OneLegacy has partnered with OrganOx to provide Southern California transplant programs with access to the OrganOx metra normothermic machine perfusion system through a specialised liver perfusion centre. The initiative involves Loma Linda University Medical Center, Keck USC Medical Center and Cedars-Sinai Medical Center, creating a shared operational model intended to preserve, assess and potentially increase the utilisation of donated livers.
The announcement is more significant as an infrastructure and delivery model than as a conventional device placement. Rather than requiring each transplant hospital to independently build a complete liver perfusion service, OneLegacy is positioning its organ procurement infrastructure as a regional hub through which several hospitals may gain access to trained personnel, equipment and standardised workflows.
OneLegacy attributed a 4% increase in transplanted livers during 2025, compared with 2024, to its use of OrganOx perfusion technology. The nonprofit organisation expects the number of livers made available for transplantation to increase by at least 14% during 2026, although that figure remains an organisational forecast rather than an independently verified outcome.
The commercial and clinical test will therefore extend beyond whether the OrganOx metra can maintain a liver under normothermic conditions. OneLegacy must demonstrate that a shared perfusion centre can coordinate multiple transplant programs, produce reproducible viability assessments and increase transplant activity without creating new delays, handoff risks or inconsistencies in organ acceptance.
What does the OneLegacy partnership change for Southern California transplant centres?
OneLegacy serves more than 200 hospitals and nine transplant centres across Los Angeles, Orange, Riverside, San Bernardino, Ventura, Santa Barbara and Kern counties. Its service area covers approximately 20 million people, giving the organisation sufficient scale to test whether advanced organ preservation can be provided as a shared regional service rather than a capability reserved for individual high-volume hospitals.
Under the partnership, OneLegacy is offering normothermic liver perfusion to Loma Linda University Medical Center, Keck USC Medical Center and Cedars-Sinai Medical Center. The organisation has also used its Azusa Transplant Recovery Center to bring together transplant hospitals and organ procurement organisations for education on perfusion practices and the adoption of the OrganOx metra system.
This approach could reduce one of the practical barriers to machine perfusion adoption. A hospital does not merely purchase a perfusion device and plug it into an existing transplant workflow. A functioning programme requires trained perfusion personnel, around-the-clock availability, blood products, laboratory support, donor assessment protocols, equipment maintenance and clear responsibility for deciding whether an organ remains suitable for transplantation.
A regional hub may concentrate those capabilities in one location, allowing several transplant centres to access the technology without duplicating the same infrastructure. That could be especially relevant for centres that have sufficient liver transplant activity to benefit from perfusion but not enough volume to justify maintaining a permanently staffed independent service.
The model may also support more consistent access across hospitals. Prasad Garimella, chief executive officer of OneLegacy, said the partnership was intended to facilitate equitable access to liver perfusion technology for local transplant centres. Whether that objective is achieved will depend on how cases are prioritised, whether all participating centres receive comparable access and whether smaller programmes can use the service as reliably as larger institutions.
How does the OrganOx metra preserve donor livers and support viability assessment?
The OrganOx metra maintains a donor liver outside the body by continuously circulating an oxygenated, blood-based perfusate containing medications and nutrients at normal body temperature. The system operates at near-physiological pressures and flows, keeping the liver metabolically active rather than substantially slowing its activity through conventional cold storage.
This functioning state allows clinicians to observe indicators such as blood flow, acid-base balance, lactate clearance, bile production and other metabolic parameters before deciding whether to transplant the organ. The technology does not independently determine that a liver is suitable, nor does it guarantee that an organ initially considered high risk will become transplantable. It provides additional preservation time and physiological information that may support clinical decision-making.
The United States Food and Drug Administration approved the OrganOx metra through the Premarket Approval pathway in December 2021. The approved indication allows the transportable device to sustain donor livers in a functioning state for a total preservation period of up to 12 hours.
The authorised use includes livers donated after brain death and certain livers donated after circulatory death. The original approval specifies donation-after-circulatory-death donors aged 40 years or younger, functional warm ischaemic time of no more than 20 minutes and macrosteatosis of no more than 15%. These label boundaries matter because broad statements about rescuing marginal or previously discarded livers should not be interpreted as permission to use the device without regard to its authorised indication and clinical criteria.
OneLegacy described the technology as allowing livers to recover from physical damage. A more precise interpretation is that normothermic perfusion may reduce additional preservation injury, restore physiological conditions and permit functional assessment. Whether a particular organ has recovered sufficiently for transplantation remains a clinical judgement requiring transplant-centre protocols and recipient-specific risk assessment.
What does the clinical evidence show about normothermic liver perfusion outcomes?
Normothermic machine perfusion has a substantial clinical evidence base, but that evidence does not support a simple conclusion that the technology improves every major outcome for every liver.
A European randomised trial involving 220 liver transplants found that normothermic preservation was associated with approximately 50% lower graft injury, measured through hepatocellular enzyme release, despite a 50% lower organ discard rate and a 54% longer average preservation period than static cold storage. However, the trial did not show significant differences in bile duct complications, graft survival or patient survival.
Those findings support the technology’s ability to extend preservation and facilitate greater utilisation, but they also show why reductions in biochemical injury should not automatically be presented as proof of improved long-term survival.
The United States randomised controlled trial enrolled 383 donor organs across 15 liver transplant centres. Of these, 266 proceeded to transplantation, including 136 in the normothermic machine perfusion group and 130 in the static cold storage group.
The trial’s primary endpoint, early allograft dysfunction, occurred in 20.6% of normothermically perfused livers and 23.7% of cold-stored livers. The difference did not reach statistical significance. Exploratory as-treated analyses suggested a larger effect among donation-after-circulatory-death livers and organs in the highest donor-risk quartile, but those subgroup findings should be interpreted as supportive signals rather than equivalent to a successful primary endpoint.
The incidence of postreperfusion syndrome, an episode of acute cardiovascular instability after blood flow is restored to the transplanted liver, was lower in the normothermic perfusion arm at 5.9%, compared with 14.6% in the static cold storage arm. The researchers concluded that the technology appeared most beneficial for marginal or higher-risk donor livers, even though it did not significantly reduce the trial’s primary endpoint across the overall population.
For OneLegacy, this means the most meaningful benefit may come from better evaluation and utilisation of organs that transplant teams would otherwise find difficult to accept. Using the device routinely for low-risk livers may deliver operational benefits, such as longer preservation and improved scheduling, but the clearest clinical value proposition remains concentrated around more complex donor organs.
Why could a centralised perfusion hub matter more than simply purchasing the device?
Real-world implementation studies suggest that the organisational requirements surrounding normothermic perfusion can be as important as the machine itself.
A United States transplant programme reporting its first 100 OrganOx metra cases described the need for a dedicated team, extensive training and coordination with the laboratory, blood bank, electronic medical record provider and billing services. The programme also developed institution-specific viability criteria rather than treating perfusion measurements as a universal automated acceptance test.
Of those 100 perfused livers, 92 proceeded to transplantation and eight were declined. Early allograft dysfunction occurred in 20.7% of transplanted cases, 90-day graft survival was 94.6% and no graft losses were directly attributed to the perfusion procedure. These results came from a retrospective single-program experience and cannot establish superiority over other preservation methods, but they illustrate the operational complexity involved in building a service.
A OneLegacy-operated model could centralise many of those requirements. Staff can gain experience from a larger combined case volume, protocols can be standardised across participating centres and equipment utilisation may improve because one platform serves several hospitals.
However, centralisation creates a different collection of risks. OneLegacy and participating hospitals will need clear protocols covering organ transport, cannulation, perfusion initiation, laboratory testing, viability reporting, equipment failure and the transfer of responsibility between the procurement organisation and the accepting transplant surgeon.
The centres will also need agreement on how to interpret borderline perfusion findings. A liver that one programme accepts may still be rejected by another because recipient urgency, surgical complexity and institutional risk tolerance differ. Shared technology does not eliminate clinical discretion, and attempts to impose overly rigid viability thresholds could exclude organs that might be appropriate in a different recipient context.
Costs will also influence adoption. The partnership announcement did not disclose device pricing, consumable expenses, service fees, contractual volumes or how costs will be allocated among OneLegacy and the three participating hospitals. Without those details, it is not yet possible to determine whether the shared model materially reduces the cost per perfusion or merely shifts expenditure from the transplant hospital to the organ procurement workflow.
What does the partnership mean for OrganOx and Terumo Corporation’s transplant strategy?
OrganOx has entered a different phase of commercial development since being acquired by Terumo Corporation for approximately $1.5 billion in October 2025. OrganOx now operates as a wholly owned Terumo subsidiary, giving the liver perfusion business access to a larger medical technology company’s manufacturing, international distribution and hospital relationships.
Terumo has described OrganOx as a new medium-to-long-term growth platform within the organ transplantation sector. It subsequently renamed the relevant reporting operation Terumo Organ Technologies, signalling that the acquisition is intended to develop into a broader business rather than remain a single-product investment.
OrganOx reported in May 2026 that its technology had been used in more than 10,000 liver transplants. The company also appointed Terumo executive Naoya Iwata as chief executive officer and president from June 1, reinforcing the parent company’s direct role in the next stage of commercial expansion.
The OneLegacy partnership provides a potentially scalable access model for that expansion. OrganOx could pursue individual device installations at transplant hospitals, partnerships with organ procurement organisations, third-party perfusion services or combinations of all three. A successful regional hub would demonstrate that one specialised centre can support several hospital customers and potentially generate recurring use of OrganOx disposable sets across a broader network.
The immediate financial effect on Terumo Corporation cannot be determined because no contract value, utilisation commitment or revenue-sharing arrangement was disclosed. The partnership should therefore be viewed as a commercial execution signal and a test of distribution strategy rather than a quantifiable near-term earnings catalyst.
What must OneLegacy demonstrate before the partnership can be considered successful?
The most visible measure will be whether OneLegacy reaches its forecast of at least 14% growth in transplanted livers during 2026. That figure will become more meaningful if the organisation explains how many additional livers were transplanted after perfusion, how many were declined, what donor categories benefited and whether growth resulted directly from OrganOx use or from broader changes in donation activity.
Post-transplant outcomes will be equally important. Higher organ utilisation is valuable only if graft survival, patient survival, biliary complications, hospital length of stay and readmission outcomes remain clinically acceptable after adjustment for donor and recipient risk.
Operational measurements should include the time from organ recovery to perfusion, total preservation time, device availability, unsuccessful perfusion attempts, staffing requirements and delays caused by transport or handoffs. These data would show whether the hub genuinely simplifies transplantation or adds another complex step to an already time-sensitive pathway.
OneLegacy will also need to demonstrate that shared access is equitable in practice. The partnership connects three prominent Southern California institutions, but the organisation serves nine transplant centres across a large and geographically diverse area. Expansion beyond the initial group may depend on staffing capacity, transport logistics, hospital willingness to adopt common protocols and the economic structure of the service.
The partnership therefore represents more than an agreement to deploy an approved medical device. It is an attempt to reorganise how sophisticated organ preservation is delivered across a regional transplant ecosystem.
The OrganOx metra already has regulatory approval, clinical evidence and extensive commercial use. The unresolved question is whether OneLegacy can convert those capabilities into a repeatable regional service that increases liver utilisation, preserves clinical outcomes and gives multiple transplant programmes reliable access without requiring each hospital to build the same infrastructure independently.
