The National Institute for Health and Care Excellence (Nice) has issued draft guidance recommending the use of the XVIVO perfusion system in the NHS for a four-year trial period. The machine, which keeps organs alive outside the body, could save four in every five donated lungs that currently go to waste in England and Wales.
Current lung transplantation challenges
The UK has one of the poorest lung transplantation rates in the world. According to NHS Blood and Transplant, 170 patients in the UK, including six children, are waiting for new lungs. Most adults wait a year for a transplant, and some wait two years or more. Up to a fifth of adults awaiting an urgent transplant die within a year of joining the transplant list before a suitable lung is found. Currently, only 23% of all donated lungs are used, with organs sometimes declined not only due to quality but also because of staffing and theatre capacity issues.
How the machine works
The XVIVO perfusion system warms donated lungs to body temperature and pumps a fluid through them that mimics blood plasma, while also ventilating them to mimic normal breathing. This allows transplant teams to monitor lung function, treat infection, drain excess fluid, and reinflate collapsed areas. The machine can keep lungs viable for up to six hours, potentially unlocking hundreds of organs for transplant.
Nice draft guidance and impact
Nice estimates that the machine could help rescue four in five donated lungs that are currently unused. Until now, the technology had been trialled at three adult transplant centres, but Nice had not endorsed it for all centres or approved its use in paediatric cases. The draft guidance aims to ensure all transplant centres can benefit, regardless of size or location.
Dr Anastasia Chalkidou, healthtech programme director at Nice, said: “Every donated lung is a precious gift, and right now too many of them never reach a patient who needs them. This technology has the potential to change that, giving transplant teams the time and information they need to make the most of organs that would otherwise go unused.” She added that the move reflects wider efforts to improve access so that “where a patient is treated no longer determines whether they can benefit from a transplant”.
Reactions from stakeholders
Jonathan Blades, head of policy at Asthma + Lung UK, said: “Lung transplant rates in the UK remain lower than in many other developed countries, while respiratory health outcomes remain the worst in Europe. Renewed political and research focus is needed to transform lung health in the UK, and this new technology marks an important step towards that ambition.” He added: “We look forward to seeing the results of this trial, which could give more people with serious lung conditions more precious time with their loved ones. It could also reduce the number of donated lungs that currently go to waste if they are unsuitable for transplantation.”
Prof Andrew Fisher, a member of the British Transplantation Society and a consultant transplant physician at Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “It’s important that robust evidence is generated that shows exactly how much impact the use of this device has on lung transplant activity and supports timely access to transplant for patients desperately waiting for a suitable organ.”
