Breaking the scalpel ceiling: Gender inequality in global transplant surgery

BACKGROUND: Gender disparities across nearly all surgical specialties have become an issue of increasing attention, reflecting persistent inequities in representation, leadership, and career advancement. Despite growing numbers of female medical graduates worldwide, women continue to remain underrepresented in surgery, particularly in subspecialties such as transplantation surgery. AIM: To explore gender inequalities among transplant surgeons from the perspective of transplant unit directors and female surgeons worldwide. METHODS: This study consists of two arms: (1) An 8-item anonymous questionnaire was sent to transplant centers to assess the gender distribution of consultant surgeons' positions and academic roles among female and male surgeons; and (2) A 23-item anonymous questionnaire with closed and open questions was distributed to female transplant surgeons worldwide, addressing demographic profile, working experiences, and suggestions towards professional equality. The questionnaires were promoted through email, social media and professional platforms. RESULTS: Of 46 transplant units participated. Among the 381 board-certified surgeons reported to work in these transplant centers, 102 were women (27%). In the second arm, 75 female transplant surgeons responded. The respondents had a mean age of 43.7 ± 8.8 years (24-70), with most of them working in European transplant centers (65.3%) and self-identifying as White/Caucasian (76%).72% reported gender discrimination, 56% faced verbal sexual harassment from colleagues, and 26.6% from patients, 41.3% were dissatisfied with their work-life balance, with commonly reported challenges including balancing career and family, lack of institutional support and inclusion and sexual harassment. The majority of recommendations involved mentorship, equal opportunities for leadership positions, and flexible working hours. CONCLUSION: This is the first cross-sectional study addressing gender equity within the field of transplantation surgery worldwide, documenting gender disparities, professional conflicts, and concerning experiences of sexual harassment. This study provides preliminary evidence that underscores the need for further research and structural reforms to promote gender equity in transplantation surgery.