Interesting Transplant Team Meeting - Power?

A little background for our none Canadian friends…Here the transplant process is done out of one hospital, no competition, and is a team format. The transplant team had the 3 or 4 surgeons and Hepatologists, as well as the other supporting roles. When you meet with them you have appointments will all the different groups and then they meet to decide who to place on the active list versus who to just continue to monitor. We aren’t as MELD driven as the US, though it is obviously taken into account.

So I met with the team and had two very different opinions. Two things to note. First I didnt share the hepatology conversation w the surgeon and second the hepatolgist I saw was the Fellow not the Head of the Department.

Hepatologist said her recommendation was to list. Surgeon said not time to list and went as far as to say that I needed some type of life threatening event to be listed or obviously great decomposition of function (which is hard to get to for PSC and my specifics).

The whole team meets to discuss this week and then let’s everyone know at the end of week.

So my questions…

How senior is a Fellow?

Who holds more power Surgeon or Hepatologist?

How can the opinions be so different? Is it that they simply look from different perspectives??



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Hi Eric, My understanding is that the TX team makes a decision together based off on a report of your case presented to the board by your sponsor(s)/the referring doctor. I was told no one person is responsible for making that decision. Our team was very vocal with their differing opinions as well which was really frustrating. Our surgeon was the one of the bunch creating doubt for the rest. (I couldn’t stand him!) He saw patients that were sicker and more deserving I guess. Eventually when the time came for our TX he became one of our biggest advocates though and that was humbling to say the least. And it was relieving for us at the time to know our case was decided by facts not personal opinions.

I hope all goes well with your evaluation, please keep us updated,

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