Transplant Anesthesia
Program Director, Dr. Tejal Desai
The Multi-Organ Transplant Program (MOTP) at London Health Sciences Centre is one of the leading transplant programs in Canada, performing approximately 200 transplants annually. This Fellowship in Transplant Anesthesia supports clinicians in the acquisition of skills and knowledge essential to providing safe perioperative care to patients undergoing liver and kidney transplantation. Fellows will participate as active members in the multidisciplinary team responsible for transplant candidacy assessment and delivery of perioperative care. In addition, fellows will gain experience in anesthetic care for a wide variety of complex hepato-pancreatobiliary procedures. The fellowship is based on the Royal College of Physicians and Surgeons of Canada’s CanMeds roles.
Clinical Summary:
Average number of orthotopic liver transplants (OLT)/year: 65
Fellows/year: 1
TEE: routinely used during liver transplant
Pathway for Basic TEE Certification: Encouraged with structured training program offered.
Point-of-Care Viscoelastic Testing: TEG6, routine use
Fellowship Summary:
Recommended OLT/fellow: 45
Clinical training days: On days when no OLT is ongoing, fellows are booked in complex OR lists with priority for major HPB and other intra-abdominal organ transplants. There is also opportunity for scheduling within other subspecialty interests (e.g., neuroanesthesia, cardiac anesthesia).
Days spent in subspecialty training/week (avg): 3 days
On-call commitment: Organ transplants are unpredictable, often occurring outside of usual working hours. Weekday on-call consists of 2-3 weeks/months to optimize clinical exposure. Physician wellness is a priority. Every other weekend is protected from on-call requirements to facilitate adequate rest. In addition, if a liver transplant continues beyond midnight, the fellow is not expected to report for duties the following day (unless there is another transplant).
Elective rotations: Echocardiography, Hepatology (some days offered in ESLD and posttransplant clinic)
Independent practice days (with consultant support as required)/week (avg): 2 days, may be in subspecialties unrelated to Transplant Anesthesia.
Educational Curriculum:
- Formal teaching sessions relevant to transplant anesthesia.
- Formal teaching sessions combined with clinical experience to gain experience in TEE.
- Workplace-based assessments to demonstrate competence & facilitate constructive feedback.
- Multidisciplinary educational rounds with hepatology and transplant surgery (weekly)
Involvement in Recipient Selection Committee: Yes, weekly
Involvement in Preoperative Recipient Assessment Clinic: Yes, weekly
Publications: Encouraged. (Reimbursement provided for conference presentation)
Dedicated research time: Yes (time provided dependent on individual project)
Eligibility Requirements for Canadian and Foreign Medical Graduates
- Candidates must possess a medical degree from a University recognized by the Medical Council of Canada (MCC)
- Candidates must have completed an anesthesia residency that is recognized by the College of Physicians and Surgeons of Ontario (CPSO)
- International Medical Graduates (IMGs) do not need to write additional exams but must be approved by the PGE Office at Western University
- English Language Requirement for IMGs: TOEFL-iBT required to achieve an overall score of no less than 93 with a minimum score of 24 in speaking; IELTS required to achieve a minimum score of 7 in each category.
- All non-Canadian trained anesthesiologists will be required to pass an assessment period taking place over the first 4 - 8 weeks to continue with the fellowship (‘PEAP’ – Pre-entry assessment period).
Please refer to the Application and Requirements page for a more detailed description
Additional Information
Fellowship Learning Objectives:
- To provide safe perioperative care for patients undergoing intra-abdominal organ transplantation, including use of relevant intraoperative assessment modalities (e.g., thromboelastography, transesophageal echocardiography).
- To contribute, as part of a multidisciplinary team, to the candidacy assessment for potential liver transplant recipients, including patient investigation and optimization.
- To provide comprehensive, safe perioperative care for major hepatobiliary surgery.
Fellowship Assessment:
Explicit fellowship assessment expectations will be provided prior to the start of the fellowship. Expectations include:
- Maintenance of clinical logbook
- Maintenance of educational logbook (e.g., attendance at rounds)
- Supervised learning events of subspecialty cases (e.g., liver transplant)
- Daily consultant supervisor evaluation for subspecialty assignments.
- Multisource feedback
Assessment results will be reviewed regularly with the learner during 3-monthly formative review.
