XVIVO Perfusion System for lung preservation: conditional NICE recommendation

A specialist machine that keeps donated lungs alive outside the body has been conditionally recommended in draft NICE guidance in a move that could unlock hundreds of organs for transplants.

With only 1 in 5 donated lungs currently considered suitable for use, the introduction of the XVIVO Perfusion System for a 4-year period while evidence is generated, could benefit hundreds of NHS patients.

An independent NICE committee has recommended the technology can be used so that evidence can be generated to address any benefits and costs that have not been fully captured in the current evidence base and economic evaluation.

The technology works by warming donated lungs to body temperature and pumping a specially designed fluid through them that mimics blood plasma, while also ventilating them to mimic normal breathing. This allows transplant teams to monitor how the lungs are functioning, treat infection, drain excess fluid and re-inflate collapsed areas, giving organs that would otherwise be discarded a chance to recover sufficiently for transplantation.

According to data held by NHS Blood and Transplant, there are 170 patients including 6 children currently waiting for a lung transplant in the UK. NHS B&T report 23% of all offered lungs meeting suitability criteria are currently used for transplantation. Many are considered unsuitable due to donor or organ reasons.

A survey of patients carried out by NICE as part of its guidance development painted a stark picture of life on the lung transplant waiting list. According to NHS B&T most adults the wait for a suitable lung lasts well over a year, with some waiting nearly two years or longer.

For those on the waiting list, the human cost of waiting is profound. People described in evidence submitted to NICE of being unable to leave home for fear of picking up infections, stopping work or education entirely, and relying on family members to remain available around the clock.

Families and carers described living in a constant state of alert, unable to take holidays and needing to stay within an hour of their transplant centre at all times.

For patients registered between April 2020 and March 2022, 21% of adults registered as urgent and 14% of adults registered as non-urgent died within 1 year of listing before a suitable lung became available, according to data held by NHS B&T.

Dr Chalkidou added: "We know that people waiting for a lung transplant face an incredibly difficult and uncertain time. That is why we believe it is right to make this technology available to NHS patients now, while we work to build the stronger evidence base that will help us fully understand its long-term benefits and value for money.

"Our recommendation supports the NHS's wider ambition to standardise access to this technology across the country, so that where a patient is treated no longer determines whether they can benefit from a transplant.”