It was only 7 years later that Redford became extremely ill again, and was diagnosed with primary sclerosing cholangitis (PSC). In 1991 his liver was failing due to the PSC, and he received a liver transplant. Only a week after the surgery doctors discovered a blood clot in Redford's new liver and were unable to repair it. He was once again on placed on the transplant list.
Redford's condition deteriorated rapidly, but a donor was found in time, and he received another liver transplant. He was released from the hospital only weeks after the surgery, with the anti-rejection medication that he'll need to take for the rest of his life.
Redford was so moved by the experience of receiving not one, but two liver transplants, that he founded the James Redford Institute for Transplant Awareness. The Institute works to raise awareness about the need for organ and tissue donors as well as educating people about what it means to be an organ donor. A documentary film created by the Institute, The Kindness of Strangers, is the story of 4 transplant patients and the families of the organ donors. The film, which premiered on HBO, was shown at several international film festivals and won the Crystal Heart Award.