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    Are the population and subgroups appropriate and described correctly?

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    Are there any other technologies that should be included in the assessment?

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    Have the care pathway and comparator been appropriately described?

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    Is the place of the technologies in the pathway described appropriately?

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    Are livers typically split at paediatric liver transplant centres?

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    Are all of the outcomes suitable for inclusion in the assessment?

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    Are there any additional outcomes which should be included, particularly for children and young people?

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    Which outcomes are most relevant to children and young people?

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    Are there any other patient issues that should be considered?

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    Are there any other issues for the implementation and adoption of ex-situ machine technologies for liver transplants?

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Ex-situ machine perfusion devices for deceased donor liver transplants

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2 The condition

Liver transplantation is a treatment option for people with end-stage liver disease (for example, because of alcohol-related liver disease, metabolic, autoimmune or infectious conditions) and some people with liver cancer or acute liver failure. In children, the most common reason for liver transplantation is congenital biliary atresia. People with end-stage liver disease are at increased risk of dying from complications of the condition and symptoms can severely affect quality of life.

In the UK, more than 11,000 people die due to liver disease each year (British Liver Trust, 2023). There has been a 400% increase in liver-related deaths since 1970, and hospital admissions for liver disease have increased by about half over the last decade (Mansour, 2023b). On 31 March 2024, there were 614 adults and 64 children on the UK active liver transplant list (NHS Blood and Transplant, 2024a). In 2023/24, 791 liver transplants in adults and 63 liver transplants in children were performed in the UK from deceased donors (NHS Blood and Transplant, 2024a).