Transplant Surgery offers a rewarding career, with technically challenging operations and the need to manage complex problems in patients with end-stage failure of at least one major organ system. More than any other surgical field, the basic science underpinning clinical transplantation is still constantly evolving, with recent scientific discoveries impacting on clinical practice earlier and to a greater extent than in other surgical fields. The transplant surgeon can use this alliance of advanced surgical skills, clinical acumen and applied science to dramatically alter the lives of their patients.
The transplant surgeon's efforts may be superhuman, but are not solo. Instead, the transplant surgeon is part of a multidisciplinary collaboration with specialist physicians relevant to the organ in question, specialist anaesthetists and intensivists, transplant co-ordinators, tissue typing scientists, pharmacists, radiologists, microbiologists... the list is almost endless.
There is no distinct training programme in transplant surgery as such, but it is recognised as a subspecialty of larger surgical specialties, according to the organ transplanted. Transplant surgery training is therefore part of Higher Surgical Training (HST) in General Surgery, Urology, or Cardiothoracic Surgery:
|HST programme||Possible organs transplanted|
|General Surgery||Kidney, liver, pancreas, small bowel|
|Cardiothoracic Surgery||Heart, lung|
Training in transplantation of abdominal organs into children is possible as part of a higher surgical training programme in Paediatric Surgery, but opportunities are limited, and most surgeons transplanting organs into children are trained primarily in adult transplant surgery before taking further training in paediatric transplant surgery.
Transplantation of hands and faces make the newspapers, but these operations are still largely experimental. If they become established at some point in the future, this particular area of transplantation will probably be a subspecialty of Plastic Surgery.
Higher Specialty Training is mainly organised as regional rotations based around the postgraduate deaneries. Not all deaneries can offer transplant training, however. Most regions have a kidney transplant centre, but some units performing smaller numbers of transplants are not recognised for training as they would not provide trainees with sufficient experience. Other organs are restricted to a small number of nationally-funded centres. Interdeanery transfers or periods of “Out of Programme Experience” may be required; approval for either of these involves a lot of time and the completion of many formalities.
The following are nationally recognised transplant centres:
|Adult liver||Birmingham, Cambridge, Edinburgh, King's, Leeds, Newcastle, Royal Free|
|Paediatric liver||Birmingham, King's, Leeds|
|Pancreas||Cambridge, Cardiff, Edinburgh, Guy's, Hammersmith, Manchester, Newcastle, Oxford|
|Adult small bowel||Cambridge, Oxford|
|Paediatric small bowel||Birmingham|
|Adult heart||Birmingham, Glasgow, Harefield, Newcastle, Papworth, Wythenshawe|
|Adult lung||Birmingham, Harefield, Newcastle, Papworth, Wythenshawe|
|Paediatric heart/lung||Great Ormond Street, Newcastle|
The table is above is believed to be correct at the time of completing this page, and only contains information about which units perform the relevant transplants, and not about whether they are recognised for training, which should be confirmed with the relevant unit before making applications to particular regions based on training for transplant surgery!
The British Transplantation Society have drawn up a curriculum for transplant training within General Surgery HST programmes, which is available at the Intercollegiate Surgical Curriculum Project. This includes experience in vascular surgery, in which training opportunities are becoming more limited, a situation which may become more acute if vascular surgery separates from General Surgery as has been proposed. Those on General Surgery programmes are advised to inform their Programme Directors early if intending to train in transplantation.
A well-run training programme should allow the right trainee to train in transplantation of at least one of the major organs in adults within the part of a training programme dedicated to subspecialty training, but further experience may be necessary after completion of specialist training and award of CCT, especially for more advanced areas such as paediatric transplantation or split-liver transplantation. Post-CCT fellowships are increasingly being advertised within the UK, and fellowships abroad are also popular.
In 2009, a number of nationally-funded post-CCT fellowships were available in organ retrieval, laparoscopic donor nephrectomy, and split-liver transplantation. At the present time it is not clear whether this funding will be continued, reduced or even increased. Given the cuts which will be needed in public spending in the near future, it is likely that funding for these posts will be reduced or stopped.
Overseas fellowships, especially in the United States, have long been popular with transplant trainees, but there are specific requirements for training recognition (which may include exams) and visas, again especially for the United States.
If coming to the United Kingdom to gain experience in organ transplantation, please be aware that posts differ considerably in their working patterns and educational opportunities. The term “clinical fellow” is very vague in the UK, and can be anything from advanced post-CCT training down to a ward-based junior post. The requirements for formal recognition of a training post are relatively strict, so some posts in smaller units which are not recognised for Higher Surgical Training can still offer valuable training opportunities to the right person. When applying for a post, it is important to visit the centre and determine what is on offer from an advertised post as well as what will be expected from the trainee after appointment.