This curriculum is designed to provide a comprehensive understanding of the care continuum for transplant patients, encompassing both pre- and post-surgical phases in both inpatient and outpatient settings. Fellows will actively participate in candidate selection, donor evaluation, peri-operative management (inclusive of lung and heart transplants), and the use of mechanical support for bridging to transplant. Following completion of our program, fellows will be eligible to become the primary lung transplant physician at an accredited adult lung transplant program.
The IU Lung Transplant Program is the sole lung transplant center in the state of Indiana. Our projected 2023 volume is 60-65 lung transplants.
- Transplant Pulmonology
- CV/CT Surgery
- Transplant Coordinators
- Administrative Assistant
- Social Work
- Transplant Psychology
During their time with lung transplant fellows will rotate between inpatient and outpatient.
During their outpatient rotation, fellows will spend five full days a week in the advanced lung and heart clinic managing pre- and post-transplant patients and new referral patients.
- New patient referrals: Seen every Monday and Thursday afternoon. Typically, four to five new patients a week. These appointments are called “Info Sessions” and include a full day in the clinic for the patients. During that day patients will attend a presentation about lung transplant by one of our surgeons and will meet with:
- Surgery to evaluate candidacy and barriers to transplant
- Dietician to evaluate nutritional health and review goals
- Social Work to evaluate support system and psychosocial barriers to transplant
- Pharmacy to review medications, address transplant-specific concerns
- COLTT Center: Patients undergo frailty testing including six minute walk test, strength, balance testing, and a short physical performance
- Transplant Pulmonologist: The final appointment for the day is with pulmonology to review patient in entirety and formulate the next steps for patient care.
- Pre-transplant Established Patients: Seen Tuesday and Wednesday afternoons. Patients are reviewed for candidacy, barriers to transplant, and appropriateness for listing.
- Post-transplant Established Patients: Seen Monday through Friday morning in 30-minute appointments. This includes urgent sick patient visits when needed.
- Listing Appointments: Once a patient has been approved for listing, they will attend a “listing appointment” which allows members from all multidisciplinary specialties to give patients final preparations for transplant. This is a time for transplant pulmonologists to emphasize the expectations of patients and review possible complications with patients and family.
- “Staffing coordinators”: At least once a day our transplant coordinators need to review patients with transplant staff. These include patient concerns, test results, medication changes, illness, or any changes to management.
Inpatient Rotation - ICU
During the inpatient rotation, fellows will rotate between ICU and floor in one week intervals. While rotating in the ICU fellows with be involved in the management of peri-operative lung transplant patient, prior lung transplant recipients with acute critical illness, emergent inpatient transplant evaluations, and ECMO bridge to transplant. At our institution transplant pulmonology is also intimately involved in many of the advanced circulator devices in conjunction with CT/CV surgery. While on their transplant ICU rotation, fellows will also manage all ECMO patients (including VA), new LVAD patients (post-op), post-operative heart transplant recipients, and post pulmonary thromboendarterectomy CTEPH patients. This reinforces our close working relationship with surgery.
- Management of:
- Peri-operative lung transplant recipients
- Urgent inpatient referrals
- Previous lung transplant recipients who are critically ill
- ECMO patientsNormal:
- VA, VV, V-AV, Oxy-RVAD.
- Bridge to transplant (lung, heart)
- Post-operative LVAD patients
- Pulmonary Thromboendarterectomy post-operative management
Inpatient Rotation - Floor
During the inpatient floor rotation fellows will manage pre- and post-operative lung transplant patients in a specialized unit (7 North). This is inclusive of all prior lung transplant recipients, whether new or remote. At our program we take great pride in providing comprehensive care to our patients and as such we are primary with the management of our patients, regardless of admission indication. Hospitalists are not consulted for our patients. We have an amazing compliment of Nurse Practitioners who assist with these patients.
A lung transplant committee meeting is held every Thursday in the same building as our clinic and physician offices. The meeting encompasses patient selection, reviewing current COLTT (Center of Life for Thoracic Transplant pulmonary rehab program) patients (both pre- and post-transplant patients), reviewed current admitted patients, discussing pre- and post- patient concerns and discussing airway management of monitored patients.
- Go on organ procurement runs
- Be involved in a unique and exceptional rehabilitation program.
- Rotate with our HLA laboratory
- Assist with review of donor offers, understanding the criteria for acceptable allograft
- Complete OPTN requirements
Fellows will have ample opportunity to perform a variety of procedures:
- Diagnostic/therapeutic bronchoscopy
- Transbronchial biopsies
- Percutaneous tracheostomy
- Chest tube placement (Percutaneous, surgical cut down)
- Central line insertion
- Arterial line insertion
- Argon Plasma Coagulation (bronchoscopy)
- Cryotherapy (bronchoscopy)
- Bronchial stents
- Primary care of 15 or more lung transplant recipients
- Record medical record, UNOS ID, date of transplant