What does a lung transplant thoracic surgeon do all day?

Dr. Shaf Keshavjee is a Toronto thoracic surgeon and a global lung transplant superstar. He is also director of the Toronto Lung Transplant Program, chief of Innovation at University Health Network, professor of thoracic surgery and biomedical engineering and vice chair for Innovation in the Department of Surgery at the Temerty Faculty of Medicine at the University of Toronto. Here is how he spends his day.5:30 a.m. – I get up and start my day with a morning coffee. I usually don’t eat breakfast so I’m out the door by six. It’s a short drive from my home in the Teddington Park neighbourhood to my office at the Toronto General Hospital (TGH) in the heart of the city, where I’ve worked since 1991.7 a.m. – I do many things and wear many hats, so every day is different though they are all long, crazy and hectic. Clinically, I do lung cancers and other thoracic tumours, some of them hard cases that involve quite complex surgeries, which I usually do on Tuesdays.I see referred patients mostly from the Toronto area and Ontario, but there are some out-of-province cases as well.I also oversee streams of academic surgeries, and train Canadian and international residents and fellows from around the world. We get new ones every July. We currently have six lung transplant surgical fellows and four surgical residents, both senior and junior.Read: What does a psychiatrist do all day?We are by far the biggest lung transplant program in the world. We do more than 200 a year. That’s about 5% of the world total and double, even triple the number done by other top lung transplantation programs in the U.S. like the Cleveland Clinic and Massachusetts General Hospital.I figure I’m best known for lung transplants, which can happen any time, day and night. I also do a lot of teaching, research and fundraising, which means I go to a lot of dinners, meetings and conferences.In the last 30 years I’ve helped to bring in over $450 million to TGH—money that has helped to make and maintain our facility among the top three in the world.It’s amazing when I stop to think about where the road of life has taken me. I was born in Kenya and moved to Canada with my family when I was ten years old.We settled in Toronto, where I went to North Toronto Collegiate. After high school, I was offered a full scholarship at another Ontario university but I chose the University of Toronto to be at institution where leading academic things were happening on the world stage.I could have done almost anything. But I grew up knowing that I wanted to be a surgeon. I really don’t know why.I did electives in other things but nothing else fit as well for me as surgery. And when I discovered thoracic surgery, well, that was it. I remember driving to class in my third year of med school in November 1983 when I heard on the radio that Dr. Joel Cooper had just performed the world’s first successful lung transplant at TGH.Before that, 44 patients had died within a few days or weeks following the procedure. But No. 45—an upbeat Toronto man named Tom Hall, who suffered from idiopathic pulmonary fibrosis, a fatal lung disease—survived the operation. The news inspired me to be a lung transplant thoracic surgeon.A few years later, when I was a junior resident, Dr. Cooper performed the world’s first successful double lung transplant at TGH.At that time TGH was home to the world’s biggest giants in thoracic surgery.In addition to Cooper, there was Alec Patterson, Bob Ginsberg and Griff Pearson.It dawned on me that I was at the epicentre of the thoracic surgery universe where real innovations in the field were taking place. I was there and training with these surgeons. It was all very inspiring.But an exodus of all these giants to the U.S. in the late 80s and early 90s changed everything.Noon. Most days I don’t stop for lunch. But if I go to a mid-day meeting I might grab a bite to eat.After doing fellowship training in thoracic surgery at U of T and another at Memorial Sloan-Kettering Cancer Center in New York City, I became a faculty member at U of T.I have received many offers to go elsewhere but I have always chosen to stay here in Toronto. I was named head of TGH Thoracic team in 1991—but I inherited a division of nobody’s, including myself.Together with Dr. Tom Waddell, who was a year behind me, we began to rebuild the team with a will and spirit of doing new things and bringing innovation.In those days lung transplant donors and recipients were literally in adjoining operating rooms and the procedure was carried out almost immediately. In lung transplant, we and others at the time began using the kidney preservation technique to preserve lungs. We realized however that this caused significant lung injury. Lung injury in fact was and remains a major problem in lung transplants. The problem stems from the fact that all organs are anerobic and when taken out of the body have no oxygen supply. We realized that with lungs this did not need to be the case.Lungs can be inflated, keeping oxygen available for cells to live. One of the first of the many hundreds of research papers I’ve written over the years showed that we could achieve 12 hours of lung preservation with a new solution we invented for lungs called LPD—low potassium dextran.LPD improved lung and airway preservation and ultimately improved the safety and reliability of lung transplantation.It has become the world standard for lung transplantation.It was a big deal. I still consider it my greatest contribution to the field.Now we are gene editing and engineering donor lungs to make them better. I think that in my lifetime we will get to the point where people will say, “Imagine that organs used to be taken out of one person and put right into another.”We also developed a technique known as the Toronto Ex Vivo Lung Perfusion System (EVLP).It involves placing donor lungs outside the body at normal body temperature—or 37 degrees Celsius—with one tube attached to the pulmonary artery and another to the veins to drain fluid out of the lungs. As lungs are brought up to body temperature in the Toronto EVLP system, lungs are healed with therapies that we also developed.As the lungs begin to inflate and deflate on their own tests are carried out over several hours using X-rays and bronchoscopies.We monitor and evaluate blood gases and fluid flow to ensure the lungs are functioning properly and are ready for safe transplantation.The results have been truly outstanding.When I was a resident, lung transplant recipients had a 50-50 chance of surviving the operation. Today our operative survival rate is 98.5%!Similarly, 30 years ago the average lung transplant recipient faced a lot of life-threatening challenges. But today 50% of them live seven or eight years. A decade ago we celebrated our 1,500th transplant here with a big gala that had 22 lung transplant recipients who had lived more than 20 years post-surgery in attendance. It was very special because, as their treating physician, you get to know these people very well.Our success in helping people has also helped our lab to grow exponentially. When I started here as senior scientist and director (of the Latner Thoracic Laboratories at the TGH Research Institute—or UHN) there were only three of us.Today we’re 150 researchers in the lab. Our clinical program has nine world-class thoracic surgeons and ten respirologists. We’re all friends and we help each other, each of us working in our areas of expertise.That culture has led to a highly productive unit. Before he died in 2016, Pearson marvelled at our thoughts and work and how we had rebuilt TGH beyond what he could have imagined.The focus of our research now is the study of support systems, molecular diagnosis and gene therapy to repair organs and to engineer better organs for transplant.Our goal is to build a lung that will last forever.Most lung transplant recipients continue to ultimately die of lung failure because their bodies never stop working to reject the donated organ.We’re confronting that challenge now. Gene therapy holds a lot of promise. In 2024 we achieved CRISPR gene editing of the human lung. The hope is that we can develop proteins that are not only beneficial to the lungs but that circulate thoroughly the body.That’s our holy grail now: to make a lung that will last forever.9 p.m. I almost always get home late. Sometimes I’ll eat something during the day, especially if I’m at a function like a fundraising dinner or meeting.Fortunately my wife, Dr. Donna McRitchie, and our daughter, Dr. Sara Keshavjee, appreciate and understand the need and reasons for my all-in commitment to my work.Donna and I met at U of T when we were both surgical residents (though we like to joke that she ignored me all through medical school!). She did a fellowship in trauma at ShockTrauma at the University of Maryland and another in critical care at Harvard (where I also studied tracheal surgery) before returning to Toronto as a general surgeon, trauma surgeon and intensivist at St. Michael’s Hospital.From 2000 until her retirement last summer she worked at North York General Hospital as medical director of critical care, division chief of general surgery and ultimately vice president of the hospital.On weekends my wife and I like to get away to our cottage in Queenston on the Niagara River. We have a boat and other stuff that allow us to have fun and enjoy ourselves any time of year. It’s an incredibly beautiful and serene part of the world.And it’s just an hour’s drive from downtown Toronto. That’s close enough for me to come in and do a lung transplant. Midnight: I usually don’t sleep before midnight. I like to work on emails or manuscripts at night. I’m more of a night owl. I’m always thinking about my work, which has always been very exciting for me. I think it’s important to really enjoy what you do.I’m still going full tilt. I love my work and research. The possibilities of CRISPR and gene editing of donor lungs are really blowing things out of the water and stretching my goals and dreams.As told to Medical Post correspondent Mark Cardwell. info@markcardwell.ca.

What does a lung transplant thoracic surgeon do all day?

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