NICE: Procedure could make more livers viable for transplant

Sue Bennett has a liver transplant using a procedure to make livers viable for transplant
Sue Bennett from Staffordshire, was one of the first to have a liver transplant using this new procedure

A procedure assessed by NICE has been hailed as an “exciting development” in increasing the number of livers viable for transplant. 

A perfusion machine can keep the donated livers viable for transplant for longer. The machine reduces the rate of tissue deterioration that occurs after the liver has been removed from the donor and extends how long the liver can be stored before transplantation.

Variations of the technique can also allow the liver to be flushed with blood at body temperature and supplied with oxygen, medications and nutrients allowing its viability and function to be assessed.

It is hoped machine perfusion could increase the number of organs viable for transplant, saving more lives and reducing liver transplant waiting lists.

Liver transplantation is a highly successful treatment for end-stage liver disease, which kills 11,000 people a year in England. Deaths from liver disease have soared by 25 per cent in a decade and continue to rise, while the average age of death from liver disease (currently 50-59 years) continues to decrease.

NICE has issued final guidance which recommends the procedure — ex-vivo machine perfusion for extracorporeal preservation of livers viable for transplant — is used under special arrangements as more data is gathered into its efficacy.

NICE’s independent advisory committee did not identify any major safety concerns.

Surgeons undertaking the procedure must inform patients about the uncertainty of the procedure’s efficacy, comply with the relevant regulatory and legal requirements of the Human Tissue Authority and should enter details about all patients having this procedure into the NHSBT UK transplant registry.

“I’m absolutely certain we are looking at a game changer that will change the way we practice organ storage and transplantation.”

NHS England and commissioners will decide whether they fund the procedure. However research is already taking place at the University of Birmingham and Queen Elizabeth Hospital Birmingham and other transplant centers across the country.

Professor Kevin Harris, programme director and clinical advisor for the Interventional Procedures Programme at NICE said, “This procedure offers another way of preserving the liver, and assessing whether livers which might have previously been considered unsuitable, can be used safely. The latest evidence reviewed by a NICE committee concluded that the procedure worked well and was safe to be offered to patients who had been fully informed of the risks and benefits.”

Sue Bennett, 45, a mother of three from Ranton in Staffordshire, had a liver transplant using this new technique in 2015. She said, “I signed up for the trial not knowing I would be one of the first to have this procedure in the country. I had a transplant after the hospital found a donor who was a match. The liver was kept alive using this procedure overnight and I was able to have the operation the following day. My life is unbelievably wonderful. I think I‘ve been very lucky.”

Darius Mirza, professor of hepatobiliary and transplant surgery at University Hospitals Birmingham NHS Foundation Trust,  said “In the 30 years I’ve been involved with transplantation there have been three or four events which have been game changers and I’m absolutely certain we are looking at a game changer that will change the way we practice organ storage and transplantation.”

in 2018 the Government reported that an Opt-out system was on the horizon for organ donation