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Annette C. and Harold C. Simmons Transplant Institute is recognized for quality patient care and excellent survival outcomes. The team of transplant surgeons has performed more than 4000 liver transplants, a remarkable milestone attained by only four other transplant programs around the world. 

Some of our highlights include:

  • Celebrating more than 32 years of organ transplantation and providing additional decades of good quality of life to our liver transplant recipients.
  • Patients gain improved access to organs through Annette C. and Harold Simmons Transplant Institute’s two transplant center locations at Baylor University Medical Center at Dallas and Baylor Scott & White All Saints Medical Center – Fort Worth. These two transplant center locations are served by two separate organ procurement organizations (OPO) providing patients access to organs from both OPO’s.
  • Baylor University Medical Center offers an American Society of Transplant Surgeons (ASTS) approved training program in liver and kidney transplantation.
  • Annette C. and Harold C. Simmons Transplant Institute has trained more than 35 transplant surgeons who are operating around the world.

Who are Candidates for Transplant?

Patients Referred To The Transplant Team May Be Experiencing The Following:

  • End-stage liver disease (which could be caused by cirrhosis or scarring of the liver from diagnoses such as viral hepatitis)
  • No reasonable alternative treatment for liver disease
  • Fulminant Hepatic Failure
  • Life-threatening upper gastrointestinal bleeding
  • Development of hepatorenal syndrome
  • Recurrent encephalopathy that can't be managed with conventional therapy
  • Liver cancer without evidence of metastases (spreading)

Referral and Pre-Transplant Process

Referral Process

The referral process begins when a member of the pre-transplant evaluation team receives a call from a patient's physician. A pre-transplant coordinator will then conduct a basic medical history by phone. The patient's medical chart and insurance information are sent to the transplant center for review. If no major contraindications are found, the patient proceeds to the transplant center for an evaluation.

This comprehensive medical evaluation is required in order to determine the extent of the patient's liver disease. The evaluation takes four to five days and is usually done on an outpatient basis. Depending on the severity of the illness, some patients require hospitalization during their evaluation.


Pre-Transplant evaluation testing and consultation includes:

  • MRI (Magnetic Resonance Imaging)
  • Ultrasound (Sonogram)
  • Cardiac Stress Test
  • Glofil or 24-Hour Urine for Creatinine Clearance
  • Echocardiogram
  • Electrocardiogram (EKG, ECG)
  • Hepatologist or Gastroenterologist Consult
  • Transplant Surgeon Consult
  • Psychosocial Evaluation
  • Nutritional Evaluation
  • Financial Meeting

Additional Tests And Consults Are Scheduled As Needed And May Include:

  • Bone Scans
  • Skeletal Survey
  • MUGA Scan
  • CT Scan
  • Liver Biopsy
  • Arteriogram (Angiogram)
  • Pulmonary Function Test
  • Endoscopy
  • Hepatobiliary Scan
  • Sclerotherapy
  • Banding/Endoscopic Variceal Ligation
  • Cholangiogram
  • ERCP
  • Colonoscopy

Possible Liver Transplant Disqualifiers:

  • Metastatic (spreading) malignancy of the liver or other primary malignancy
  • Other serious diseases, such as infection, heart disease, or lung disease
  • History of noncompliance with your medical regimen
  • Inadequate support from family or friends
  • Alcohol or other chemical abuse

Patient Selection

Upon completion of the pre-evaluation tests, potential candidates are evaluated by the Patient Selection Committee. The Patient Selection Committee is comprised of physicians and consultants from various specialties, social workers, nurse coordinators, and dietitian. In addition to the medical suitability, a candidate must be considered an acceptable surgical risk, must be reliable and compliant, and must have an adequate support system to help the patient adhere to the required post-transplant treatment program. Once the selection committee confirms a patient is a viable medical candidate, Baylor works with a patient's insurance company to obtain financial clearance.

Waiting List And MELD

Once a patient has been accepted as a transplant candidate, he/she is placed on the United Network for Organ Sharing (UNOS) waiting list. Each transplant center is required to continuously monitor changes in a patient's condition, which directly affect their placement on the waiting list and their priority for transplant.

The placement on the list is determined by the patient's MELD score (model for end-stage liver disease), which uses specific lab values to determine the severity of illness. based on the clinical data, patients with higher scores (between 1 and 40) will be given higher priority on the waiting list. each meld score requires lab results to be submitted to UNOS within a certain time period (ranging from every 7 days to once a year) or the meld score will be automatically lowered and the patient downgraded on the waiting list.​


Liver Transplant Surgery​

The transplant team will contact the patient to come to the hospital when a suitable donor is located. Liver transplant surgery is performed under general anesthesia and usually takes between 5 and 8 hours. Following surgery, the patient is transported to the transplant intensive care unit (ICU) where they will begin the recovery process for the next 24-48 hours. From the transplant intensive care unit, the patient continues recovery and receives comprehensive care on the transplant nursing floor.​


​​​​​Post Liver Transplant Surgery

Once a patient is discharged, he/she is required to visit the transplant outpatient clinic at Baylor twice a week for two weeks and then once a week for three months. During this time, the transplant coordinator works with the patient to educate them about new medications, signs of infection, rejection, and future physical expectations.

Once clinic visits conclude, a patient may return to his/her primary care physician. Lab work is required weekly for the first month, every other week for the second month, and monthly thereafter. Annual evaluations are done at the transplant center for the one, two, and five-year anniversaries of a patient's transplant and every five years following. Patients with previous viral hepatitis are required to have yearly evaluations.​

​​​​​Liver Transplant Resources

Web Resources

United Network for Organ Sharing (UNOS) Located in Richmond, Virginia, the United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the nation's only Organ Procurement and Transplantation Network(OPTN), established by the u.s. congress in 1984. through the optn, we

  • Collect and manage data about every transplant event occurring in the United States.
  • Facilitate the organ matching and placement process using UNOS-developed data technology and the UNOS organ center
  • Bring together medical professionals, transplant recipients and donor families to develop organ transplantation policy.

US Transplant - Scientific Registry of Transplant Recipients
Reports on activities at each transplant center and organ procurement organization in the United States. These reports include statistics about organ donation and recovery, waitlist activity such as transplant rate, and post-transplant outcomes such as graft and patient survival.

Transplant Living
Comprehensive information on transplantation.

Donate Life America

NFT - National Foundation for Transplants

Organization providing a program of healthcare and financial support services and patient advocacy for transplant candidates, recipients and their families nationwide.

National Transplant Assistance Fund
Has over 20 years experience empowering you to raise money in your communities to cover uninsured medical expenses related to transplantation and catastrophic injury.

What is a Living Donor Transplant?

Living donor liver transplantation can be an alternative to deceased donor liver transplantation for some patients on the waiting list. The ideal candidates are patients who foresee a long wait on the deceased transplant list and experience complications of liver disease, such as ascites and encephalopathy and patients diagnosed with hepatocellular carcinoma.

Living donor liver transplantation requires an operation to remove a portion of a healthy person's liver and put it into a person who has a sick liver. The liver has a right and left side that functions as a unit, although it can be separated in surgery. During a hepatectomy, the liver is divided and either the right or left side is removed and donated for transplant. Within approximately 6-8 weeks both half- livers (of donor and recipient) will grow to full size.

What are the Benefits?

Living donor liver transplantation may be an option to any person who is presently on the liver transplant waiting list. Living donor liver transplantation offers immediate organ availability and is a planned operation which can avoid the progression of the recipient's disease and its life-threatening complications. Additionally:

  • A living donor liver is the best quality liver.
  • A living donor transplant will eliminate the long wait time on the national deceased donor waiting list.
  • Living donation maximizes the chance for a recipient to receive a transplant before a recipient’s condition dramatically worsens.
  • The surgery can be timed for optimal health of the recipient and for donor convenience.

The Team

Dr. Giuliano Testa is the Surgical Director of Living Donor Liver Transplantation at Baylor University Medical Center at Dallas. Dr. Testa specializes in living donor liver transplantation for adult patients and has been performing living donor liver transplants for more than a decade. That experience combined with the expertise of the living liver donor transplant team broadens the Simmons Transplant Institute's services and offers liver transplant patients hope for better outcomes and improved quality of life. Other members of the Baylor multidisciplinary team for the living liver donor include:

  • Surgeon
  • Hepatologist
  • Physician Advocate
  • Living Donor Advocate
  • Living Donor Transplant Coordinator
  • Social Workers
  • Transplant Nurses

Dr. Testa speaks about who can be a Living Liver Transplant Donor.

To find out who can be a living liver donor, what to expect during and after surgery visit Baylor Living Donor Liver Transplant Program page.

​Living Liver Donor Resources

Living Liver Donor Brochure (english)

Liver Donor Brochure (spanish)