In-situ abdominal normothermic regional perfusion for donor liver preservation recommended for NHS use

A procedure that keeps donor livers supplied with oxygen inside the body before removal has been recommended for NHS use and could help more people on the transplant waiting list.

It’s the first time a NICE committee has reviewed the evidence behind the procedure which preserves the donor liver by pumping oxygenated blood through it using a machine for around two hours. This allows the liver to recover from damage while it is still in the donor's body. Doctors can also run tests during this time to check how well the liver is working before it is removed.

An independent NICE committee has recommended in the draft guidance that in-situ abdominal normothermic regional perfusion (NRP) can be used as an option to preserve donor livers during retrieval after the donor's heart has stopped.

Currently, most donor livers are preserved by immediately flushing them with cold fluid and packing them in ice for transport, a method known as static cold storage. However this can result in the liver being damaged as it has stopped receiving blood and oxygen.

In a separate appraisal, NICE has recommended specialist liver preservation machines in draft guidance that preserve donated livers outside the human body.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, actively pump a specially formulated solution through the liver's blood vessels. This helps protect the organ from deteriorating.

Between April 2024 and March 2025, 727 livers were donated after circulatory death in the UK. Of these, only 309 were transplanted. That means 58% of donated livers were not used, largely because of concerns about damage caused by interrupted blood flow.

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.

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."

Professor Rick Body, chair of NICE's interventional procedures advisory committee, said: “The committee reviewed consistent evidence from multiple observational studies, and the findings point in the same direction."

Jim Kilpatrick, 66, from Donaghadee in Northern Ireland, is a liver transplant recipient and is Chair of the Royal Victoria Hospital Liver Support Group. He said: "Knowing that there is another opportunity for a liver which might previously have been deemed unusable is a huge step forward. Some patients are on the list for several years, becoming a little exasperated at not having received the call. If there are more livers out there which are usable, that is exactly what they need to hear."