Nice Draft Guidance Recommends XVIVO Perfusion System for NHS Evaluation

Draft Guidance Recommends XVIVO Perfusion System for NHS Evaluation

The UK maintains one of the poorest lung transplantation rates globally. Figures from NHS Blood and Transplant indicate that 170 patients in the UK, including six children, are waiting for new lungs. While most adults wait a year and some wait two years or more, up to a fifth of adults awaiting an urgent transplant die within a year of joining the transplant list before a suitable lung is found. Currently, only 23% of all donated lungs are used, with organs sometimes declined due to staffing and theatre capacity issues alongside organ quality concerns.

How the Perfusion Technology Operates

The XVIVO perfusion system warms donated lungs to body temperature and pumps a fluid through them that mimics blood plasma while ventilating them to simulate normal breathing. This process allows transplant teams to monitor how the lungs function, treat infections, drain excess fluid, and reinflate collapsed areas.

Prior to the draft guidance, the machine had been trialled at three adult transplant centres, but Nice had not endorsed the technique across all transplant centres or approved its use in paediatric cases. According to Theguardian, the draft guidance aims to ensure all transplant centres can benefit from the technology regardless of size or location.

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Dr Anastasia Chalkidou, healthtech programme director at Nice, stated that the machine should allow more lungs to remain available for transplantation that otherwise would be discarded. Jonathan Blades, head of policy at Asthma + Lung UK, noted that lung transplant rates in the UK remain lower than in many other developed countries while respiratory health outcomes remain the worst in Europe. Prof Andrew Fisher, a member of the British Transplantation Society and consultant transplant physician at Newcastle upon Tyne hospitals NHS foundation trust, emphasised the importance of generating robust evidence to show the device’s exact impact on lung transplant activity.

Pilot Hubs and Clinical Context

Royal Papworth Hospital has become the first UK transplant centre to begin an NHS pilot as an Assessment and Recovery Centre (ARC) for donor lungs to be preserved and assessed, utilizing the XPS machine for borderline or difficult-to-assess donor lungs, according to NHS. Since 2024, Royal Papworth has carried out more lung transplants than any other UK transplant centre, recorded the shortest waiting times, and achieved the best organ utilisation rates, serving as the only UK centre using the ex vivo lung perfusion (EVLP) technique for clinical cases under separate NHS England funding.

Daniel Evans-Smith, a 49-year-old from Northampton, became the first person in the UK to receive a double-lung transplant using this system, and 12 patients have undergone life-saving lung transplants at Royal Papworth Hospital through the technique. Marius Berman, surgical lead for transplantation at Royal Papworth Hospital, and Dr Jas Parmar, transplant consultant and chair of the Cardiothoracic Advisory Group (Lungs), highlighted that the pilot will help recover donor organs and keep them healthy to maximize the gift of donation.