NICE has opened a consultation on draft guidance recommending four specialist machines for routine NHS use to keep donated livers functioning outside the human body, in a move the organisation says could help more of the 600 adults and children currently waiting for a liver transplant in England. The draft guidance, published on 20 May 2026, says the technology could also address unequal access to advanced transplant care across the country.
The four devices listed in the guidance are Liver Assist (XVIVO BV), metra (OrganOx Ltd), PerLife Pro (Aferetica Srl) and VitaSmart Hypothermic Oxygenated Perfusion System (Bridge to Life Ltd). NICE says these machines actively pump a specially formulated solution through the liver’s blood vessels, rather than simply storing the organ on ice, helping to protect it from deterioration during transport and giving surgeons a better chance to assess whether it is suitable for transplant.
Why the technology matters for liver transplant patients
According to NICE, the current method of static cold storage typically preserves a liver for only 8 to 12 hours. If transport takes too long or logistical delays arise, the organ may no longer be safe to transplant. Because doctors cannot properly assess how a liver is functioning during cold storage, surgeons may also have to make difficult decisions based on how the organ looks alone.
The agency said that some of the machines operate at near-normal body temperature, which allows clinicians to check whether the liver is working properly before transplant. In its draft guidance, NICE said this could mean livers from older donors or donors after circulatory death, which might previously have been declined because of uncertainty, can now be assessed and potentially used.
NICE also said the case for wider adoption is grounded in real-world need. It noted that around 600 people are on the active waiting list for liver transplantation in England and that the median waiting time is approximately five months for adults and six months for children and young people. Across the UK, 874 liver transplants from deceased donors took place in 2024/25. NICE news release
Access has varied by location
The consultation says access to these machines has historically depended heavily on where a patient is treated, with some transplant centres relying on local charity funding. NICE says routine NHS funding would remove that postcode lottery and provide a consistent, evidence-based approach across transplant centres.
The organisation’s independent committee reviewed economic analysis showing that all four devices represent good value for the NHS, with cost-effectiveness considered well within the range NICE would typically accept. Dr Anastasia Chalkidou, NICE’s HealthTech Programme Director, said where a person lives should not determine whether they can access the best available care.
Monica Walsh and Charlotte Vockins, both of whom gave evidence to the NICE committee based on their personal experiences of liver transplantation, described the emotional toll of waiting and the difference machine perfusion technology can make. Their evidence helped inform the draft guidance, which NICE says is intended to reduce inequalities and make more transplants possible.
The consultation is open until 10 June 2026, with a second committee meeting scheduled for 25 June 2026. NICE expects final guidance in August 2026. If adopted, the recommendation could mark a significant step toward broader, more consistent use of organ preservation technology in NHS transplant services.
