In our recent commentary in the journal Transplantation, “Transplant Surgery: Sustaining a Workforce at a Critical Juncture,” we address an urgent reality: while abdominal transplantation remains one of medicine’s greatest successes, the specialty itself faces growing workforce instability. Declining trainee interest, unpredictable 24-hour call structures, misaligned productivity metrics, and promotion pathways that fail to reflect the true scope of transplant work all threaten long-term sustainability. We outline three structural priorities: • Redesign clinical operations to improve predictability — including greater use of machine perfusion to enable more daytime scheduling. 
• Modernize fellowship training and strengthen early-career support. 
• Realign academic promotion metrics to recognize clinical complexity, applied innovation, and systems leadership. This is not simply about surgeon wellbeing. A stable transplant workforce is fundamental to organ utilization, equity, and public trust. Sustaining transplant surgery requires structural reform — now. What is your opinion on that?