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Job Title: Fellow in Cardiothoracic Transplantation and Mechanical Circulatory Support and Cardiothoracic Organ Retrieval.

Location: Harefield Hospital

The transplant fellow forms a key part of the multidisciplinary team in transplantation and the surgical treatment of heart and lung failure. The fellow will provide surgical input to the care of transplant patients on the ward, and Intensive Care Unit, will participate in transplant operations, and play a leading role in the optimization and retrieval of organs for transplantation. The fellow will be actively involved in the bridge-to-transplant programme for implantable ventricular devices (VAD), Extra-corporeal Membrane Oxygenation (ECMO) and other similar mechanical circulatory and respiratory support systems.

The fellow will also participate in training junior medical and surgical staff in matters of organ optimisation and retrieval, recipient selection and management.

The Trust has engaged in a new style national solid organ offering rota, which requires Harefield Team to be part of an on-call national rolling rota of 1 week on, 1 week off. During the week off, the site is still active to receive organs.

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• The Fellow will participate in the rota for surgeons engaged in the retrieval of organs for transplantation.
• The Fellow will be expected to establish a close working relationship with the transplant physicians and be a ready source of surgical advice for the care of transplant patients on the transplant wards.
• The Fellow will be expected to assist in transplant operations at the request of the consultant surgeon in charge.
• The Fellow will participate in the surgical management of patients who have undergone a variety of mechanical circulatory support including VAD, and ECMO implantation.
• The Fellow will lead the ICU and ward round every morning for transplant patients.
• The Fellow will present patients for discussion at the weekly MDT meetings following their pre-operative assessment.
• The Fellow will be expected to play an active part in training junior surgeons in transplant patient management.
• The Fellow will be expected and supported to pursue relevant research studies within the Trust’s overall research portfolio, publishing at least 1 paper per year and submitting 1 abstract to an international conference.
• The Fellow will assist with organising and managing the transplant, VAD and short-term MCS databases, transforming these files to more accessible format, facilitating generation of audit and research projects.
• There will be an expectation to support non-transplant cardiac surgery activity on a rotational basis.

The transplant service at Harefield Hospital provides around 30 - 40 heart transplants annually with around 20 lung transplants, and 12 -15 durable LVAD implants per annum. In addition, there is an active short term mechanical circulatory support programme using peripheral and central VA ECMO, short term biventricular support devices and other forms of mechanical support for the circulation.

All new Doctors at the Royal Brompton and Harefield Hospitals will be provided a detailed and focused Trust and Departmental Induction upon their arrival. As part of the local induction, a Professional and Management Mentor will be allocated, with whom the appointee will meet for regular meetings.

Training will be2 years and will be divided into 4 stages. Progression from one stage to the next will be dependent on demonstration of competence in the key skills as follows:

Stage 1 (6 months): Junior Retrieval Fellow:

• Participates in organ retrieval as an assistant, learning how to optimise and retrieve donor organs.
• Acts as an assistant in recipient operations.
• Attends ITU and ward rounds to become familiar with aspects of perioperative care.
• Attendance with Interventional cardiologist to learn ultrasound and wire skills.
• Attendance at with lung transplant physician to learn bronchoscopy.
• Attendance with echocardiography technicians and consultants to become familiar with TTE and TOE.

Objectives:
Work towards achieving DBD retrieval of heart and lungs under direct supervision. This will in part depend on surgical skill set of the individual.

Stage 2 (6 months): Retrieval Fellow:

• Progresses towards leading donor optimization and organ retrieval team. Participates in teaching of Junior Retrieval Fellow.
• Develops skills in post-operative management of transplant patients.
• Initiation in DCD retrievals.
• Active participation with peripheral ECMO cannulation.

Objectives:
To become independent in DBD retrieval of heart and lungs.

To participate actively in DCD lung retrievals.

Stage 3 (6 months): Senior Retrieval Fellow:

• Acts as first assist to consultant surgeon with transplant procedure.
• Leads post-operative care of the transplant patient in close collaboration with Intensive care team and transplant physicians and surgeons.
• Initiation to DCD heart retrieval procedure and organ perfusion techniques.

Objectives:
Achieves sign off for DCD retrieval of lungs.

Achieves independence in peripheral ECMO cannulation.

Stage 4 (6 months): Senior Retrieval Fellow-2:

• Assists consultant surgeon with transplant procedures or acts as lead surgeon in less complex procedures.
• Achieves competence in post-operative care of the transplant patient in close collaboration with Intensive care team and transplant physicians.

Objectives:
Achieves independence for all type of retrievals, percutaneous insertion of devices and less complex transplant procedures.