Simulation in Orthotopic Liver Transplantation

Anesthetic management of orthotopic liver transplantation (OLT) is one of the more complex clinical challenges an anesthesiologist can face. Given the variable distribution of liver transplants performed at different centers, trainees in anesthesiology gain uneven OLT exposure and, potentially, expertise. Simulation can serve to bridge this gap through the use of part-task trainers, high-fidelity simulation, and serious gaming. Liver transplantation cases can involve the management of critical events uncommon in the course of standard anesthetics such as hyperkalemia, massive hemorrhage, and cardiopulmonary arrest. Simulation-based scenarios designed to contain specific events seen during liver transplantation can serve as a means of assessing a learner’s ability to perform effective crisis resource management. Liver transplantation is a highly coordinated affair involving collaboration among multiple surgical and medical professionals and support staff. Multidisciplinary team training in the simulated environment can serve to prepare providers for the care of patients undergoing liver transplantation through a focus on improving communication and crisis resource management. Current curricular development for liver transplant anesthesiology education is limited due to the lack of clinical volume at many centers and a lack of requirements for exposure to this surgical procedure by governing bodies such as the Accreditation Council for Graduate Medical Education (ACGME), United Network for Organ Sharing (UNOS), and Organ Procurement and Transplantation Network (OPTN). While high-fidelity simulation may be the most effective simulation-based tool, its application can be limited due to its resource-intensive nature. Serious gaming, while lower in fidelity, may provide a lower-resource alternative and accessibility to a wider audience.