Beyond the Fellowship: Rebuilding the Pathway to Transplant Leadership

Training in abdominal organ transplantation has historically lacked standardization and alignment with contemporary surgical education paradigms. The current fellowship-based model in the United States provides variable exposure, inconsistent academic structure, and limited integration with related fields such as hepatopancreatobiliary (HPB) surgery and surgical oncology. Drawing lessons from integrated cardiothoracic and vascular surgery pathways, a restructured, competency-based model emphasizing early specialty exposure, academic development, and alignment with national certification frameworks could enhance the quality and coherence of transplant training. Integrated training has been shown to improve recruitment, research productivity, and trainee satisfaction in other disciplines, and similar principles could strengthen transplantation. Moreover, the growing convergence between HPB surgery, oncology, and transplantation highlights the emergence of transplant oncology as a new subspecialty. This evolving field integrates oncologic and advanced HPB surgical principles with core transplant expertise, warranting formal recognition through a dedicated three-year fellowship that includes focused experience in living donor liver transplantation and complex cancer surgery. Reforming transplant education through such models is essential to ensure the sustainability, academic vitality, and multidisciplinary evolution of the field and to reaffirm transplantation's central role in advancing academic surgery.