Iain

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What is the scope of their work? Do they do all transplants - Kidneys, Livers, Hearts, etc? How does one become one - general surgery residency, and then a fellowship? Is it ultra-competitive? Would you say there is a high risk of medical advances taking away the demand for transplants?

I have just never thought of this specialty.
 

Faebinder

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I tell you, I have to question the sanity of becoming a transplant surgeon. The hours from what I saw are above and beyond horrible. Maybe it's my n=1 experience that sucked.
 

supercut

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Transplant training usually includes liver, kidney +/- pancreas, maybe small bowel, depending where you go.

Heart and lung transplants are done by cardiothoracic surgeons.

I did an elective in hepatobilliary/liver transplant as a med student. It was great. Then I did the transplant service as a resident, and it sucked. How the service is run depends a lot on where you are, and the hepatology support (great at my med school location, nonexistent at my current program)

Neither CT surgery or transplant are competitive...both have poor lifestyles.
 
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imtiaz

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i echo supercut. its great as a student, but not so great as a resident. even more involved as an attending. transplant surgeons are very very very territorial with their patients.
 
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Iain

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Thanks for your insight guys - how does one become a cardiothoracic surgeon. Is it a residency? Or is a general surgery residency, plus a fellowship? What makes the quality of life poor - lots of hours, a number of years to complete your education, incredibly stressful, etc? Is there anything I can do at the pre-med level that would be beneficial, or gain exposure to this.
 

Faebinder

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Both transplant and cardiothoracic are fellowships of general surgery...

If you don't know whether something is a fellowship or a residency then you need to look at FREIDA. Here is the link.

http://www.ama-assn.org/vapp/freida/srch/


Why are the hours horrible for a transplant surgeon?

Extraction operations are usually done at midnight, so that there is enough time to put them into the patients immediately in the morning... (Plus some other factors I am sure I am not aware of but that's the reason I was told.) You're not done after the operation.. you must watch the patient who might get a reaction to the organ and might require an immediate removal of the donated organ....

You pretty much committed your life to this career. I am sure others can add to what I said above...
 

ghost_its

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From my experience on the transplant service at our school...

Kidney transplants are usually about 4-5 hour affairs on average to put the organ in. To harvest it, you have to go to another hospital before that, where the harvest is anywhere btw. 2-4 hours long (depends on how many organs are coming out of the donor). Then you transport the organ to your site and immediately put it in. With kidneys there's a little more leeway, because they have a longer cold ischemia time than other organs such as heart and lungs.

For heart/lung transplants, due to the short amount of time that the organs can withstand, one team goes to collect the organ at the donor hospital, while a second team prepares the recipient at your hospital. The donor run that I did started at 2pm to go retrieve the lungs, by 8:30pm we were back in our hospital with the organ (meanwhile the other team prepped our recipient to the point where his lung was about to come out), and then we put the lung in, which took until about 2:30-3am in the morning. BTW, the previous posts were right. Most transplants happen in the evening/during the night, and there is significant close followup that needs to be done due to the chance or organ rejection and the side effects from the immunosuppressive drugs the recipients get.

and this is just the barebones of your responsibility as the surgeon. they also automatically participate in all the follow-up clinics, the coordination of the organ donation and selection of recipients, etc...

Hope that sheds some light on things.

BTW, it's pretty amazing when you see the new kidney hooked up to the iliacs, the clamp comes off, and you get this nice purple color going, and the ureter starts making urine right away. Not to mention when you see a new lung or a new heart start working/beating in the patient's chest.
 

Apollyon

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At Duke, the transplant people (well, some of them) are some of the most upbeat, happy people in the hospital (on par with, believe it or not, heme/onc and the decedent care people). The ones that are not "happy" are NOT malignant - by any means - just not warm fuzzy/"touchy-feely" types.

But it's true about the territorial thing. Even jaded PGY-5 (of 7) senior residents knew that "I sent Mr. Jones, POD67 OKT, home" is a no-go.
 
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Iain

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Guys,

Thanks ever so much for taking the time to reply. Certainly seems a fascinating, and reward specialty, even if it does have it draw backs.

Rgds,
 

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Faebinder said:
You're not done after the operation.. you must watch the patient who might get a reaction to the organ and might require an immediate removal of the donated organ....
Pre-op antobody crossmatch assays have mostly relegated hyperacute rejection of kidneys to the realm of inservice examinations. Our kidney guy has done hundreds of kidneys and claims to have never seen a hyperacute rejection.

Of note, some centers do the PRA, and donor crossmatch with blood serum... this is less sensitive. Our institution uses donor lymph tissue which is the gold standard for donor antibody assays.
 

AznDoc

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here is a link to a q&a w/ a transplant surgeon working out of pittsburgh.
http://www.amsa.org/surg/transp.cfm
i'm not sure how representative it is of other transplant surgeons around the country, but it does seem like she has a pretty demanding life. cheers.
 
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AznDoc said:
here is a link to a q&a w/ a transplant surgeon working out of pittsburgh.
http://www.amsa.org/surg/transp.cfm
i'm not sure how representative it is of other transplant surgeons around the country, but it does seem like she has a pretty demanding life. cheers.
Is transplant surgery a board certified specialty? I'm assuming it's not since there are no programs listed in FRIEDA. I did find a list of the current transplant fellowships http://www.asts.org/fellowshiptraining/accreditedprograms.aspx
but there wasn't very much info there - e.g. links to the actual sites, etc.
 
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