I’ve had two liver transplants. The first was from a living donor in 2013; the second from a cadaveric donor in 2025. Getting an organ transplant is profoundly humbling—but receiving two? I consider myself one of the luckiest men on earth.
I walked into my first transplant with youth but little physical or mental preparation. The second time around, I vowed to approach things differently, and I trained.
Going into my first transplant, I had been riding my bike a lot. I was reasonably fit and lean, but frail. By contrast, I entered my second transplant with a four-year plan focused on building as much muscle as possible. The quote below captures the philosophy I took to heart.
You need to make regular, rational deposits into your physiological 401K. You need to bank tissue for retirement. Resistance training for strength, more than any other exercise modality, allows you to offset the inexorable decline of musculoskeletal tissue with aging, and all the suffering that goes along with it.
— Jonathon M Sullivan, Andy Baker, The Barbell Prescription
So how do you actually “train” for a transplant? That’s the question I’ll answer in this guide. Before we get there, I want to share three lessons that shaped my approach, along with three priorities that should sit at the center of your training.
Lesson One: Practice Gratitude
When you’re facing a transplant, it may be tempting to think you’ve been handed the worst luck on earth. But let’s be honest; you have the tremendous good fortune to be alive during a time when doctors can remove the organ of another person and place it in your body so that you can live. Whatever that is, it’s not bad luck.
Invite the truth of death into your life and you’ll receive its lessons.
— BJ Miller
Your health journey may be different than those around you, but there are people today—and throughout human history—who would give anything to be in your shoes: still in the game and fighting for a chance to live.
Gratitude arises from paying attention, from being awake in the presence of everything that lives within and without and beside us.
— David Whyte
Practicing gratitude makes a profound difference because it shifts our perspective from being a victim of illness to someone with agency—someone who can positively impact their own health and the lives of others.
Lesson Two: Pain Is Unavoidable, Suffering Is Optional (Buddhist Philosophy)
When illness overwhelms our lives, it’s natural to be seduced by a sedentary lifestyle. The problem with being sedentary while waiting for a transplant is that inactivity accelerates our physical and mental decline during a time when we should be fighting with whatever energy we have to get physically and mentally stronger.
So it is not always the pain per se but the way we see it and react to it that determines the degree of suffering we will experience. And it is the suffering that we fear most, not the pain.
— Jon Kabat-Zinn, Full Catastrophe Living
Said another way, even while moving between doctor’s appointments, painful procedures, and the stress of waiting for a transplant, there are still moments each day when you can choose to build your mind and body. In doing so, you can reduce your own suffering while improving your odds of a successful transplant outcome.
Lesson Three: Training Is Non-Negotiable
Under the best circumstances, establishing a training habit is really difficult. When your health declines, building habits becomes even harder. That’s why you must view training as a non-negotiable element of your life. Here’s how to make that happen.
1. Train at home
Imagine if you had to drive to a facility every time you needed to brush your teeth. How often would you end up skipping that essential routine? Your goal is to reduce as many barriers to exercise as possible. Like brushing your teeth, you may not enjoy training—but you have to do it. No excuses.
2. Train in the morning
You slept poorly. You feel unmotivated to train. You might have a slight cough. No, you’re not going to skip your workout.
Unless you’re so ill that you’re heading to the hospital, make training the first thing you do in your day. The worst decision you can make about training is to “put it off” until later.
“Later in the day” is a convenient way of avoiding something you don’t feel like doing in the present. Consistently nailing your workouts must become part of your identity, and the best way to make that happen is to get it done before the rest of life gets in the way.
The obstacle in the path becomes the path. Never forget, within every obstacle is an opportunity to improve our condition.
— Ryan Holiday, The Obstacle Is the Way
3. Train simple
Training doesn’t have to be complicated. Starting out, limit your total investment to 20–30 minutes, four times per week. The most important variable in training is consistency, and your first step is to build a habit of exercise to which the rest of your life must accommodate (not the other way around).
OK—with a few lessons out of the way, let’s get to the priorities in our training plan.
Training Plan Priorities:
One: Focus on Strength & Muscle
To start, you’ll complete a short strength training routine every Monday and Wednesday morning. On Tuesdays and Thursdays, you’ll walk for 15 minutes. That’s it. There will be plenty of opportunities to increase volume over time, but for now the focus is on building the habit.
Your training routine will prioritize building strength and muscle. For this reason, we’ll select four compound movements (exercises that use multiple joints).
- Squat
- Hinge
- Push
- Overhead push
These exercises can be performed without equipment, with minimal equipment like dumbbells, or with ideal equipment like plates and a barbell.
If you’re starting with no equipment, do your best to get a set of adjustable dumbbells and a bench. If you have the opportunity to add a rack, barbell, and plates, the guide at this link outlines what you’ll need.
While training without equipment is a solid starting point, if you want to truly maximize your “physiological bank account” heading into surgery, performing these movements against the resistance of dumbbells or a barbell will produce the best results.
Two: Mind Your Protein
Building strength and muscle requires essential building blocks found only in protein. This means your eating habits may need to shift to include more foods like tofu, beans, dairy, lean beef, chicken, and/or whey protein powder.
To put things bluntly, training for a transplant requires prioritizing high-protein foods on a daily basis. How much protein do you need? Check with your transplant team first, but your general target will likely be somewhere around 1.5 g/kg/day (this can vary based on the type of illness or transplant you’re facing—so again, check with your doctor). If you weigh 165 lbs, that translates to about 110 g of protein per day.
One challenge of declining health is that appetite is often suppressed and eating can feel uncomfortable. For that reason, you may need to rely more on liquid protein sources. Leading up to my second transplant, I found myself drinking close to a gallon of chocolate milk each week just to maintain my weight as my illness progressed and hospitalizations stacked up.
Speaking of gratitude, if you’ve ever had Strauss chocolate milk straight from the bottle, you know it’s one of life’s most glorious experiences.
If you want to read a more in-depth guide on protein geared toward athletes (who ironically have similar protein needs to you as a transplant patient), check out this link.
Three: Build Your Mind
Preparing your body for a transplant is only half the journey; the other half is training a calmer, more composed mind.
If you belong to a religious or philosophical tradition that offers insight and support, make a deliberate plan to return to it as you prepare for the stress of transplantation.
For me, Buddhism and Stoicism — along with the practice of meditation — provided a framework for developing a more flexible mind, better able to accommodate uncertainty and illness.
Things falling apart is a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart.
— Pema Chodron, When Things Fall Apart
Whatever path you’ve taken up to this point in your transplant journey, developing greater perspective and mental flexibility may be the most important training you do.
Plan Specifics
Before we jump into specifics, one obvious caveat. Make sure you’re following your doctor’s advice when it comes to diet and exercise. If any of these training suggestions seem beyond your capacity, ask your doctor for guidance on what to do next.
Strength training prescription is generally written as sets X reps @ target weight. A set is a group of repetitions done without rest, and a repetition is one complete movement (such as a bench press).
Here’s an example of how a common prescription would be written for the bench press. 3 (sets) X 5 (repetitions).
If you have access to equipment, choose a weight for each exercise that feels challenging but manageable. Using a 1–10 effort scale (commonly known as Rating of Perceived Exertion or RPE)—where 1 is very easy and 10 is a maximal effort—your workouts should feel around a 4–5 at the start. After a month or so of consistent training, that effort should gradually increase to about a 6–7.
One major benefit of using the RPE system leading up to your transplant is that it allows you to auto-regulate the weight you’re lifting. If you’re not feeling well, you simply adjust the load downward while still matching the prescribed effort. In short, the goal isn’t to abandon the workout when you feel ill—it’s to do what you can, lift less, finish the session, and move on to the next day.
If you’ve been consistent with two strength workouts and two walks per week, try progressing to three strength workouts per week while lengthening the two walks if possible. The three-day strength schedule is demonstrated in both the dumbbell and barbell workout options.
Please click on any exercise to see a short demonstration video.
No Equipment/Bodyweight (add more repetitions if/when these exercises get too easy)
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| Bodyweight Squat | 3 X 10 | 15m walk | 3 X 10 | 15m walk | |
| Assisted Pushup | 3 X 10 | ||||
| Pike Pushup | 3 X 10 | ||||
| Bodyweight Good Morning | 3 X 10 | 3 X 10 |
Minimal Equipment/Dumbbells & Bench (as you get stronger, add more weight to remain around the RPE target)
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| Dumbbell Squat | 3 X 8 @ RPE 6 | 15m walk | 3 X 8 @ RPE 6 | 15m walk | 3 X 8 @ RPE 6 |
| Dumbbell Bench Press | 3 X 8 @ RPE 6 | 3 X 8 @ RPE 6 | |||
| Dumbbell Overhead Press | 3 X 8 @ RPE 6 | ||||
| Dumbbell Deadlift | 3 X 8 @ RPE 6 | 3 X 8 @ RPE 6 | 3 X 8 @ RPE 6 |
Ideal Equipment/Rack, Barbell, Plates, & Bench (as you get stronger, add more weight to remain around the RPE target)
This guide doesn’t address barbell warm-ups in detail. If you need guidance, here’s an article on how to structure an effective barbell warm-up.
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| Barbell Squat | 3 X 6 @ RPE 6 | 15m walk | 3 X 6 @ RPE 6 | 15m walk | 3 X 6 @ RPE 6 |
| Bench Press | 3 X 6 @ RPE 6 | 3 X 6 @ RPE 6 | |||
| Overhead Press | 3 X 6 @ RPE 6 | ||||
| Deadlift | 2 X 6 @ RPE 6 | 1 X 6 @ RPE 6 | 1 X 6 @ RPE 6 |
Summary
- Training provides agency and focus during a time that can otherwise feel overwhelming.
- Through my two transplants, I learned three lessons that have had a lasting impact on my life:
- Practice gratitude, and make a point to acknowledge the people who support you.
- Acknowledge that pain is unavoidable, but suffering is optional. How you perceive stress and hardship directly affects how much you suffer.
- Accept that training is non-negotiable during your transplant journey. Life must accommodate your training plan, not the other way around.
- When it comes to training priorities, focus on building and maintaining strength and muscle, eating adequate protein, and setting aside time to develop a calmer, more flexible mind.
- When it comes to execution, keep the plan simple, prioritize consistency, and progress toward using dumbbells or a barbell and plates whenever possible. These tools give you the best chance of building a savings account of strength and muscle before your transplant.