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Ex-situ machine perfusion devices for deceased donor liver transplants

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4 Unmet need

There is a shortage of high-quality organs available for transplant in the UK and demand is rising due to the increasing prevalence of chronic liver diseases in the general population. At the same time, organ donors in the UK are becoming older, which is associated with a higher risk of comorbidities. According to experts, this has resulted in the growing use of suboptimal organs from extended criteria donors, who are older and may have conditions that affect liver function such as hepatic steatosis; and those who donated their liver after circulatory death. But these organs are at higher risk of worse outcomes (both short-term graft function and long‐term complications) if they are preserved using static cold storage only.

The shortage of suitable donor organs results in significant mortality and morbidity for people on the waiting list for liver transplants. Around 12% of people listed in the UK between April 2021 and March 2022 for a liver transplant either died or became too sick for liver transplantation within a year of joining the waiting-list (NHS Blood and Transplant, 2024b).

In the UK, many donor livers are discarded because clinicians are concerned about giving potentially lower quality livers to people. In 2023/24, 18.5% of livers retrieved from donors after brainstem death (DBD) and 35.5% of livers retrieved from donors after circulatory death (DCD) were not transplanted (NHS Blood and Transplant, 2025). But, these decisions are based on the characteristics of the donor and the appearance of the liver because it is not possible to do a formal assessment of how well the liver is functioning during cold storage. This uncertainty may lead some clinicians to decline to transplant organs that could potentially be used.

The Department of Health and Social Care independent report: Honouring the gift of organ donation (2023) and NHS Blood and Transplant strategy: Meeting the need (2020) both highlight the need to embrace technological solutions such as ex-situ machine perfusion devices to maximise the use of available organs to meet demand.