We have become the first UK transplant centre to begin an NHS pilot as an Assessment and Recovery Centre (ARC) for donor lungs to be preserved and assessed, which could improve the number of lungs available for donation and benefit more patients currently waiting for a lifesaving lung transplant.
The pilot, organised by NHS Blood and Transplant (NHSBT) and funded by the Department of Health and Social Care (DHSC), is trialling the use of several transplant centres as regional perfusion (reconditioning) hubs to improve organ utilisation for the lungs, liver and kidneys.
With nearby Cambridge University Hospitals (CUH) perfusing livers and kidneys, it means Cambridge is one of only two cities (along Newcastle upon Tyne) offering perfusion for all three organs. This further strengthens the reputation of Cambridge Biomedical Campus as a leading location for organ transplantation and innovation.
The donated lungs are assessed outside the body on the XPS machine
As part of the ARC pilot, donated lungs which are considered difficult to assess or borderline for transplant will be brought here to Royal Papworth, the UK’s leading heart and lung hospital.
Here clinicians will use a technique called ex-vivo lung perfusion (EVLP) which assesses the lungs outside the body in a special machine – the XPS system from XVIVO – and allows greater monitoring of their function. If they are deemed suitable for donation, they will be transplanted into a patient on the lung transplant waiting list at another UK lung transplant centre.
Since 2024, Royal Papworth - which carries out more lung transplants than any other UK transplant centre, has the shortest waiting times for people on the lung transplant list and has the best organ utilisation rates - has been the only UK centre using the EVLP technique for clinical cases, thanks to separate funding from NHS England.
Daniel before being taken to the operating theatre for his double lung transplant
Daniel Evans-Smith, a 49-year old from Northampton, became the first person in the UK to receive a double-lung transplant using this system. To-date, 12 patients have gone on to have life-saving lung transplants at Royal Papworth Hospital, thanks to this technique.
Daniel (second left) months after his double-lung transplant with transplant doctors, surgeons and specialist nurses, and the XPS machine
Innovation like this is needed. Each year hundreds of people die waiting for a transplant while hundreds of potential donor organs are retrieved but later discarded because their ability to function is in doubt. The potential donor pool is also reducing as the population ages and more people live with long term health conditions.
Perfusion is already used to varying extents at different centres. Investment will promote best practice, ensure expertise, reduce the pressures on some centres, and support equal access for patients.
If the NHSBT pilot successfully proves proof of concept and a full ARCs model is implemented, it could see other dedicated facilities created around the country. The model will also help explore new research opportunities, such as treating donated organs with medicines or cell and gene therapies. It will also enable more organs which cannot be transplanted to instead be used for potentially lifesaving medical research.
Marius Berman, Surgical Lead for Transplantation at Royal Papworth Hospital, said: “We are delighted to be the first pilot hub for the assessment and reconditioning of lungs donated for transplant. We know how transformative transplantation can be and our innovative work with EVLP over the last two years has continued to push the boundaries of what is possible in organ utilisation.
Dr Jas Parmar, Transplant Consultant at Royal Papworth Hospital and also Chair of the Cardiothoracic Advisory Group (Lungs), said, “The rapidly changing landscape of UK organ donation has seen a significant shift in the ability to assess donor organs. Being part of this NHSBT pilot will allow our expertise to benefit even more lung transplant patients across the UK to receive the gift of life. It also ensures we are making the most of every single donor offer we receive.”
“With other ARCs also being opened for other selected donor organs, the hope is that this pilot will pave the way for a full programme to be implemented. With demand for organs currently outweighing supply, that would only benefit more patients awaiting a lifesaving transplant.”
Anthony Clarkson, Director of Organ and Tissue Donation and Transplantation at NHS Blood and Transplant, said: “There is an urgent need to innovate in organ utilisation. Survival on the transplant waitlist is a daily struggle, and hundreds of patients will die this year before they can receive a life-saving transplant. Donation alone cannot close the gap. The ARCs programme will help us recover donor organs and keep them healthy, so we can make the best use of the gift of donation.”
Derek Manas, Medical Director for Organ and Tissue Donation and Transplantation at NHS Blood and Transplant, said: “This is a pilot, which could lead to full ARCS - unique facilities where precious donated organs can be sent to be evaluated and assessed for suitability to be transplanted."
Richard Baker, President of the British Transplant Society, said: “The British Transplant Society welcomes the ARCs programme and the opportunity the improve the quality of donor organs. The UK transplant community has worked hard to increase organ utilisation and looks forward to engaging with ARCs to improve further. In addition, we hope that ARCs will ultimately improve equity and workforce sustainability.”
With ex-vivo lung perfusion, explanted lungs are placed in ice as normal, but then when they arrive at Royal Papworth they are attached to the XPS machine that will perfuse and ventilate the donor organs. This machine mimics the environment of the human body, allowing the lungs to inflate and deflate as normal.
A special fluid maintains the lungs and helps to restore the normal function and allows the donor lungs to be maintained for up to four hours. This allows a dedicated team of highly trained specialist to complete a detailed assessment.
If the lungs perform well over at least three hours of testing, they are removed from the system and put on ice for delivery for transplantation.
