NHS Organ Recovery Pilot Could Deliver 750 Extra Transplants a Year

NHS Blood and Transplant has launched a specialist liver pathway as part of a pilot scheme intended to make use of organs that would once have been discarded as too risky to transplant. The launch follows the earlier opening of a lung pathway and comes ahead of a kidney pathway due to begin this autumn.

The timing is significant. The UK transplant waiting list stood at 8,237 people as of late January, its highest level on record and well above the 6,138 people waiting just before the pandemic. Last year 463 patients died while on the active waiting list, up from 372 in 2019-20.

The scheme works by sending selected organs to specialist centres for what is known as machine perfusion. Oxygenated blood or a nutrient-rich fluid is circulated through the organ outside the body, keeping it functioning and giving surgeons extra time to assess whether it can be used safely. Many organs are currently rejected not because they are unsuitable, but because there is too little time after retrieval to test them properly before a decision has to be made.

Fifteen hospitals are acting as pilot sites across the UK. The liver pathway has opened at Cambridge University Hospitals, the Royal Free in London and King's College Hospital, alongside centres in Newcastle and Edinburgh. Kidney pilots are running at seven sites, including Oxford, Manchester and Hammersmith Hospital. Lung perfusion began earlier this year at Royal Papworth Hospital in Cambridge, with Newcastle and Harefield Hospital due to follow.

If the pilots prove successful, NHS Blood and Transplant plans to establish a small number of dedicated multi-organ facilities, known as assessment and recovery centres, forming a national network that officials say would be the first of its kind anywhere in the world. Later phases are expected to go beyond assessment and introduce active reconditioning of organs, including surgical repair, alteration of blood type and cell-based treatments, in an effort to widen the pool of organs fit for transplant.

Officials estimate that a fully operational service could enable up to 750 additional transplants a year across lungs, livers and kidneys, including around 200 extra liver transplants and 345 extra kidney transplants. That would be roughly equivalent to adding 400 deceased donors to the system annually, without any rise in donation rates. NHS Blood and Transplant has put the savings to the health service at approximately £230,000 for each additional donor, largely through avoiding long-term costs such as dialysis. The programme is jointly funded by the health departments of England, Scotland, Wales and Northern Ireland.

Anthony Clarkson, NHS Blood and Transplant's director of organ and tissue donation and transplantation, has described survival on the waiting list as a daily struggle, warning that hundreds of patients will die this year before a transplant becomes available. He has said that donation alone cannot close the gap, and that the new centres will help the service make fuller use of organs that have already been donated.

Pamela Healy, chief executive of the British Liver Trust, welcomed the launch of the liver pathway. She said the wait for a transplant could be an intensely anxious time for patients and their families, and that the scheme offered renewed hope of what amounts to a second chance.

Clinicians involved in the pilot have also pointed to its potential to ease inequalities in access to transplantation. Patients from some ethnic minority backgrounds and those with rarer tissue types often wait considerably longer for a matching organ, in some cases more than five years.

The Royal Free, which has used a liver perfusion device known as the OrganOx metra since 2019, has installed a second machine to support its expanded role under the pilot. Cambridge will assess livers, kidneys and lungs, making it one of only two centres nationally offering perfusion across all three organ types.

A decision on a full national rollout is expected once results from the pilot phases, including the kidney pathway launching in the autumn, have been reviewed.