Donation and Transplantation Plan 2021 to 2026: annual progress update - December 2025

5. Priority 2 - Increasing organ transplantation

5.1 Increase the number of viable organs for transplantation by using novel technologies, such as rolling out use of machine perfusion. Subject to the findings of initial feasibility work, consider moving ahead with the development of a Scottish Assessment and Recovery Centre.

Between 2022 – 2024, the Scottish Government provided funding to the transplant centres in Edinburgh and Glasgow for the increased use of Organox - Normothermic Machine Perfusion for livers (NMP) and ex-vivo normothermic perfusion for kidneys (EVNP). These technologies recondition marginal organs that would otherwise not be used and as a result increase organ utilisation and the number of transplants.

From 2025/26, National Services Division is providing recurrent funding to the Edinburgh Transplant Unit for two OrganOx perfusion staff members.

A business case has yet to be submitted to National Services Division from the Glasgow Transplant Unit requesting funding for EVNP.

The Scottish Government continues to support the use of Normothermic Regional Perfusion (NRP) for abdominal organs retrieved by the Edinburgh organ retrieval team and DCD (donation after circulatory death) heart retrieval by the Golden Jubilee cardiothoracic retrieval team and provides annual funding to NHSBT for both these technologies.

In 2024/2025, the Scottish Government funded Scotland’s full share of costs to NHSBT for Abdominal Normothermic Regional Perfusion (ANRP) - £367k and £360k for DCD hearts.

As part of the ISOU’s work to drive the delivery of the recommendations set out in the OUG report ‘Honouring the gift of donation: utilising organs for transplant’ an Assessment and Recovery Centre (ARC) sub group was established to consider options for how national multi-organ centres for organ assessment and repair may be introduced in the UK in order to maximise the number and quality of organs available for transplant.

An ARC would repair, preserve and improve the assessment of donor organs using machine perfusion technology and therefore help to deliver improvements to the UK’s organ utilisation rates, by using marginal organs to increase the number of transplants per year. This is particularly important as the transplant waiting list is at the highest levels in over 10 years.

As part of the ARC programme, NHSBT has set up an ARC pilot with NHS Transplant Centres across the UK becoming an ARC location during this pilot phase. The pilot will run until 2027.

The Scottish Government has provided £200k in 2025/26 towards the full share of Scotland’s costs towards the NHSBT ARCs pilot.

5.2 Work to ensure sustainable, patient-centred transplant services, including exploring options for increased shared services between renal units, in particular to avoid the need for patients to miss out on any suitable organs offered for them.

The Scottish Renal Collaborative has been working with National Services Division, part of NHS National Services Scotland, and a cross-site working group has been created gathering members from the two renal units. Work is currently underway to review the composition of the Collaborative.

5.3 Raise awareness among relevant staff across NHS Boards to seek to ensure all those patients who would be likely to benefit from a transplant are offered the opportunity.

It is important that all patients likely to benefit from transplantation are offered the opportunity and that transplant units, in partnership with the territorial NHS Boards as well as referring clinicians, continue to proactively identify and discuss transplantation with any patient who may be eligible for and likely benefit from a transplant.

A short-life working group, set up to lead on this action, undertook a review of the current and projected need for referral to transplant units and found variations in referral rates between NHS Boards.

The co-chairs of the Scottish Donation and Transplant Group wrote to each NHS Board Medical Director in mid-November 2023 setting out the transplant referral data and transplantation rates for their Board, with the range for Scotland also indicated for comparison. The ask was to seek their support in sharing this information with the teams involved in the care of patients with end-stage organ disease for which transplantation is offered, in order to maintain awareness of the importance of timely referral for consideration of transplantation, when appropriate.