‘Revolutionary’ donation technique enabling more, better functioning, abdominal transplants, rolling out across UK

A technique to keep donor organs oxygenated will be rolled out across the UK, enabling more transplants and enabling transplants to keep working for longer.

During ANRP (Abdominal Normothermic Regional Perfusion), oxygenated blood is circulated through the liver, kidneys and pancreas of organ donors who have had their death confirmed following their heart stopping beating (known as Donors after Circulatory Death or DCD donors). (1)

ANRP has already been successfully used on a pilot basis at several transplant centres.

Now, after research confirmed its effectiveness, it will be introduced as routine for the whole of the UK by NHS Blood and Transplant, with funding from the Department of Health and Social Care and the health departments of Scotland, Wales, and Northern Ireland.

The use of ANRP will increase the number of organs available for transplant and will reduce patient deaths on the waiting list. (2)

ANRP has proven to have the most benefit for liver transplants. NHSBT has estimated that when the national roll out is complete it will enable an estimated 150 extra liver transplants per year. (3)

A clinical evaluation has concluded that ANRP also helps organs function better. People who had liver transplant where ANRP was utilised had a 51% lower risk of the transplant failing after 12 months compared to people who had transplants from similar DCD donors where it was not used. (4)

For kidneys, transplants where ANRP had been utilized had a 35% lower chance of developing delayed graft function than non-NRP kidneys, using risk-adjusted analyses. An important measure of the kidney function (the eGFR, or estimated glomerular filtration rate), when taken at 12 months, suggests the ANRP kidneys will provide an extra additional 5 years of graft life for the recipients. (4)

Overall, ANRP has been found to enable 3.3 organ transplants per donor compared to 2.6 when it was not used for the same type of donation. (4)

Similar donors go on to provide a liver transplant almost twice as often when ANRP is used, donating in 63% of cases compared to 34% when it is not used. (4)

ANRP is vital because of the injury organs suffer during DCD donation. During DCD donation, circulation is impaired during the time that the donor is dying. There is also no circulation at all following death but before the organs have been cooled down enough for transplant.

During ANRP, the oxygenated blood supply restores the organ’s energy stores, so the organ can better tolerate the cold storage during transport, making them more likely to work well when transplanted.

Addenbrooke's Hospital in Cambridge and the Royal Infirmary of Edinburgh pioneered ANRP in the UK. ANRP has now been piloted by 6 of the UK's 10 abdominal transplant centres, with local arrangements, and through various local funding sources. The new central funding from the four UK health departments will enable it to be rolled out to all 10 abdominal retrieval teams by 2027 on an ongoing basis. It will also enable nationwide sharing of ANRP organs between the centres.

Alex's story

Alex Cornish's transplanted liver benefitted from abdominal normothermic regional perfusion.

The 38-year-old had the operation at the Royal Free Hospital in London during 2025.

She had liver failure from autoimmune hepatitis and primary sclerosing cholangitis.

The married mum of a boy and a girl, who owns her own hairdressing business, is from Sennybridge, in Powys, Wales.

"I diagnosed 12 years ago – I was feeling sick, losing weight, jaundiced, I had itchy skin. My daughter was one at the time," said Alex, whose husband is Michael, and who is mum to Jacob, 15, and Evelyn 13.

"I was told about 4 years ago I'd need a transplant one day and then things started to deteriorate, my liver started to fail, and I went on to the waiting list in March 2025.

"When you are on the waiting list it's like you have a dark cloud over you. You carry on, put on a smile for the kids, but that feeling is lingering on. Too many people die on the waiting list.

"I was excited to get the call. I am feeling really good now. I am extremely grateful to the hospital and grateful to the family of the donor. I will be writing them a letter, to say how much I appreciate what they have done. I can make plans and look forward to time with my children now. Evey day feels like gift.

"The new liver technique really make sense - it's something that should be done as much as possible."

Statements

Statement from Anthony Clarkson

Anthony Clarkson, Director of Organ and Tissue Donation and Transplantation at NHS Blood and Transplant, said:

"Most people who donate now have death confirmed following circulatory death. They can usually donate fewer organs than people whose death is confirmed by neurological criteria.

"Regional perfusion keeps the organs of these donors oxygenated and at body temperature, after circulation has stopped. This helps prevent organ damage, improves organ function, and increases the chances that more organs will be suitable for transplant.

"The roll out of Abdominal Normothermic Regional Perfusion is a major step forwards in organ utilisation. Organs that would previously have not been donated will now save lives.

"But organs can only be donated if people support donation. It is critically important we get more people to confirm they want to donate on the NHS Organ Donor Register."

Statement from Carlo Ceresa

Mr Carlo Ceresa, Hepato-Pancreato-Biliary consultant and liver transplant surgeon at the Royal Free Hospital, said:

"Abdominal Normothermic Regional Perfusion has allowed us to safely expand our donation through circulatory death programme and offer transplants to more of the patients who need them most. By resuscitating the liver in the donor, we are able to transplant livers which would have otherwise carried a higher risk into patients who might otherwise face a long wait for a suitable organ — with excellent outcomes. The successful implementation of ANRP at the Royal Free London is a testament to the hard work and dedication of our entire team."

Statement from Andrew Butler

Mr Andrew Butler, consultant transplant surgeon at Addenbrooke's Hospital, part of Cambridge University Hospitals NHS Foundation Trust, said:

"Normothermic regional perfusion has revolutionised the way that we are able to provide care for our patients. By using NRP as part of the retrieval process, we can double the number of livers that are transplanted from donors who donate under specific circumstances. We are better able to honour the amazing gift that the donor and their family have so generously offered and this is a privilege for us as a transplant team."

Statement from Zubir Ahmed

Health Minister Zubir Ahmed said:

"This is a significant step forward for UK donation and transplantation and cements its status as a world leader. As a transplant surgeon, I know first hand the difference this innovative technique will make to UK patients who are desperately waiting for an organ and a new life. By funding its rollout, we will help save and improve hundreds more lives every year and offer the gift of transplantation and hope to more patients than ever before. I urge everyone to take a moment to register their organ donation decision - it's a simple step that could save someone's life."

Statement from Jeremy Miles

Cabinet Secretary for Health and Social Care for Wales Jeremy Miles said:

"Wales has been an early adopter of innovative organ preservation techniques and it is really positive to see them being rolled out to all transplant centres in the UK. As organ donation is delivered on a UK-wide basis, this will further benefit patients in Wales on the transplant waiting list, improving outcomes for patients."

How you can help

Learn more about organ donation and confirm your decision to donate on the NHS Organ Donor Register.

Press release notes

People can become donors after having their death confirmed in one of two ways; donors after brain stem death (DBD) or donors after circulatory death (DCD) when the heart has stopped beating.
There are around 8150 people waiting on the transplant waiting list. This includes 6650 people waiting for a kidney transplant, 630 people waiting for a liver, and 340 people waiting for a combined kidney and pancreas transplant. Last year 24/25, 313 people died on the waiting list for a kidney transplant or within one year or removal. 53 people died on the waiting list for a liver transplant or within one year of removal and 23 people died on the waiting list for a combined kidney and pancreas transplant or within a year of removal. Hundreds more people who were removed and are expected to have died after more than year.
NHSBT modelling.
Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death. Transplantation 107(2):p 438-448, February 2023.