“So you want to become a Transplant consultant surgeon” Career Pathways 1

Blog Post By Mr Callaghan, Cambridge University Clinical Society

·         What does the speciality offer?

Abdominal transplant surgery is complex, technically challenging surgery involving transplantation of the liver, kidneys, pancreas, small bowel, stomach, or any combination of these organs. As such, transplantation surgery offers exposure to the GI, vascular, biliary, and urological systems. This makes transplantation surgery unique within the adult surgical specialties.

Transplant surgeons work closely with nephrologists, hepatologists, and gastroenterologists in the assessment of transplant candidates, and the post-operative management and follow-up of transplant recipients. A multi-disciplinary approach is essential due to the complexity of these patients. Transplant surgeons must also have a good working knowledge of general medicine, infectious diseases, and immunology. As such, this specialty tends to attract surgeons with interests in a broad range of medical and surgical specialties and the basic sciences.

A large part of the transplant workload involves procurement of donated organs, from either cadaveric donors (brainstem dead or non-heart beating donors), or increasingly, live donors (most commonly laparoscopic donor nephrectomy). 

Transplant surgeons usually provide general surgical services to patients with renal failure, and in many hospitals are involved with the surgical vascular access service (i.e. placement of peritoneal dialysis catheters and formation of arteriovenous fistulae).

 Most abdominal transplant surgeons also do general surgery on-calls and clinics.

·         What is the career pathway to consultant stage? Any academic routes (if relevant)?

ST in General Surgery, with final 2-3 years specialising in abdominal transplant surgery. Depending on where this is undertaken this may be liver, kidney, pancreas, multivisceral transplantation, or a combination of these. The overwhelming majority of consultants will have undertaken a formal period of research (often laboratory-based), leading to an MD, or PhD.

Transplantation surgery lends itself to academic surgery due to the requirement for an understanding of transplantation immunology and the research opportunities leading from this. Academic transplant surgeons require an MD, or PhD, and, since MMC, will usually train as Academic Clinical Fellows and subsequently as Clinical Lecturers.

Trainees interested in cardiothoracic transplantation require training via a cardiothoracic surgery pathway. 

·         What can I do as a student to improve my chances of getting into this specialty?

An exposure to transplantation surgery via the student transplant rota is a good start in order to determine if this specialty might suit you. As transplant surgeons are invariably based in large teaching hospitals, a strong academic background is necessary. Like most surgical specialties, students who succeed in becoming transplant surgeons show initiative, confidence, the ability to work hard for long periods, excellent communication skills, good technical skills, and dedication to their patients.

If you are interested in transplant surgery then you should contact one of the transplant surgery trainees or consultants to discuss how you might become involved in research projects, audits, and other activities within the department. 

·         What would you have done if you couldn’t do your speciality?

Vascular surgery or HPB surgery. Both are similar to transplant surgery in terms of the complexity of the surgery, and the high degree of technical skill required.  

·         What are the drawbacks to your specialty?

– bad hours (often called in when not on-call and most organ procurements and implants take place out of hours). This places large burdens on family and social commitments. An understanding partner/family are essential!

– little/no private practice (in the UK, but very different elsewhere)

– few consultant posts available in liver transplantation in the UK 

·         Useful books/ links?

www.bts.org.uk

www.uktransplant.org.uk

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