Download Sub-speciality spotlight - Lung transplant

BTS Specialist Trainee Advisory Group
Sub-Specialty Spotlight
LUNG TRANSPLANT
KEY WORDS FOR WORKING IN LUNG TRANSPLANT MEDICINE
multidisciplinary, teamwork, critical care, risk assessment,
communication, rewarding, highs and lows, technology
BACKGROUND
Lung Transplant is a specialty within respiratory medicine to which many trainees have minimal exposure outside
essential curriculum requirements. Prior to the 2015 changes this could vary substantially; but the current
requirements mean all trainees will attend at least 2 transplant clinics. For some this will be another curriculum
tick-box, for others it may inspire them to consider a career as a transplant physician.
The aim of this subspecialty spotlight is to help you understand how transplant services work and for
interested parties to get an idea of what might be involved in becoming and working as a transplant
physician.
The first UK lung transplant was performed at Freeman Hospital in Newcastle in 1987. Since then the number of
lung transplants performed has risen year on year. Sadly the number of donor lungs still falls significantly short of
the numbers who need new lungs. Changes in criteria to allow non-heart beating donors, campaigns to increase
numbers on the organ donor register and new technologies allowing “reconditioning” (Ex-Vivo Lung Perfusion) of
donor organs are all current strategies aimed at overcoming this issue.
HOW IS CARE STRUCTURED AND FUNDED?
Transplant care is funded centrally commissioned by the national commissioning group (NCG). Care is provided by
multi-disciplinary transplant teams located in specialist centres. These teams include transplant surgeons,
transplant physicians, co-ordinators, specialist nurses, psychologists, microbiologist and others….. Transplant
teams work closely with critical care in providing care pre and post-operatively with some centres having
dedicated critical care facilities.
Patients are referred by local teams using specific forms listing the information needed for initial assessment by
the transplant team. This frequently involves radiological imaging, cardiac and exercise assessments, microbiology,
nutritional status, current medications, other co-morbidities and current disease trajectory. Usually patients are
seen in clinic first, then admitted to the transplant centre for a more involved assessment prior to listing. Once
listed they will continue to see the transplant team in clinic periodically as well as informing them of any changes
in their clinical condition. The co-ordinator acts as their key point of contact and should be contacted urgently in
the event of any changes.
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Written by Dr Charlotte Addy. Last updated June 2016
Post-op immediate care is provided in critical care in collaboration with transplant physicians and surgeons. Once
on the ward and eventually at home the transplant physicians act as the patient’s primary physician and will
monitor patients especially closely over the first year. Any clinical changes are discussed with the transplant team
– by patients and their local teams. Over time if patients are well the frequency of review is reduced but the
transplant team will remain a key point of contact even many years post-transplant.
WHERE ARE THE TRANSPLANT SPECIALIST CENTRES?
There are 5 specialist Lung transplant centres in the UK:
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Freeman Hospital, Newcastle upon Tyne
Harefield Hospital, London
Queen Elizabeth Hospital, Birmingham
Wythenshawe Hospital, Manchester
Papworth Hospital, Cambridge
Most hospitals refer to their nearest transplant centre but patients can choose to go to any centre. In some cases
clinicians may choose a specific centre due to specific need eg ability to deliver ECMO in Harefield/Manchester or
previous attendance at a centre for other reasons eg PH patients at Papworth.
Almost all Transplant teams will also run satellite clinics in other hospitals to reduce travelling for individual
patients – for example Newcastle run a clinic in Belfast.
WHAT DOES THE DAY TO DAY ROLE INVOLVE?
As you can see from the pathway above the role of the transplant physician is multi-faceted and multidisciplinary. They must be able to work closely with a large multi-disciplinary team and liase with respiratory
physicians and MDTs in other centres. On a day to day basis they will be:
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assessing suitability of patients in clinic and on the ward
discussing treatment options and disease trajectories with patients and other teams
monitoring those on the list
reviewing pre-op patients and those with failed calls
caring for patients post-op – in critical care, on the ward and in clinic
dealing with queries about post-transplant patients at home or in other hospitals
Team working, communication and time management skills are therefore critical!
Being a transplant physician also inevitably means discussing “big issues” on a daily basis. By its very nature their
patient population has end stage disease and is starting on a pathway where large numbers may not be suitable,
may not survive to receive a transplant or run into life-threatening complications peri-operatively or post-op.
There is a significant mortality post-transplant which has to be discussed and anyone contemplating this
as a career should be happy discussing and managing these issues.
Yet this is also a career with a high success rate – outcomes post-transplant are improving, those who do well
post-transplant can go on to gain a second lease of life and achieve amazing things, technology is advancing and the
scope of people being considered for transplant is widening.
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Written by Dr Charlotte Addy. Last updated June 2016
HOW DO I BECOME A TRANSPLANT PHYSICIAN?
The career pathway is relatively straightforward. As well as completing specialist respiratory training future
transplant physicians must complete a transplant fellowship in one of the specialist centres at home or abroad.
These usually last for 1-2 years and are advertised online or in the BMJ; as well as on the IHLST (International
Society for Heart and Lung Transplantation) website which keeps a list of fellowships abroad. These can involve a
period of research but are primarily clinically focused – although you may want to consider a research fellowship
as well.
Most will consider such a fellowship as a senior SPR or post-CCT simply due to the level of basic respiratory
knowledge needed to get the most out of these fellowships!
INSPIRED? HOW DO I F IND OUT MORE?
The best way to find out more is to visit your local transplant centre or chat to a transplant physician. The BTS
transplant short course faculty is a good place to encounter UK transplant physicians and get a feel for a career in
transplant medicine!
Have a look on the British Transplantation Society website, and also visit our forum for the latest resources on
lung transplant and give us your opinion on which are most useful!
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Written by Dr Charlotte Addy. Last updated June 2016