The National Institute for Health and Care Excellence has issued draft guidance supporting the use of the XVIVO perfusion system across NHS transplant centers for a four-year evaluation period. The device is designed to address England and Wales’s persistently low lung transplantation rates, with only 23% of donated lungs currently used for transplants.
The perfusion system maintains donated lungs at body temperature while circulating a plasma-mimicking fluid and ventilating the organs to replicate normal breathing functions. This process extends the viability window for transplantation to approximately six hours, providing transplant teams with time to assess organ quality, treat infections, remove excess fluid, and reinflate collapsed sections. Nice estimates the technology could enable the use of four in every five lungs that are presently discarded, potentially unlocking hundreds of additional organs for transplantation.
Currently, 170 patients in the UK, including six children, are on the lung transplant waiting list. Most adult patients wait approximately one year for a transplant, with some waiting two years or longer. Approximately one in five adults on the urgent transplant list die within a year of joining the list before receiving a suitable organ. Donated lungs are declined for various reasons beyond organ quality, including staffing constraints and operating theatre availability.
The technology has previously been trialled at three adult transplant centers. The draft guidance aims to expand access across all transplant centers regardless of size or location and represents the first Nice endorsement for pediatric use cases. Health sector leaders and patient advocates have characterized the development as a significant step toward improving lung transplant outcomes and reducing organ waste in the UK.
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