A machine that keeps organs alive outside the body could save four in every five donated lungs that currently go to waste in England and Wales.
The UK has one of the poorest lung transplantation rates in the world. The latest figures from NHS Blood and Transplant show that 170 patients in the UK, including six children, are waiting for new lungs.
Most adults wait a year for a transplant 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. But only 23% of all donated lungs are used, with donated lungs sometimes declined not only because of organ quality but due to staffing and theatre capacity issues.
Draft guidance from the National Institute for Health and Care Excellence (Nice) recommends that the XVIVO perfusion system be used in the NHS for a four-year period to assess its effectiveness and value for money. Nice estimates that the machine could help rescue four in five donated lungs that are currently unused, by helping them remain viable for transplantation, which could unlock hundreds of organs for transplants.
The machine warms donated lungs to body temperature and pumps a 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 reinflate collapsed areas.
While the machine has been trialled at three adult transplant centres, until now Nice had not endorsed the technique in all transplant centres or approved its use in paediatric cases. Nice says the draft guidance aims to ensure all transplant centres can benefit from the technology, regardless of their size or location.
Dr Anastasia Chalkidou, the healthtech programme director at Nice, said the machine should allow more lungs to remain available for transplantation that otherwise would be discarded.
“Every donated lung is a precious gift, and right now too many of them never reach a patient who needs them,” she said. “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.”
Chalkidou said the move reflected wider efforts to improve access “so that where a patient is treated no longer determines whether they can benefit from a transplant”.
Jonathan Blades, the head of policy at Asthma + Lung UK, said: “Lung transplant rates in the UK remain lower than in many other developed countries, while respiratory health outcomes remain the worst in Europe. Renewed political and research focus is needed to transform lung health in the UK, and this new technology marks an important step towards that ambition.
“We look forward to seeing the results of this trial, which could give more people with serious lung conditions more precious time with their loved ones. It could also reduce the number of donated lungs that currently go to waste if they are unsuitable for transplantation.”
Prof Andrew Fisher, a member of the British Transplantation Society and a consultant transplant physician at Newcastle upon Tyne hospitals NHS foundation trust, said: “It’s important that robust evidence is generated that shows exactly how much impact the use of this device has on lung transplant activity and supports timely access to transplant for patients desperately waiting for a suitable organ.”
