Clinical Responsibilities

Service description:

Potential liver and kidney recipients are evaluated by the transplant team and listed when approved by the appropriate selection committee. Patients are admitted on the transplant surgery service for their procedure and are subsequently discharged to the outpatient clinic. Once surgical issues are resolved, liver transplant recipients are followed by the transplant hepatologists and kidney transplant recipients by the transplant nephrologists. Patients are readmitted to the transplant surgery service for all transplant surgery related problems.

Fellow role:

Service: The transplant fellow will be expected to evaluate patients for transplantation in the appropriate transplant clinic. The fellow will be assigned to a transplant clinic for 2 half-days a week, covering both liver and kidney transplant patients. The fellow will lead multidisciplinary rounds on the inpatient service and is expected to be involved with daily clinical decision-making, immunosuppression management and discharge planning. The transplant service is a surgical service and the fellow would be the most senior surgical trainee with supervision responsibilities over the surgical residents rotating on the service. Autonomy will be incremental as the fellow acquires more expertise and it is expected that the fellow would manage the service independently with staff oversight by the latter part of the first year. The fellow with also review radiological studies and transplant biopsies with senior staff.

The fellow is expected to share in the performance of liver and kidney allograft biopsies with the hepatology and nephrology fellows. All inpatient biopsies will be assigned to the surgical transplant fellow, depending on his availability.

The fellow would share call with the senior surgical resident on the service but would be his or her backup for complex decision-making issues. Fellowship follows ASTS time management guidelines.

Operative: The fellow will be expected to be present at all cadaver and living donor organ procurements during his training period. The fellow will attend deceased donor calls. It is expected that the fellow will perform well over 55 multiorgan/liver procurements and 30 laparoscopic donor nephrectomies as a primary surgeon during his training period.

A fellow is expected to be involved with all liver transplant procedures, depending on his availability. Operative strategy and technique will be emphasized, and it is expected that the fellow will gain more responsibility with experience for most primary liver transplants. The fellow will perform acute re-transplants for PNF and HAT. Re-transplants for chronic disease states will be performed by the fellow during his second year, earlier if technically capable by the judgment of the Program Director. It is expected that the fellow will perform well over 60 liver transplants as a primary surgeon during his training period.

The fellow would be expected to perform kidney transplants with the senior staff surgeon. The transplant fellow will perform the majority of living donor kidney procedures, with senior staff assistance. It is expected that the fellow will perform well over 60 kidney transplants as a primary surgeon during his training period.