*Purpose: We utilized a modified Delphi technique to develop recommendations to guide service responsibilities for liver transplant anesthesia teams (LTATs).

*Methods: The Society for the Advancement of Transplant Anesthesia (SATA) appointed a task force of transplant anesthesiologists to produce initial statements which they felt reflected best practices for LTATs. These statements were then refined by a multidisciplinary panel of experts from the field of liver transplantation using a modified Delphi process. The Delphi panelists were asked to rate agreement with and importance of each statement on a 5-point Likert scale in multiple rounds. Anonymized responses (scores and open-ended comments) were reviewed by the task force between rounds and statements were revised before being presented back to the panelists. Consensus was defined as ≥ 80% of panelists “agreeing” and/or “strongly agreeing” while ≤ 10% “disagreed” or “strongly disagreed.”

*Results: Three rounds were required to achieve consensus in all statements. Most statements (14/17) reached consensus in the first round. Two additional statements reached consensus in the second round. One statement required clarification from panelists to elucidate reasons for disagreement prior to reaching consensus after a third round. These final 17 statements were modified to produce 13 recommendations.

*Conclusions: Seventeen statements refined by a panel of experts in liver transplantation using the Delphi process were used as the basis for the development of SATA recommendations for LTATs.

The final recommendations are:

Institution:

– The host institution has advanced physiologic monitoring equipment (e.g. pulmonary artery catheterization, transesophageal echocardiography, and processed electroencephalographic (EEG) monitors).

– The host institution has immediate 24-hour access to expert consulting services to assist with perioperative decision-making.

– The host institution supports pre-procedure transplant anesthesiology services.

– The host institution provides case record data for each LTAT member upon request.

Director of Liver Transplant Anesthesia (DLTA):

– The DLTA is credentialed at the host institution.

– The DLTA satisfies all UNOS Bylaws Appendix F4 requirements.

– The DLTA attends > 50% of multidisciplinary selection committee/Quality Review (QR) meetings.

Liver Transplant Anesthesia Teams (LTATs):

– Each LTAT has written criteria for team membership defined by case volume and previous training.

– All LTAT members are credentialed at the host institution.

– All LTAT members participate in multidisciplinary selection committee/Quality Review meetings.

– Anesthesia risks and benefits are explained to patients by an LTAT member.

– Supervision of the in-room provider is performed by an LTAT member.

– The LTAT has a published schedule of anesthesia coverage for and a written procedure for 24-hour coverage.

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