consultation has begun on draft guidance recommending 4 specialist liver preservation machines for routine NHS use, which could help more of the 600 people in England waiting for a life-saving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donated livers functioning outside the human body should be made routinely available on the NHS, NICE has said in new draft guidance. 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.
NICE's medical technologies advisory committee reviewed the evidence and recommended 4 devices can be used in NHS hospitals:
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Liver Assist (XVIVO BV)
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metra (OrganOx Ltd)
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PerLife Pro (Aferetica Srl)
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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.
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.
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.