A specialist machine that keeps donated lungs alive outside the body has been conditionally recommended in draft guidance by the National Institute for Health and Care Excellence (NICE) in a move that could unlock hundreds of organs for transplants.
With only one in five donated lungs currently considered suitable for use, the introduction of the XVIVO Perfusion System for a four-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.
NICE’s recommendation forms part of a broader national programme of reform aimed at improving organ utilisation across the UK.
An independent review commissioned by the ISOU found that the UK has one of the lowest lung transplant rates among comparable countries, with donated lungs sometimes declined not only because of organ quality but due to staffing and theatre capacity constraints.
NICE’s guidance directly supports the national ambition to address these gaps and make better use of every donated organ.
XPS is currently only available in three of five specialist adult lung transplant centres in England, meaning access to this technology depends on where a patient is being treated. NICE’s draft guidance supports the technology use, including through NHS Blood and Transplant’s Assessment and Recovery Centre (ARC) pilot programme.
Under this model, donated lungs will be transported to specialist regional hubs for assessment and reconditioning using machine perfusion, before being sent to the recipient’s local transplant centre. This approach aims to ensure all transplant centres can benefit from the technology, regardless of their size or location.
The committee also heard that XPS could improve the efficiency of the process.
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.
“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.”
