Giuliano Testa¹, Meiqi Huang²

¹Living Donor Liver Transplantation, Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center, Dallas, Texas, USA; ²HBSN Editorial Office, AME Publishing Company.

Editor’s note

The 11th Joint Conference of the University of Chicago and PUMCH Liver Surgery was successfully held in Beijing, China, from September 5 to 6, 2025. This year’s conference focused on Liver Transplantation, Cell Therapy, Robotic Surgery, Artificial Intelligence (AI), and the Comprehensive Treatment of Liver Cancer.

Taking this opportunity, we conducted an interview with Dr. Giuliano Testa from the Living Donor Liver Transplantation, Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center, Dallas, Texas, USA

Expert’s introduction

Dr. Testa is a Clinical Professor at Texas A&M College of Medicine at Texas A&M Health Science Center, Dallas. He is Chief of Abdominal Transplant at Baylor University Medical Center, part of Baylor Scott & White Health and Chairman of the Annette C. and Harold C. Simmons Transplant Institute.

He specializes in living donor liver transplantation and is the principal investigator of the Uterine Transplant Clinical Trial that resulted in the first U.S. birth of a baby following uterine transplant. Dr. Testa was honored in 2018 as one of TIME Magazine's Top 100 for leading the medical team that performed the first successful uterus transplants in the nation.

Dr. Testa is a graduate of t he University of Padova Medical School in Italy. After graduating cum laude, he completed a residency in general surgery at the same university. He went on to complete a general surgery residency at the University of Chicago and then a fellowship in abdominal organ transplant at Baylor University Medical Center in Dallas. Later at the University of Essen in Germany, he was instrumental in starting the first adult living donor liver transplant program in Europe. Dr. Testa returned to the U.S. in 2001, where he served as Director of Liver Transplant at the University of Illinois. In 2005, he moved to the University of Chicago where he rose to the rank of Professor of Surgery and served as Director of Liver Transplant and Hepatobilliary Surgery.

Dr. Testa returned to Baylor University Medical Center in 2011 to lead the Living Donor Liver Program. He became Chief of Abdominal Transplant for the Annette C. and Harold C. Simmons Transplant Institute in 2017. Dr. Testa is author or co-author of more than 160 publications and several book chapters. He is a recognized authority in Uterus Transplantation and Living Donor Liver Transplantation. His other interests include complex liver surgery of benign and malignant diseases.

Interview

HBSN: What prompted you to associate liver transplantation with commercialization, and in this context, what additional risks does it entail?

Prof. Testa: My primary interest has always been the ethics of transplantation, and I’ve been interested in it from the very beginning of my career.

There are many aspects of transplantation that relate to autonomy, decision-making processes, equity — how do we distribute organs, who owns the organs that are distributed, and to what point does the donor maintain ownership? Who owns the organ once it's transplanted, and who owns it in between? All of these processes have technical and workflow implications, but they really stem from very simple questions related to the ethics of transplantation. For instance, who decides when you're dead? How do we determine when you're dead? Can you decide how you die? Can you choose how your body is disposed of? Can you sell parts of your body? Is it ethical to sell part of your body? If so, what are the implications of allowing people to sell parts of their body? These are all fundamental ethical questions that form the foundation of anything related to the clinical application of transplantation. That’s where my interest comes from.

HBSN: How has liver transplantation progressed in recent years? Do you foresee any major breakthroughs in the near future?

Prof. Testa: From a technical point of view, the operation is really set. The only new technology that might have an impact for certain patients right now is robotic liver transplantation. But in general, for the time being, this is limited to a very small group of transplant patients. So, technically, we are pretty much where we need to be.

All other innovations will focus on immunosuppression, aiming to make those organs last as long as possible. Clearly, we also have to consider the methodologies used to procure and preserve organs. These will significantly and dramatically change our field. My entire career has been built around working on demand — when an organ becomes available at 1 o'clock in the morning, someone has to go procure it, and the transplant must occur within a certain time, or the organ is no longer viable. But this is changing dramatically. In the next five years, we will be able to preserve organs for two or three days, making almost all transplants elective surgery. This will be a very tangible change in the world of transplantation.

HBSN: We know that you have conducted research on uterine transplantation. Since this field is still relatively new, could you briefly explain its main challenges or future prospects?

Prof. Testa: So the uterus transplant is the last transplant that has been performed in significant numbers and has nothing to do with the normal transplant that we think about. All the transplants we do are generally transplants that benefit the recipient of that specific organ — for instance, if I have liver failure, I need a liver transplant that will benefit me. The uterus transplant is in reality a fertility treatment. So it is dedicated to the women who are either born without the uterus or who have lost their uterus because of a benign or malignant pathology or have a non-functional uterus. For this reason, a uterus transplant may seem esoteric — something that is not really that important or something that will not affect the life of many people. But in reality, if you look at the number of women who have a problem with being mothers because of uterine factors, we're talking millions of people.

In the United States alone, we calculated that 2.7 million women have what we define as absolute uterine infertility. Even if just 1% of these 2.7 million women consider uterus transplant as a solution and think that's the way they become mothers. That's already 27,000 women.

Now, 27,000 women in the United States is more than the people that are on the transplant waiting list aside kidney transplant. So that's the magnitude of the problem and that's why I got so interested into it.

HBSN: As an expert in organ transplantation, what advice would you give to younger surgeons who wish to pursue a career in this field?

Prof. Testa:: I am still very passionate about this profession. At this point I would never change what I do with any other field in medicine. What is beautiful about transplant is, number one, you really change people's lives and you don't change people's lives for a short time. For example, in cancer surgery there is always the possibility or the idea that the cancer may come back. In transplant the outlook is much longer, so you really give people the chance to survive for decades after a transplant. So that's fascinating in itself, the fact that you really impact people's lives for the long term. Then it's a field that is truly multidisciplinary at the start. You need to be a good doctor to be a transplant surgeon. You need to know about immunology, about infectious diseases. You need to be a good surgeon. You need to like the challenge of doing complicated surgery. You also live in a field that is in continuous evolution. That's the beauty of transplant. As I mentioned in the beginning, there are so many ethical questions that are pertinent to the world of liver transplantation or any transplant. That makes this a very enthusiastic, beautiful field to belong to and to contribute to.

HBSN: As we all know, you have received numerous honors and awards. What do you consider to be the key to success?

Prof. Testa: This is a very nice question. I think as human beings we have only one possibility. We have to decide on which stage we want to perform in life. To me it was always important the distinction between profession and career. Profession is what you learn because you have a passion for it. I always thought that was the driver for anything that I've done in my life as a doctor. Career is a byproduct and the success is also a byproduct. What I'm trying to say is that if you are passionate and you put everything you have into an idea, a vision or into the contribution to a certain field there is a great chance you will become a good doctor and possibly an expert in the field. My field is transplantation. I try to leave a mark, as small as it is. That was really what I wanted to do. The success is people recognizing that you have left or you have given something, a contribution to the field. To me, that's not the stage that I define myself. The success is nice, I like it, but it's in the past. What I did and what I want to do is every day taking care of people, giving them a chance and taking the satisfaction that comes from their well-being or their returning to well-being. As I said, my stage is not the one that wants to be on the stage for being publicly recognized as who knows what. My stage is to be able to say to everybody, I can help you with that because that's the contribution I gave to the field and that's why I'm an expert. It's a little different view of that. I think it's a different understanding of what success really is.