Leadership and innovation in transplant care

The 40th anniversary of transplant at Baylor University Medical Center at Dallas (Baylor Dallas), part of Baylor Scott & White Health, is an opportunity to celebrate over 11,000 life-changing transplants delivered by a team who is continually innovating to deliver the best care to patients and donors. Baylor Dallas’ program combined with Baylor Scott & White All Saints Medical Center - Fort Worth (BSW -Fort Worth) make up Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, which is one of the highest-volume transplant center in Texas and one of the largest multi-specialty transplant programs in the country. Innovations in care are underway across the full range of transplant services.

Robot-assisted minimally invasive surgery

"The altruistic nature of live organ donation demands that we continue to seek better, safer, and less traumatic modalities for our donors," says Amar Gupta, MD, Surgical Director, Liver Transplantation at Baylor Dallas. With this vision in mind, Baylor Dallas was the first in Texas to perform robot-assisted hepatectomy and the first in the US to perform robot-assisted uterus donation. It is the only transplant center in the world to use robotic techniques for four types of transplant surgery: liver donation, kidney donation, uterus donation, and kidney transplant (recipient surgery). During robot-assisted surgery, the physician guides highly dexterous robotic equipment via a video console to perform precise movements. The robot-assisted procedure is technically demanding for the surgeon and requires extensive training, but the benefits include smaller incisions and improved surgical outcomes relative to open surgery.

Although robot-assisted procedures are primarily used for organ donation, in 2022, the Baylor Dallas team performed its first robot-assisted kidney transplant recipient surgery, the first such transplant in Texas. Using robotic techniques allows patients with a high body mass index, who would otherwise be transplant-ineligible due to reduced wound healing, to receive the gift of a new kidney.

Specialized transplant procedures

The breadth of multidisciplinary expertise has made Baylor Dallas a leader in delivering specialized transplant procedures that are only available at select medical centers. A key example of this leadership is in the rapidly developing field of uterus transplantation. Baylor Dallas has been involved with the technology from the beginning, launching the Dallas Uterus Transplant Study (DUETS) in 2016 and developing uterus transplant into a highly successful clinical care option for eligible women with uterine factor infertility to carry their own children to term. “Among the women with successful grafts, 95 to 100 percent become pregnant, which is a much higher success rate than any other fertility treatment available,” says Liza Johannesson, MD, PhD, medical director of uterus transplant at Baylor Dallas. The team celebrated the landmark first US birth of a baby born to a mother who received a uterus transplant in 2017 and has grown to become the largest uterus transplant program in the world and one of the few established programs in the US. Results of the DUETS study were published in 2024 in the Journal of the American Medical Association (JAMA).

Baylor Dallas is also recognized as a destination center for complex multi-organ transplant procedures. Multi-organ transplant requires exceptional communication among the transplant teams and fine-tuned protocols to ensure the new organs function well together. Typical dual-organ transplants performed at Baylor Dallas include heart-kidney or heart-liver transplants, as well as kidney-pancreas dual transplants for patients with type 1 or type 2 diabetes. In 2021, the team performed their first triple heart-liver-kidney transplant, and they have experience with more complicated procedures involving a combination of transplant and traditional abdominal surgery.

Bridges to transplant

Patients experiencing heart or lung failure sometimes need temporary circulatory support as a bridge to transplant. Baylor Dallas is recognized by the Extracorporeal Life Support Organization (ELSO) as a Center of Excellence for extracorporeal membrane oxygen (ECMO) life support and is one of four ECMO sites in Baylor Scott & White Health, which is the largest ECMO provider in Texas. ECMO pumps the patient’s blood to an oxygenator and back into the body, temporarily mimicking the function of the heart and lungs until the transplant procedure. Baylor Dallas is also home to the region’s only ECMO deployment program, where the ECMO team travels to the patient and initiates life support before transfer.

Baylor Dallas also offers mechanical device support as a bridge to heart transplant and has implanted over 500 left ventricular assist devices (LVADs) since the program started in 1986. In addition, in 2016, Baylor Dallas was the first hospital in North Texas to use an artificial heart as a bridge to transplant, and the physicians continue to support innovative circulatory support clinical trials.

Expanding access to transplant

Baylor Dallas is home to a robust clinical trial program seeking to improve patient access to transplant. The Baylor Dallas team has been on the forefront nationwide for the implementation of normothermic regional perfusion (NRP), an innovative technique that allows superior outcomes for donation after circulatory death (DCD). In 2022, Baylor Dallas and Southwest Transplant Alliance convened a multidisciplinary Donation after Circulatory Death (DCD) summit to explore strategies for improving the quality and acceptance of DCD organs. In 2024, the Baylor Dallas team organized the first NRP-DCD course, which was attended by over 100 transplant professionals. Giuliano Testa, MD, MBA, chief of abdominal transplant for Baylor Dallas and chairman of the BSW Simmons Transplant Institute, says, “The use of DCD organs is increasing and optimizing this approach represents that best available opportunity to meet the needs of patients waiting for life-saving transplants. We are working with leaders worldwide to provide these technologies in a way that optimizes quality and cost-effectiveness within a robust ethical framework.”