Transplant surgeon / recovery surgeon

A transplant surgeon is a physician who performs the surgical transplantation of organs, and a recovery surgeon (also called a procurement surgeon) is a physician who performs the surgical recovery of organs from a deceased donor.[1][2] The two roles are often filled by the same fellowship-trained specialists and the same training pathway, but they act at different stages of the donation pathway: the recovery surgeon operates on the donor to retrieve organs, while the transplant (implant) surgeon operates on the recipient to implant them.[2][3] In the United States, transplant surgery is a fellowship-trained subspecialty rather than a primary specialty board; abdominal-transplant fellowships are accredited and certified by the American Society of Transplant Surgeons (ASTS) through its Transplant Accreditation and Certification Council.[1][4]

The transplant (implant) surgeon

The transplant surgeon, based at a transplant center, performs the operation that places a donated organ into a recipient and manages the recipient's surgical candidacy and perioperative care.[3] In abdominal transplantation this includes kidney, liver, pancreas, and intestinal/multivisceral transplants; in thoracic transplantation it includes heart and lung transplants, performed by cardiothoracic-trained surgeons.[3][5] Beyond the operation itself, the surgeon participates in candidate selection, evaluates surgical risk, accepts or declines organ offers on technical grounds, and follows recipients for surgical complications.[3] Organ-specific surgical detail is described in the organ articles, including Kidney transplantation and Liver transplantation.

The recovery (procurement) surgeon

The recovery or procurement surgeon performs deceased-donor organ recovery, frequently under contract with or on behalf of an organ procurement organization.[2][6] In a multiorgan recovery, several organ-specific teams may operate in sequence or in parallel under the coordination of a lead surgeon familiar with the recovery of all the solid organs.[2] The recovery surgeon assesses the organs in situ, conducts the aortic cross-clamp and cold-preservation flush, and provides intraoperative leadership in the donor operating room, modeling professional conduct, coordinating the teams present, and communicating any findings that affect organ suitability promptly to the recipients' transplant teams.[2][6] ASTS has published procedural standards for deceased-donor organ recovery that describe these expectations.[2] Recovery technique differs between donation after brain death and donation after circulatory death, as described in Deceased donation.

Training and certification pathway

The pathway to transplant surgery in the United States proceeds from medical school (MD or DO) through a general-surgery residency that satisfies the requirements for certification by a recognized American surgical board, and then a transplant-surgery fellowship.[1][4][7] Certification in general surgery is provided by the American Board of Surgery; "transplant surgeon" itself is a fellowship-trained subspecialty and is not a separate primary board of the American Board of Medical Specialties.[4][7]

For abdominal transplantation, ASTS accredits fellowship programs and sets training requirements through its Transplant Accreditation and Certification Council.[1][4] ASTS requirements specify that an accredited abdominal-transplant fellowship be no less than 24 months in length, including a minimum of 18 months of clinical training, with the remaining time available for clinical or research work; entry requires satisfactory completion of a surgical residency that meets the educational requirements for board certification.[1] To receive the Council's certificate of completion, fellows must complete the program's requirements (including a logged operative experience) and achieve a satisfactory score on a knowledge assessment.[1][4] Thoracic (heart and lung) transplant surgeons train through cardiothoracic-surgery pathways and corresponding board certification.[5]

Relationship to other roles

The surgeon's work is supported by, and distinct from, the coordinating and clinical roles around it.[8] On the donor side, the organ procurement coordinator manages donor evaluation, placement, and the logistics of the recovery operation; on the recipient side, the clinical, pre- and post-transplant coordinator manages evaluation, listing, and lifelong follow-up.[8] The surgeon's intraoperative role sits at the recovery and transplantation stages of the broader workforce, summarized in Workforce and roles in donation and transplantation.

See also

• Organ procurement organization (OPO)
• Organ procurement coordinator
• Clinical, pre- and post-transplant coordinator
• The donation pathway
• Deceased donation

References

• American Society of Transplant Surgeons (ASTS). Abdominal Transplant Surgery Fellowship Training and Requirements (ASTS Fellow Requirements). https://www.asts.org/docs/default-source/fellowship-training/asts-fellow-requirements.pdf
• American Society of Transplant Surgeons (ASTS). Procedural Standards for Deceased Donor Organ Recovery (approved Jan. 2022). https://www.asts.org/docs/default-source/public-comments/procedural-standards-for-deceased-donor-organ-recovery---approved-jan.-2022.pdf
• OPTN. The basic path of donation. https://optn.transplant.hrsa.gov/learn/about-donation/the-basic-path-of-donation
• American Society of Transplant Surgeons (ASTS). Fellowship Resources and Requirements; Fellowship Certification Pathway. https://www.asts.org/transplant-accreditation-certification-council/fellowship-resources-and-requirements
• Surgical Techniques of Multiorgan Procurement from a Deceased Donor. IntechOpen. https://www.intechopen.com/chapters/73562
• The Alliance / Organ Donation Alliance. Procurement Surgeon (role description). https://www.organdonationalliance.org/job/procurement-surgeon/
• American Board of Surgery. https://www.absurgery.org/
• American Board for Transplant Certification (ABTC). Certification. https://abtc.net/candidates/certification