The impact of liver transplant programs on anesthesia personnel and services

Liver transplantation procedures are being performed at an increasing number of hospitals throughout the United States. These procedures are challenging because of hemodynamic, metabolic, renal, and coagulation dysfunctions and may require prolonged periods of time for completion. Anesthesia departments are developing or managing teams of personnel to perform liver transplants. A survey was sent to directors of liver transplant anesthesia teams to investigate how teams were structured, compensated, and the impact of participation upon personnel involved. Thirty-nine centers were surveyed and 31 responded. The results showed an arithmetic doubling of cases for each of the last six years, most being performed at large medical centers (more than 759 beds) with populations served of 2 million or more. Cases were reported to average 13 hours in length and required a mean of five anesthesia personnel to complete. Compensation methods for work on a liver transplant team were variable; however, CRNAs and technicians received monetary reimbursement more frequently than physicians. Emotional responses of personnel were equally divided between favorable and unfavorable responses. Discriminate analysis showed that positive personnel attitudes were most closely tied to the presence of a protocol for breaks, call schedules, compensation, and the frequency of performing these cases. However, most protocols for personnel management were instituted in response to dissatisfaction. As the number of transplants per year increases, departments will need effective plans for personnel management to maximize departmental resources, increase research interest, and maintain personnel enthusiasm.