Transplant Anesthesia

The work of a transplant anesthesia team is to provide specialized care for adults and pediatric patients undergoing liver, kidney and pancreas transplantations. In the case of living donor liver transplantations (involving a kidney or part of a liver donated by relatives or other altruistic donors), we provide perioperative care for both donor and recipient. All our attending physicians have received extensive training in this field and we provide evidence based care using state-of-the-art procedures.  We are involved in the pre-intra and postoperative management of transplant patients. Our team works together with the surgical transplant and intensive care teams to ensure the continuity of patient care. 

Does the transplant patient meet with the transplant anesthesia team before the transplant operation?

Every patient that undergoes surgery has to be evaluated by the anesthesia team.  Patients for live-donor-related transplants are usually seen in the anesthesia preoperative evaluation clinic several days before their surgery.  Patients for not-living-donor transplantation are usually evaluated by the anesthesiologist on the day of transplantation, depending on organ availability.  
Generally, the transplant anesthesiologist visits the patient on the day of surgery in order to meet the patient and answer any questions.  


Is special training required to provide anesthesia for a transplant procedure? 

Special anesthesia care and management are required for a transplant procedure; therefore, the anesthesiologist caring for a transplant patient is required to have additional specialized training. Members of our transplant anesthesia team have been trained at major transplantation centers and have extensive experience and a high level of expertise in this field.


How long does a transplant operation take? 

The length of the operation varies depending on many factors, including the physical condition of the patient, past abdominal surgeries, and which organ(s) are being transplanted. Most transplant procedures take a minimum of four hours but can take up to twelve hours. 


Does a patient lose a lot of blood during a transplant operation?

Patients undergoing an organ transplant very frequently need transfusions of blood and blood products (for example, plasma). Liver transplant recipients, especially, very often need transfusions due to compromised coagulation. Currently, blood products undergo very strict controls by blood banks to rule out possible infections. The risk for blood transmitted diseases or a transfusion of mismatched blood products is absolutely minimal.

How long after the transplant operation will the patient wake up from anesthesia?

Depending on the situation, the patient is sometimes woken up immediately after surgery while still in the operating room.   In other cases, the patient is taken to the post-anesthesia care unit (PACU) or intensive care unit (ICU), where they are closely monitored and woken from anesthesia. The patient will stay on monitors in the PACU or ICU until they are stable, at which time they are transferred to a regular hospital room.

How is postoperative pain managed for a transplant recipient or donor?

Immediately following the operation, the staff in the post-anesthesia care unit (PACU) monitors the patient’s pain. They provide the treatment necessary to insure that the patient is as comfortable as possible. Once the patient is transferred from the PACU to a hospital room, the nurses and the Anesthesia Acute Pain Management Team monitor the patient closely to provide pain medication as needed. If the patient is transferred from the operating room directly to the intensive care unit (ICU), the ICU team provides pain management.

Is it possible to use an epidural catheter for pain relief after transplantation?

Currently, an epidural catheter for pain relief has become a standard for abdominal surgery.  We routinely place an epidural catheter for a patient who donates the organ. Unfortunately, it is not possible to use an epidural for the organ recipient. In the case of liver transplantation, coagulation is significantly compromised and an epidural catheter could lead to neurological problems. For kidney and pancreas transplantations, the catheter is also not recommended. The post-anesthesia care unit staff and/or intensive care unit team will provide intravenous therapy to manage postoperative pain.