The British Liver Trust welcomes the news that hundreds more liver transplants could be carried out after a new procedure that supplies a donor liver with oxygen before removal was approved by NICE for use in the NHS.
In-situ abdominal normothermic regional perfusion (NRP) involves a machine pumping oxygenated blood through the donor liver for two hours while it is still in the donor’s body. This allows the organ to recover from damage and gives doctors time to check how well it is working prior to removal.
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.
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 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.”
This is the first time a NICE committee has reviewed the evidence behind NRP and an independent NICE committee has recommended in the draft guidance that it can be used as an option to preserve donor livers during retrieval after the donor’s heart has stopped.
Most donor livers are currently preserved through static cold storage where the organ is removed, immediately flushed with cold fluid and packed in ice for transport. However, this can cause damage as the liver has stopped receiving blood and oxygen.
Between April 2024 and March 2025, 727 livers were donated after circulatory death in the UK. Of these, only 309 were transplanted, meaning 58% of donated livers were not used, largely because of concerns about damage caused by interrupted blood flow.
NRP is currently available at eight of the 10 organ retrieval centres in the UK, but is only used regularly in around three. This means that whether a patient benefits from the technique can depend on where in the country their donor is treated. However, NHS Blood and Transplant announced in November 2025 that NRP would be introduced as routine practice across the UK, with all 10 centres are expected to offer it by 2027.
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: “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.”
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, pump a specially formulated solution through the liver’s blood vessels which protect the organ from deteriorating.
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.
