The NHS could soon widen access to specialist machines that keep donated livers functioning outside the body, after NICE published draft guidance recommending four devices for routine hospital use. The proposal is aimed at helping more of the 600 people in England currently waiting for a life-saving liver transplant, while reducing the postcode lottery that has shaped access to the technology so far.
According to NICE, the devices can help preserve organs that might otherwise be declined because their condition has deteriorated during transport. In its draft guidance published on 20 May 2026, the organisation said the machines should be available through core NHS funding, rather than depending on local charity support at individual transplant centres. NICE also said the technology represents good value for the NHS based on the economic analysis reviewed by its committee.
How the technology changes transplant decision-making
Traditionally, donated livers are transported in static cold storage, where the organ is flushed with a preservation solution, packed in ice and moved quickly from donor to recipient. NICE said that method is effective, but it does not allow clinicians to check how well the liver is functioning before transplant and can also lead to damage over time.
The new machines actively pump a specially formulated solution through the organ’s blood vessels. Some operate at near-normal body temperature, which allows surgeons to assess whether the liver is working properly before proceeding. NICE said this could make it possible to use livers from older donors, or those donated after circulatory death, which may previously have been rejected because of uncertainty about quality.
In the draft guidance, NICE recommended four devices for use in NHS hospitals: Liver Assist, metra, PerLife Pro and VitaSmart Hypothermic Oxygenated Perfusion System. The consultation on the draft guidance is open until 10 June 2026, with a second committee meeting planned for 25 June 2026 and final guidance expected in August 2026. NICE draft guidance
Aimed at reducing unequal access across the UK
NICE said access to the machines has depended heavily on where a patient is treated, with some centres able to secure funding through local charities while others could not. The organisation said routine NHS funding would ensure access no longer depends on local support networks.
Dr Anastasia Chalkidou, NICE’s HealthTech Programme Director, said the aim is to ensure people are not denied the best available care because of where they live. NICE said the guidance is intended to provide a clear evidence-based framework for more consistent and fair access across the country.
The consultation invites feedback from patients, families, clinicians, commissioners, charities and the public. NICE said the technology could help more patients receive a transplant and may reduce the number of people who die while waiting. NICE committee meetings
For patients and transplant teams, the shift could mean more organs being assessed rather than automatically ruled out, and more opportunities to proceed with surgery when time and transport constraints might otherwise make transplantation impossible. NICE said around 600 adults and children are on the active waiting list in England, while 874 liver transplants from deceased donors took place across the UK in 2024/25.
With the consultation now underway, the next stage will determine whether the draft recommendation becomes final guidance later this summer. If approved, the move could mark a significant step toward standardising access to advanced liver preservation technology across the NHS.
