--- title: The NHS Will Fund Machines That Keep Donated Livers Alive Outside the Body description: NICE has told the NHS to routinely fund machines that keep a donated liver alive and oxygenated outside the body, to improve transplants and save marginal organs. author: Darie Nani (Editor-in-Chief) updated: 2026-08-28T01:18:08.117Z canonical: https://richhealthmagazine.com/article/the-nhs-will-fund-machines-that-keep-donated-livers-alive-outside-the-body image: https://cdn.nanimediahouse.com/nhs-liver-perfusion-machines-217220.webp categories: Longevity & Science content_type: News region: United Kingdom publication: Rich Health Magazine schema_type: Article --- The NHS in England has been told to routinely fund a machine that keeps a donated liver alive and oxygenated outside the body between the moment it is recovered from a deceased donor and the moment it is transplanted. The National Institute for Health and Care Excellence (NICE) published the guidance on 20 August 2026, and in its own words the technology could “[help hundreds of people waiting for transplants](https://nice-newsroom.prgloo.com/news/embargoed-new-machines-that-keep-donated-livers-alive-outside-the-body-could-help-hundreds-of-people-waiting-for-transplants-says-nice)”. For anyone on the liver transplant waiting list, the hope is concrete: fewer donated organs written off, and better odds that the one they receive works well from the start. The machines carry out what clinicians call ex-situ machine perfusion. Instead of packing a recovered liver in ice, the technique that has been standard for decades, the organ is connected to a device that pumps a cold, oxygen-rich solution through its blood vessels. The version with the strongest evidence behind it, hypothermic oxygenated perfusion (HOPE), keeps the liver cold while supplying it with oxygen, which appears to protect the organ during the hours between donor and recipient. ## Four Machines Approved, All Judged Equal NICE recommended four devices and treated them as clinically equivalent and cost-effective, with none singled out: Liver Assist, made by XVIVO; metra, made by OrganOx; PerLife Pro, made by Aferetica; and VitaSmart, made by Bridge to Life. The guidance covers deceased-donor liver transplantation only. It does not apply to kidney, heart or other organ transplants. The clinical case rests on evidence that has been building for years rather than a single new result. [A meta-analysis of 11 studies](https://pmc.ncbi.nlm.nih.gov/articles/PMC10793758/), including five randomised controlled trials and roughly 1,000 patients, found that hypothermic oxygenated perfusion reduced early allograft dysfunction, an early failure of the transplanted liver to work properly, by about 46%. It also cut one-year graft loss and reduced biliary complications, including the bile-duct narrowing known as non-anastomotic strictures. HOPE has been studied in randomised trials since 2017, among them the HOPE-ECD-DBD trial and the 262-patient COMPARE trial, so the benefit NICE is funding is established rather than newly discovered. ## The Gain Is Better Outcomes, and a Few More Usable Organs The clearest gain is in the quality of transplants and in the willingness to use organs that would otherwise be turned down. Machine perfusion mainly allows surgeons to safely use marginal or “extended-criteria” donor livers, organs from older donors or those recovered in less-than-ideal conditions, and to see how the liver performs before committing to the operation. That is different from a large jump in the raw number of organs available. Warm, or normothermic, perfusion, which keeps the liver at body temperature, is generally seen as having more potential to expand the donor pool. Someone waiting for a liver should therefore expect better outcomes and a few more usable organs, rather than a transformed waiting list. NICE's guidance recommends routine NHS use and funding, and trusts are expected to adopt it. It does not, though, carry the legally binding funding mandate that attaches to a NICE technology appraisal, so uptake across transplant centres is expected rather than automatic. Rebeca Sanabria Mateos, a liver transplant surgery specialist at University Hospitals Birmingham NHS Foundation Trust, said NHS funding of devices such as VitaSmart “marks the beginning of a new era for UK liver transplant programmes”, allowing surgical teams to “safely and confidently use organs from expanded donor criteria donors”. Bridge to Life, which is based in Duluth, Georgia and London and makes the VitaSmart device and the Belzer UW cold-storage solution, welcomed the recommendation. Its chief executive and president, Don Webber, said it “marks a decisive step toward establishing hypothermic oxygenated perfusion as the standard of care” in liver transplantation, and noted that Europe has used HOPE for over a decade. ## FAQ **Q: What is hypothermic oxygenated perfusion?** It is a way of preserving a donated liver by pumping a cold, oxygen-rich solution through its blood vessels after it is recovered from a deceased donor, keeping the organ cold but supplied with oxygen until it is transplanted. It replaces packing the liver in ice for that waiting period. **Q: How does keeping a donor liver on a machine improve a transplant?** In randomised trials and a meta-analysis of about 1,000 patients, hypothermic oxygenated perfusion reduced early failure of the new liver by around 46%, lowered one-year graft loss, and reduced bile-duct complications. It also lets surgeons assess an organ before transplanting it. **Q: Will this mean more livers are available for transplant?** Somewhat. The main effect is that surgeons can safely use marginal or extended-criteria organs they might otherwise decline, and get better results from them. A larger increase in the total number of organs is more likely to come from warm, or normothermic, perfusion. **Q: Is NICE's recommendation binding on the NHS?** No. This is health-technology guidance recommending routine NHS use and funding. Trusts are expected to adopt it, but it does not carry the legally binding funding mandate of a NICE technology appraisal, so uptake is not automatic. **Q: Which machines has NICE recommended?** Four, treated as clinically equivalent: Liver Assist (XVIVO), metra (OrganOx), PerLife Pro (Aferetica) and VitaSmart (Bridge to Life).