After a successful gastric bypass in 2019, 43-year-old Alisha Hernandez felt fine until 2023. That’s when she began experiencing ongoing joint and muscle pain. Other symptoms followed – including jaundice, fever, water retention, and fatigue – so she underwent a series of lab tests.
“Those tests indicated super high numbers, and I was referred to many different specialists because no one had any idea what was going on. I was seeing a rheumatologist, and then a gastroenterologist, and so many other specialists that I forgot what the names of them even were,” she says.
Hernandez spent two years bouncing among medical professionals and facilities in her local community of Merced, California with a vague diagnosis of liver failure.
“Finally, in October of 2025, I felt so depleted that I asked my husband to take me to the Emergency Room at Kaiser Permanente in Modesto. They got me feeling a little more stable and transferred me to nearby Doctors Hospital of Modesto. That’s when Stanford got hold of my case,” she says.
Hernandez describes being contacted by the Stanford Liver Transplant Program at Tri-Valley. She was transferred there to complete an expedited inpatient liver transplant evaluation, and she was placed on the national transplant waiting list. Unbeknownst to Hernandez, doctors from hospitals throughout Northern California, including Doctors Hospital where she had been admitted, call the Stanford Transfer Center requesting transfers for liver transplant evaluation or hepatology care.
“Unlike my previous experiences, they were so accommodating at Stanford Tri-Valley, and everyone knew all of the stuff I was dealing with. Every doctor and nurse I had contact with knew my case, and they all seemed to be so in sync with each other. Then they sent me home with a whole bunch of meds to keep my levels under control so I was prepped for a liver transplant. At that point I didn't think I needed a new liver, but they did,” she says.
The evaluation had resulted in Hernandez being approved as an appropriate candidate for liver transplantation, and she was discharged until a suitable organ was available.
Just a few months later, Hernandez experienced fatigue, severe swelling, and confusion. One of her adult children drove her to a local hospital, which contacted Stanford’s liver transplant program. Staff at Stanford Hospital in Palo Alto requested that Hernandez come right away because a donor liver had just become available. After a lengthy, but successful liver transplant, today Hernandez is healthy, with good energy and a positive spirit.
Hernandez’s case illustrates the life-saving impact of the Stanford Liver Transplant Program at Tri-Valley.
The program, which began in January 2025, is vitally important for patients who face imminent death from their liver disease.
We started this initiative because we saw a clear unmet need in the community.
“We started this initiative because we saw a clear unmet need in the community. Stanford serves as a referral base for transplants that extends far beyond the San Francisco Peninsula, and sometimes these patients never make it to transplant evaluation because they were not able to get into the system soon enough,” says Deepti Dronamraju, MD, clinical associate professor of Gastroenterology & Hepatology. While Dronamraju leads the liver transplant service and hepatology services at Stanford Health Care Tri-Valley, she notes that transplant evaluations are a multidisciplinary process and require input from multiple service lines and significant testing.
“While the diseased liver is the primary focus, there is much to consider when you're talking about going into a major surgery,” Dronamraju says. “It's also whether the heart is strong enough, or are the lungs going to tolerate a major surgery? Is the patient an appropriate candidate for transplant from a social and behavioral standpoint? In addition to my field, hepatology, there are multiple disciplines involved in the evaluation process. Here at Stanford Health Care Tri-Valley we've been able to create an infrastructure so we can bring some of the sicker folks and finish their evaluations closer to home.”
Dronamraju explains that the transplant program at Stanford Health Care Tri-Valley falls under the larger umbrella of Stanford’s transplant program.
“Their support, along with support from Stanford Health Care Tri-Valley, have been crucial in creating what’s needed to complete evaluations,” she says.
Like Hernandez, many patients arrive extremely ill and complete their assessment at Stanford Health Care Tri-Valley. If they are deemed to be suitable candidates, they are then transferred directly to Palo Alto for transplant
“Some of these patients have a narrow window where transplant is a realistic possibility. For these patients, their only avenue to get an urgent transplant evaluation is from an inpatient to inpatient transfer. Previously, Palo Alto was the only Stanford campus that did evaluations, and sometimes that main campus couldn't accommodate some patients just because there was no bed available in a timely fashion. Today, Tri-Valley is able to handle some of that excess volume and has become an important pathway for accelerating access to care,” Dronamraju explains.
To be considered as a candidate for a liver transplant the patient must receive a thorough evaluation.
“Historically, those only took place at tertiary medical centers, which oftentimes are a great distance from where patients live, and you're talking about patients at the sickest time of their lives trying to access that subspecialty service,” Dronamraju says.
The program at Stanford Health Care Tri Valley makes it easier for patients by offering subspecialty care closer to home in a more community-based setting.
“It’s a huge burden on those patients to have to make it to Palo Alto for the evaluation process. So to be able to have that done closer to home relieves a great hardship from a financial standpoint for many of these patients, and it allows them to be closer to their families.
“I think this really increases access to care for many patients who otherwise might not get it. Most of the patients I see here in Pleasanton are from the Central Valley – Modesto, Madera, Fresno, and even Bakersfield. I think for those patients especially, being able to come to Pleasanton makes their life a whole lot easier,” she says.
