On 28 July, NICE opened a consultation on a proposal to use the XVIVO system for donor lungs in the NHS for four years

On 28 July, NICE opened a consultation on a proposal to use the XVIVO system for donor lungs in the NHS for four years

The proposal would allow the system to be used for marginal lungs from adult donors while data are collected on transplants, the waiting list, postoperative outcomes, and costs. After four years, NICE will decide whether this pathway should become routine NHS practice.

According to NHS Blood and Transplant, 23% of donor lungs offered for transplantation are used in the UK. The remaining organs may not reach a recipient because of the condition of the lung or because the team does not have enough time to assess and prepare it.

The XVIVO Perfusion System gives the team dedicated time to do this work. The machine warms the lung to body temperature, pumps a plasma-like solution through it, and ventilates it. Doctors can assess how the organ functions outside the body, remove excess fluid, reinflate collapsed areas, and treat infection before deciding whether to send the lung to the recipient. This is how NICE describes the system.

The proposal links the machine to a pilot programme of assessment and recovery centres (ARC). After retrieval, the donor lung will be transported to a regional centre and then to the recipient’s centre. XPS is currently available at three of England’s five specialist adult centres. ARC is intended to make the procedure available to all of these centres, rather than only those that already have the machine.

Over four years, NICE will measure how many perfused lungs proceed to transplantation, how the use of all donor lungs changes, what happens to the waiting list, how much the entire pathway costs, and how patients fare after surgery. In NICE’s model of 2 220 people, XPS results in 211 additional transplants and 211 fewer deaths on the waiting list. These estimates will now be compared with outcomes in NHS practice.

Perfusion adds a stage between organ retrieval and surgery during which doctors can assess the lung and address some reversible problems. If this pathway allows more organs that have already been offered to proceed to transplantation, patients will not have to wait for the system to identify another donor organ.