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The Abdominal Organ Transplantation Anesthesia Fellowship is a program developed at Toronto General Hospital.
The fellow will be actively involved in the perioperative and intraoperative care of patients undergoing liver transplant, kidney transplant, kidney-pancreas transplant and occasional "cluster" transplantation. Another component of this fellowship is the anesthetic care of patients undergoing major surgical oncology procedures on the hepatobiliary, pancreatic and general surgery.
A fellow is assigned each day to see patients who are candidates to be listed for transplant and are seen in the outpatient clinic. The fellow will assess the patient, review the considerations for transplant with the consult clinic attending and, together, they will plan further investigations and optimization. There is an expanding living donor related program for both the liver and kidney recipients. In addition to transplant recipients, the fellows will be involved in the screening and teaching of prospective living related donors. Counselling regarding thoracic epidurals and the management of postoperative pain is a major commitment of the department and the transplant program.
Home call for liver transplants is shared between 4 fellows and on average comes to 4 to 5 weekday calls and 2 weekends per month.
Listing Rounds. Liver Transplant Listing Round occur each Friday and anesthesia plays an important role in patient selection for transplantation. Fellows will be asked to attend list meeting approximately once every month. A staff anesthesiologist will be responsible to patient review as required. In addition, kidney transplant listing meetings occur later in the day on Friday and input from anesthesia is always requested. Attendance at this listing meeting is usually staff lead, but fellows are encouraged to attend.
Educational Rounds.Rounds occur each Thursday morning in a block of time for much of the morning. An attending staff and fellow will participate each week and represent anesthesia at the listing rounds. Tuesday weekly Fellows’ rounds at 17:00 are mandatory.
Transesophageal and Transthoracic Echocardiography.Transesophageal reading rounds are conducted each week on Thursday and again fellows are encourage to attend. For more hands on training in TEE or TTE special arrangements will be made to review case in the cardiac OR.
There will be opportunities to complete existing research projects, initiate new ones and to present findings at local, national and international meetings. Participation and presentation in academic conferences is encouraged. Data from each patient will be collected and used primarily for quality improvement, but summative information will be available to review a candidates work experience. Each year, we conduct 170 to 200 liver transplants, 130 – 150 deceased donor kidney transplants and 50 – 60 pancreas transplants.