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A specialist machine that keeps donated lungs alive outside the body has been conditionally recommended in draft NICE guidance in a move that could unlock hundreds of organs for transplants.

With only 1 in 5 donated lungs currently considered suitable for use, the introduction of the XVIVO Perfusion System for a 4-year period while evidence is generated, could benefit hundreds of NHS patients.

An independent NICE committee has recommended the technology can be used so that evidence can be generated to address any benefits and costs that have not been fully captured in the current evidence base and economic evaluation.

The technology works by warming donated lungs to body temperature and pumping a specially designed 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 re-inflate collapsed areas, giving organs that would otherwise be discarded a chance to recover sufficiently for transplantation.

According to data held by NHS Blood and Transplant, there are 170 patients including 6 children currently waiting for a lung transplant in the UK. NHS B&T report 23% of all offered lungs meeting suitability criteria are currently used for transplantation. Many are considered unsuitable due to donor or organ reasons.

A survey of patients carried out by NICE as part of its guidance development painted a stark picture of life on the lung transplant waiting list. According to NHS B&T most adults the wait for a suitable lung lasts well over a year, with some waiting nearly two years or longer. 

For those on the waiting list, the human cost of waiting is profound. People described in evidence submitted to NICE of being unable to leave home for fear of picking up infections, stopping work or education entirely, and relying on family members to remain available around the clock.

Families and carers described living in a constant state of alert, unable to take holidays and needing to stay within an hour of their transplant centre at all times.

For patients registered between April 2020 and March 2022, 21% of adults registered as urgent and 14% of adults registered as non-urgent died within 1 year of listing before a suitable lung became available, according to data held by NHS B&T.

Dr Anastasia Chalkidou, HealthTech programme director at NICE, yesterday said:

Every donated lung is a precious gift, and right now too many of them never reach a patient who needs them. 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.

Dr Chalkidou added:

"We know that people waiting for a lung transplant face an incredibly difficult and uncertain time. That is why we believe it is right to make this technology available to NHS patients now, while we work to build the stronger evidence base that will help us fully understand its long-term benefits and value for money.

"Our recommendation supports the NHS's wider ambition to standardise access to this technology across the country, so that where a patient is treated no longer determines whether they can benefit from a transplant.”

NICE's recommendation forms part of a broader national programme of reform aimed at improving organ utilisation across the UK.

An independent review commissioned by the ISOU found that the UK has one of the lowest lung transplant rates among comparable countries, with donated lungs sometimes declined not only because of organ quality but due to staffing and theatre capacity constraints. NICE's guidance directly supports the national ambition to address these gaps and make better use of every donated organ.

XPS is currently only available in 3 of 5 specialist adult lung transplant centres in England, meaning access to this technology depends on where a patient is being treated. NICE's draft guidance supports the technology use, including through NHS Blood and Transplant's Assessment and Recovery Centre (ARC) pilot programme. Under this model, donated lungs will be transported to specialist regional hubs for assessment and reconditioning using machine perfusion, before being sent to the recipient's local transplant centre. This approach aims to ensure all transplant centres can benefit from the technology, regardless of their size or location.

The committee also heard that XPS could improve the efficiency of the process.

This guidance is currently in draft and is open for public consultation until Monday 17 August 2026. Anyone with an interest in this area is encouraged to share their views. The final guidance is expected to be published in October 2026.