Division of Respirology

Lung Transplantation

University of Toronto
The Lung Transplantation rotation is an external elective at the University of Toronto. You will assess both inpatients and out patients before and after transplantation. Resident skills with bronchoscopy and transbronchial biopsy will be enhanced during this rotation.

Medical Expert

  1. To know the criteria for identifying appropriate candidates for lung transplant.To gain expertise in the process of assessing patients for transplantation, including pre-assessment review, ordering and interpretation of appropriate investigations, and participation in multi-disciplinary assessment meetings.
  2. To gain expertise in the management of patients listed for transplantation, including clinical follow-up, status assignment, and rehabilitation.
  3. To understand in detail the use, physiologic and adverse effects, indications, and monitoring of immunosuppressive medications used in lung transplant recipients and to be able to make appropriate decisions regarding changes in dose or type of medication.
  4. To be able to identify and manage medical issues in the early post-transplant period (including immunosuppression and anti-rejection therapy, chest tubes, infection prophylaxis, and the detection and management of reimplantation injury and acute rejection).
  5. To identify and manage post-hospitalization and long-term complications of lung transplantation, including rejection, infection (esp. CMV), bronchiolitis obliterans syndrome, post-transplant lymphoproliferative disorder, and osteoporosis.
  6. To understand the epidemiology related to lung transplantation, including survival and morbidity data and how this varies with pre-transplant diagnosis.
  7. To gain an appreciation of the surgical procedure by observing the transplant operation and to understand the process of donor selection and organ allocation.
  8. To understand and be able to organize surveillance of transplant recipients, including blood tests, bronchoscopy, and clinical assessments

Communicator

  1. To learn to counsel patients and their families about the lung transplant process, including the risks and benefits of lung transplantation.
  2. To communicate effectively with referring physicians in managing pre and post transplant patients.

Collaborator

To appreciate the multidisciplinary approach for caring for the transplant population, including the pre-transplant assessment and post-transplant follow-up.

Health Advocate

  1. To promote organ donation and retrieval via education of the public regarding importance of signing organ donation cards and teaching medical staff how to approach families to request organ donation.
  2. To understand the social and economic impact of transplant on the patient and their families.

Manager

To understand the factors limiting the supply of donor organs and the role of transplant programs in managing this limited resource.

Scholar

To update respiratory physicians, residents and other colleagues who do not work in a lung transplant center of new clinical advances in the area.

Professional

  1. To understand the importance of counseling of end-of-life care for patients with advanced lung disease.
  2. To understand and participate in discussion of ethical issues surrounding transplant selection.