Download Introduction Lung Transplant is a speciality within respiratory

Introduction
Lung Transplant is a speciality 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 tickbox, for others it may inspire them to consider a career
as a transplant physician.
The aim of this spotlight section is to help 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.
Some History…
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.
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 specialist centres?
There are 5 specialist Lung transplant centres in the UK:
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? What skills will I need?
As you can see from the pathway above the role of the transplant physician is multi-faceted and
multi-disciplinary. 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.
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 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 find 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!
Also visit our forum for the latest resources on lung transplant and give us your opinion on which are
most useful!