Expanding normothermic regional perfusion across the UK could increase liver transplant capacity while reducing regional variation in access to donor organs. Draft guidance from the National Institute for Health and Care Excellence recommends the procedure as an option for preserving livers after a donor’s heart has stopped. The technique restores oxygenated blood flow inside the donor’s body, allowing transplant teams to assess liver function before retrieval. NHS Blood and Transplant plans to introduce it as routine practice, with national funding in place and all ten abdominal retrieval centres expected to offer the procedure by 2027.
Restoring Blood Flow Before Retrieval
In-situ abdominal normothermic regional perfusion, known as NRP, uses a machine to pump oxygenated blood through the donor liver while the organ remains inside the body. The procedure is intended for livers donated after controlled circulatory death, when the donor’s heart has stopped. Maintaining circulation for around two hours gives the liver an opportunity to recover from damage associated with the loss of blood and oxygen. It also creates a period in which doctors can perform tests and judge how well the organ is functioning before it is removed.
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Most donor livers are currently preserved by static cold storage. Under this method, the organ is flushed immediately with cold fluid, packed in ice and transported for transplantation. The interruption of blood flow and oxygen before cooling can damage the liver, contributing to concerns about whether an organ is suitable for use. NRP offers a different approach by restoring warm, oxygenated circulation before retrieval rather than relying only on rapid cooling after circulation has ceased.
The committee reviewed consistent evidence from several observational studies. NRP matched or exceeded standard cold storage in the reviewed evidence, with no identified safety concerns. Objective assessment before removal may also reduce variation in clinical decision-making, as transplant teams can evaluate liver function rather than relying only on concerns about damage caused by interrupted circulation.
More Donated Livers Could Be Used
Most livers donated after circulatory death do not proceed to transplantation. Between April 2024 and March 2025, 727 such livers were donated in the UK, but only 309 were transplanted. Concerns about damage from interrupted blood flow were a major reason that the remaining organs were not used. During the same period, demand remained high, with 584 adults on the active liver transplant waiting list at the end of March 2025.
NHS Blood and Transplant estimates that broader use of NRP could make around 150 additional liver transplants possible each year. The technique may bring livers into use that would previously have been considered unsuitable, while the ability to test organ function before retrieval can give transplant teams clearer information on viability. Some patients remain on waiting lists for months or years without receiving a suitable organ.
Specialist liver preservation machines used in NHS hospitals can also preserve donated livers outside the body. These devices pump a specially formulated solution through the liver’s blood vessels to protect the organ from deterioration. The two approaches operate at different stages: NRP preserves and assesses the organ within the donor before removal, while external machines support the liver after retrieval. Both approaches aim to maintain organ condition and increase the number of livers considered suitable for transplantation.
National Rollout Aims to Reduce Variation
NRP is available at eight of the UK’s ten organ retrieval centres, but regular use is currently limited to around three centres. Whether a patient benefits can therefore depend on where in the country the donor is treated. The procedure enables objective assessment before removal, which can reduce variation in clinical practice and improve fairness of access to donor livers across the country.
NHS Blood and Transplant announced in November 2025 that NRP would become routine practice across the UK. Funding has been provided from April 2026 for the planned national introduction by the Department of Health and Social Care and the health departments of Scotland, Wales and Northern Ireland. All ten abdominal retrieval centres are expected to offer the procedure by 2027, extending access beyond the limited number of centres that currently use it regularly.
Consultation on the proposed use of NRP closes on 28 July 2026. Patients, families, clinicians, commissioners, charities and members of the public can submit comments. A further committee meeting is scheduled for 10 September if required, with final recommendations expected later in the year. The consultation will determine whether changes are needed before publication, while the announced national rollout aims to establish routine use across all ten abdominal organ retrieval services throughout the UK.
Normothermic regional perfusion offers a way to preserve donor livers, support recovery from interrupted blood flow and assess organ function before retrieval. Its wider adoption could allow more donated livers to be transplanted and reduce geographical differences in access to the technique. The planned rollout across all abdominal retrieval centres is intended to move NRP from limited use to routine practice, supported by national funding. Final recommendations will follow consultation, while NRP is expected to operate alongside existing cold storage and external liver preservation machines.
Source: National Institute for Health and Care Excellence
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