NICE recommends lung preservation machine that could help
rescue four in five donated lungs currently unused
EMBARGOED UNTIL: 00.01 BST, TUESDAY 28 JULY 2026
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 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.
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 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.
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.
This guidance is currently in draft and is open for public
consultation until Monday 17 August 2026. Anyone with an interest
in this area is encouraged to share their views via nice.org.uk.
The final guidance is expected to be published in October 2026.
