2. Machine perfusion- Evaluation criteria HMPNRPNMP Better outcome ?++? Prediction of functionlimited++ Expansion of organ pool-++++? Organ reconditioning?Potential Ease of implementation+++? Costs££ £££?

3. Machine perfusion- Benefit assessment Within current selection/acceptance criteria Increased organ recovery/utilisation Better organ function Expand organ acceptance criteria Assess function of “extended criteria” organs Kidneys11.6% Livers21.62% Pancreas48.91% Expand organ acceptance criteria Assess function of “extended criteria” organs

4. From aspiration to national clinical reality?

5. Technology development

7. Staff training and competency Self sufficiency Staff training

8. Staffing model ? Advanced practitioner in organ preservation and transplantation Donor management Organ perfusion Organ preservation Responsible for “the machine(s)”

9. Funding HMPNRPNMP Capital costs£22,454£23,483?? Consumables/case£650*£495??*

11. Organ donorDCD In Situ Normothermic perfusion Ex situ normothermic perfusion TransplantationEx-situ organ modulation TransplantationDBD ? In situ organ modulation Ex situ organ modulation Transplantation

12. 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

13. THE REVOLUTION BEGINS THIS YEAR

14. 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

15. How? NHSBT support Organ acceptance and distribution CUSUM exception to promote innovation Funding Step 1: £ 40k – capital costs £ 150k – staff costs Step 2:

16. 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)