Interviewed by Katarina Zorcic, Shreya Sharma, and Amy Kwon
What interests you about the field of organ transplantation?
Dr. Sener: The first thing is the patients – we have a really unique group of patients that are so grateful and so wonderful to work with. End stage renal disease is such a devastating disease. Unfortunately, oftentimes our patients succumb to renal failure at one point, and eventually they end up on dialysis and need a transplant. It [a transplant] is such a definitive way to change the course of their disease and to help these patients. It’s very rewarding and it’s a really unique field where you can make such a big impact instantly.
When and how did you know that you wanted to be an organ transplant surgeon?
Dr. Sener: It was a long and surprising course. I initially wanted to be a cardiologist in medical school, and I had not placed much thought into going into the field of transplantation. In second year medical school at the University of Calgary, we had translational research blocks. One of the preceptors was a transplant surgeon and he really liked the fact that I had a research background – I completed a PhD before coming to medical school. He was the head of the transplant program there at that time.
We started talking about various projects, and the first project that I did in transplant was the comparison of AV fistulas versus grafts for use in hemodialysis in patients with end stage renal disease and their outcomes. I started to go to his clinics and see some of the surgeries. I saw what an immediate response these patients had after transplant. It was remarkable. It was [also] a bit scary. It was daunting because of how complicated the patients were, but I realized how much fun the surgery was and how there was so much research that still needed to be done in the area. Kidney transplantation has become my favorite operation. [Also, around that time] I stumbled upon urology as well. At the time, I didn’t know urology, in fact, even existed. I was really happy to see that a lot of urologists do kidney transplants and I also began to see what a great specialty urology was. So, combining the two career paths seemed to be the way to go for me.
The take home message really is that I think of life like water – always be open to let it take you down the path and it usually finds the right way for you. I think you can’t force certain things. Oftentimes life has a different way of showing you something, and you may, in fact, like it better than your original plan.
What does a typical day in your life look like?
Dr. Sener: I wear multiple hats: I’m the chair of our division, so there’s a lot of administrative work to be done there, and I have a full-time translational research lab. Oftentimes there’ll be meetings first thing in the morning, followed by an all day clinic. During clinic, oftentimes we’re on the phone answering messages and emails. If you’re on call, you’re also getting pages during the day. Clinics are usually nice because you get to see patients and spend time teaching medical students, residents and fellows. Then, [there’s] paperwork and lab work in the evenings. If you’re on call, you’re doing transplants at night or if you’re on call for urology you may also be in the OR. Otherwise, I like to spend time with my family. It is hard, but trying to maintain that balance is key.
A typical day is tough, but a typical week is probably easier. I have clinic one day a week along with some virtual clinics. Then, we’ll have, a living donor transplant day, usually on Wednesdays, which is really nice. If you’re on call for transplant all week, it’s very unpredictable. Sometimes you’re transplanting all the time, and sometimes like nothing happens. Then, we have lab meetings during the week, and oftentimes I have grad students and postdocs who are sending papers [they’re writing] back and forth.
What are the most rewarding / challenging parts of your job?
Dr. Sener: Seeing that kidney pink up and make urine after the vascular clamps come off – I love that. It’s quite amazing, and really does not get old. Seeing patients do well is the best part of the job. . Obviously, the teaching aspect of surgery is also extremely rewarding as well. We get to work with fantastic fellows from all over the world. They are coming to us for a very specific learning opportunity. It’s really nice because we learn from them as well. There are so many ways to do a particular operation, which they may have learned in a different way; so in reality the learning goes both ways, which is always fun. Then, we have medical students and residents come through and I love seeing their faces when we’re doing surgery because it’s a very cool experience, especially for the people who’ve never seen transplantation before. I also love the research aspect of what I do as there are so many research ideas and pathways yet to be discovered. Working with patients allows us to take research problems from the bedside to the bench, come up with novel strategies to improve upon what we do, and then eventually translate that work back to patient care.
Although I love doing all these things associated with transplant, the business of transplantation can be quite challenging. Many transplants occur over night and then oftentimes there are clinics and potentially other operations that may happen the next day. In addition, family time is extremely important and since transplantation can be very unpredictable, maintaining a balanced family life can be very challenging. The positive thing is that the system is slowly changing, as the stereotypical phenotype of the constantly working surgeon is starting to be shaped into a model that takes into account a work life balance. I think this is great, and will ensure that we continue to attract the top surgical candidates into transplantation. The ultimate goal is to create a system where we train very competent people but we allow them to have time on their own, time with their family, time to do research, time to do things that they’re interested in; and not always on nights and weekends. This would absolutely translate to optimal patient care as well.
In terms of urology and kidney transplant research, have you seen any significant trends or progress in recent years that have been beneficial and that you’d like to see explored further in the future?
Dr. Sener: Urology is a fantastic specialty as it straddles medical and surgical topics simultaneously. Many of our patients are long-term – we see a lot of benign and more chronic diseases as well as cancers, which gives a massive breadth to one’s practice. Not to mention that there are numerous new advancements in technologies like robotics, minimally invasive surgeries, endoscopic surgeries, including new instruments and lasers. It is a very exciting time for urology and urologists right now. In the field of transplantation, there are several exciting new developments. One area that is gaining a lot of traction in the field of transplantation is the modification of organ preservation solutions as well as the optimization of organ perfusion temperatures. Our laboratory is working on both of those projects and has made some excellent headway, including translation into human trials. Another exciting area is the development of new immunosuppressive medications are coming around, which will lead to better graft function and improved patient outcomes. Even if these new strategies could have a 10% improvement in the long term functioning of transplanted kidneys, it could mean that tens of thousands of additional people around the world could have access to the much needed kidneys.