Research Group

  • Prof. Peter Friend, Principal Investigator
  • Dr. Susan Fuggle, Co-Investigator
  • Dr. Charles Imber, Co-Investigator


  • Nuffield Department of Surgery, Oxford, UK


  • Prolonged Preservation of Donor Livers Using Normothermic Perfusion

At present the preservation of organs for transplantation is based on cooling to ice temperature in order to reduce metabolic activity and the infusion of a solution designed to maintain ionic and fluid balance across cell membranes. Organs preserved in this way suffer injury caused by the period of preservation, due to persisting low-level metabolic activity and the process of reperfusion with warm blood at the time of transplantation. In the case of a liver, additional problems occur because of the deposition of fat within the cells of the liver; this is a response to injury that occurs in many livers before removal from the donor. Whereas this has no measurable effect upon biochemical liver function in the donor at normal body temperature, it is recognised as a serious adverse prognostic factor following transplantation. Cooling a fatty liver increases the susceptibility to preservation-reperfusion injury through a poorly understood mechanism, leading to poor function of the liver within the patient immediately after transplantation. For this reason, many potential livers are discarded before transplantation because of the risk of “primary non-function”.

Because much of the injury that occurs is related to cooling and rewarming, a preservation system that enables a liver to be maintained in a viable, non-deteriorating state without recooling would be of enormous benefit. Liver function immediately following transplantation would be no worse than immediately prior to removal from the donor, enabling rapid recovery following surgery. It should enable livers with significant fatty deposition to be used for transplantation, thereby increasing the donor pool by 10-15%. Because the liver would be stored in a functioning state, it would also enable viability to be assessed after removal from the donor and prior to transplantation, thereby enabling the safe use of more marginal donors. It might also allow time for damage to the liver to recover before transplantation.

The ability to maintain a donor organ for several days might also allow time to pre-treat the patient or the liver in such a way as to reduce or remove the likelihood of rejection. It would enable the scheduling of transplant operations and the transport of organs over considerable distances without loss of viability.