Mr Paul Gibbs is the surgical transplant lead - consultant surgeon

Ayaz Hossain (surgeon SpR) coordinates the junior rota and is the person to approach for information regarding the rota or queries pertaining to swaps.

Miss Irum Amin (surgeon)coordinates induction upon junior arrival.

Renal and Liver teams have a lead medical consultant and registrar and 1-2 juniors on the ward. Multivisceral team normally have their own permanent junior but we cover their team when we are on-call on evenings, weekends, nights. Multivisceral patients are covered by Surgical SpR on call during weekday and weekend nights not the gastroenterology on call SpR

Additional Info –

G5/F5 ward has most of the Transplant patients but we sometimes have patients outlying around the hospital (this is rare). We also have many patients in ICU. Post operatively, liver transplant patients spend their first 24-48 hours in ITU, SPK (simultaneous pancreas and kidney) transplants spend their first 5 days in F5 HDU and kidney transplants return straight back to the ward.

As above. Meet Miss Amin for induction, obtain rota from Ayaz Hossain.

Transplant handbooks advising you on how to manage renal, liver and multivisceral transplant admissions can be found on CONNECT (printed versions available in the G5 Doctors office). There are now order sets on EPIC that include most blood tests, investigations and pre/intra/post-operative medications that need to be prescribed for transplant admissions however this is not all-inclusive, so refer to the handbook if in doubt.

When a new transplant patient arrives it is expected that you review them straight away as they may need to dialyse before surgery which will hold things up in theatre. You will then need to take a full set of bloods for tissue typing, G+S, biochem, haem, clotting, virology and a VBG. These are then delivered in person to the correct lab for urgent analysis. (Tissue typing is taken to the genetics lab on level 6 of the ATC (leave in the fridge in genetics reception OOH and call via switchboard if they are not there in person).

N.B follow order set but always make sure VBG done urgently in case dialysis needed and make sure crossmatch requested for renal transplants if not on order set

ALL PATIENTS WHO HAVE RECIEVED/ARE DUE TO RECEIVE A TRANSPLANT SHOULD HAVE HEPATITIS E NEGATIVE BLOOD PRODUCTS

Foolproof route for hand delivery of bloods for new recipient: VBG FIRST ON G5 FOLLOWED BY… 1) crossmatch sample to level 3 hatch on corridor to right past theatres entrance in main block 2) pathology specimens (haem/biochem/clotting) to specimen reception hatch in pathology block on level 4 3) micro specimens (10ml tubes) to pathology block level 6 hatch 4) tissue typing (10ml tubes) to fridge in ATC level 6 tissue typing

G5 Doctors office is a handover morning 08.00 and before nights 20.00. G5 ward F5 HDU The two wards above are a square ward a the entire thing commonly referred to as G5.

We have our own blood gas machine on G5. Transplant surgical team led by Mr Paul Gibbs

MDTs on Friday afternoon - juniors expected to present ward patients. CLinics can be arranged whenever as long as there are sufficient juniors on the ward - minimum is 1 per team. Theatre (same as clinics) -never timetabled to be in theatre but opportunities if you are interested (providing staffing levels are sufficient)

CMT teaching THURSDAY AM FY2 teaching FRIDAY PM

NB: we monitor Tacrolimus levels and Sirolimus levels (immunosuppressants) daily (except Sunday) and the levels (blood tests) must arrive in lab before 10.00 or they miss the run…and the results arrive back from labs at 14.00. Consultants and Registrars need to know everyone's levels for that day and all immune doses need adjusting accordingly. This means daily prescribing. N/A E-hospital has improved Transplant life…order sets available for most common tests. On admission, click transplant order set for renal or liver transplant…and follow protocol!

Remember to set up daily standing orders for blood tests including Tacrolimus so that it hits the lab before 10.00 Senior support as required - all registrars available 24/7 on long-pager

==== Documents ==== CONNECT has a range of helpbooks and pamphlets with guidelines for patients both preoperatively and postoperatively. There are separate bookts for kidney transplant, liver transplant, simultaneous pancreas and kidney transplant, and mutlivisceral transplants.

==== Wards ==== G5 is the ward - there are 4 Transplant HDU beds (F5) on this ward. We look after those patients too as they are usually liver transplant patients immediately post-operatively. Kidney transplant patients routinely come straight back to us on the ward.

=== In the event of an admission for ORGAN TRANSPLANTATION ===

The transplant co-ordinator will call you/ the ward and give you the details:

• Type of organ transplantation
• Patient (recipient) demographics
• Recipient of DBD/DCD
• Mismatch status (important for determining immunosuppressive medications - Azathioprine/ MMF [see protocol])
• CMV/ EBV/ Toxo status (they may not know but ask)
• ETA

Admission Order Sets

Liver Transplant: Liver Transplant admission

Renal Transplant: 1) Kidney Transplant from Deceased Donor Admission or 2) Live kidney donor admission (unlikely over night)

Most important thing to do first is get ALL THE BLOODS and personally run them to the respective labs (tissue typing ATC 6th Floor). Either print the blood labels off in HDU (F5) or ask one of the nurses if they can. The labels will tell you how many bottles you need and what colour. (Blood bottles: TT stands for tissue typing, M stands for Micro)

Important: group and save not on order set, so order separately, dont forget to take a blue bottle and CXM 2 units for renal tx. Take a VBG as well for quick gauge of K+ - may require haemodialysis PRE-THEATRE if >5.0 therefore will require prompt action (inform Renal SpR ASAP with results of VBG K+)

After youve done bloods, clerk the patient (standard clerking and examination):

Important points to note for renal transplant:

• Indication for kidney tx
• Native urine output
• Current form of RRT and details e.g. last haemodialysis session

If youre not sure that they are suitable for surgery e.g. chest pain - do Ix and discuss with surgeons/ anaesthetist/ respective transplant teams.