Machine perfusion- Evaluation criteria

HMP NRP NMP

Better outcome ? + +?

Prediction of function limited ++ ++

Expansion of organ pool - ++ ++?

Organ reconditioning ? Potential Potential

Ease of implementation ++ + ?

Costs ££ ££ £££?

Machine perfusion- Benefit assessmentWithin current selection/accepta

nce criteria

Increased organ recovery/utilisatio

nBetter organ

function

Expand organ acceptance

criteria

Assess function of “extended

criteria” organsKidneys 11.6%

Livers 21.62%

Pancreas 48.91%

Expand organ acceptance criteria

Assess function of “extended criteria” organs

From aspiration to national clinical reality?

NRP in clinical

practice

Critical appraisal

Experience and training

Technology development

Staff training and

competency

Regulatory supportFunding

Implementation

Clinical evaluation

DisseminationTechnology

development

NRP in clinical

practice

Critical appraisal

Experience and training

Technology development

Staff training and

competency

Regulatory supportFunding

Implementation

Clinical evaluation

Dissemination

Staff training and

competency

• Self sufficiency• Staff training

Staffing model ?

Advanced practitioner in organ preservation and transplantation

Donor managementOrgan perfusionOrgan preservationResponsible for “the machine(s)”

NRP in clinical

practice

Critical appraisal

Experience and training

Technology development

Staff training and

competency

Regulatory supportFunding

Implementation

Clinical evaluation

Dissemination

Funding

HMP NRP NMP

Capital costs £22,454 £23,483 ??

Consumables/case £650* £495 ??*

Organ donor

DCD

In Situ Normothermic perfusion

Ex situ normothermi

c perfusion

Transplantation

Ex-situ organ modulation

Transplantation

DBD

? In situ organ modulation

Ex situ organ modulation

Transplantation

Summary

• Machine perfusion is here to stay• In situ and ex situ perfusion required• Normothermic perfusion is likely to be the future

• Start simple – NRP– Cheap intervention that may benefit all organs

• Further technological refinements are needed• Graft assessment and modulation• Wider applicability

THE REVOLUTION BEGINS THIS YEAR

The way forward?

• First step• Expand NRP utilisation in the three centres• Allow technological development• Establish training programme• Supportive data for wider applicability

• Second step• Expand to other centres adding NMP as it becomes

available

How?

• NHSBT support• Organ acceptance and distribution• CUSUM exception to promote innovation

• Funding• Step 1: £ 40k – capital costs

£ 150k – staff costs• Step 2:

Staffing costs for proposed model

• Staff costs per centre/zone• 5.5 WTE band 6

• Capital costs per centre/zone

• £269,032

• £175k (NRP)• £???k (NMP)