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Organ Procurement Surgeons: A Viable Surgical Specialty?

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Roger Evans, PhD
The United Network for the Recruitment of Transplantation Professionals
Rochester, MN, USA

Over the past year, I have received numerous inquiries related to the recruitment of what are being called "organ procurement surgeons." I have come across 10 to 12 position postings on various electronic job boards. With one exception, the postings have only referred to cardiothoracic organs.

Employer of Record: For the most part, the positions have been posted by hospitals and medical centers offering transplant services. In one instance, the position was posted by an organ procurement organization (OPO), in cooperation with a university medical center. Some of the other postings mention the local OPO, without elaboration.

Responsibilities and Duties: The responsibilities of the organ procurement surgeon are variable. Some positions are clearly organ procurement only. In other words, there are no patient care/transplant responsibilities. Thus, the procurement surgeon only has a relationship with deceased organ donors. However, there are variations. Some organ procurement surgeons may also function as a first surgical assistant, and might be expected to provide extracorporeal oxygen membrane oxygenation (ECMO). This, in turn, means the organ procurement surgeon has a relationship with deceased organ donors, as well as patients requiring clinical care.

Qualifications: It goes without saying, organ procurement surgeons must be medical doctors. However, it's noteworthy that some transplant centers and OPOs use physician assistants (PAs) for purposes of deceased donor organ procurement. Some PAs function independently of physicians and surgeons. Others assist physicians and surgeons in the procurement of deceased donor organs. This clearly raises several questions regarding the credentials of advanced practice providers. I will not address them here.

Licensure and Board Certification: Licensure and board certification are critical considerations for organ procurement surgeons. Requirements potentially differ by state, but certainly by scope of clinical practice. In this regard, I have created a simple table to emphasize what may be necessary.

As shown in the table, if a surgeon solely procures deceased donor organs, and has no patient care responsibilities, only a medical license may be required. Alternatively, if the organ procurement surgeon also has patient care responsibilities, board certification will most likely be required.

Appointment Type: Based on the position descriptions, most organ procurement surgeon positions are temporary or intermittent, sometimes part-time, and relatively insecure. Surgeons may simply be called upon as needed. In other words, they're on-call without a schedule.

Appointments at academic health centers are usually at the "instructor" level, without tenure and faculty privileges. Group practice appointments are typically at the "associate" level, not the permanent staff level (sometimes referred to as the "consultant," or "voting staff" level). Consequently, organ procurement surgeons are expendable, and can be readily relieved of their duties. In many cases, organ procurement surgeons are appropriately described as, and essentially function as, "independent contractors." In fact, there are a few examples of organ procurement surgeons who are independent contractors, and are paid accordingly.

Compensation: As expected, compensation is on the low end. I have seen organ procurement surgeon positions posted with a salary figure of $150,000 annually. This is unrealistic. There are transplant professionals without medical degrees who are paid a much higher salary with generous benefits, and enviable job security. Meanwhile, junior cardiothoracic transplant/MCS surgeons typically make $500,000 or more annually.

Future of the Position: Based on the foregoing, the typical organ procurement surgeon position is unattractive for most individuals. Consequently, individuals who may be interested most likely fall into one of several categories, including the following: (1) They could be junior people who have not been offered a suitable permanent position. They, in turn, see organ procurement as a temporary employment opportunity until they can get a "real job." (2) They might be individuals who have international credentials and, thus, have been denied positions requiring board certification. However, despite this, they may be able to obtain a restricted or specialty medical license allowing them to procure deceased donor organs. (3) They may be surgeons with organ procurement-related research interests who see the procurement of deceased donor organs as a means to further their research.

Based on the foregoing, I'm skeptical of the long-term viability of surgeons whose sole responsibility is procurement. Alternatively, I think cardiothoracic surgeons should be recruited with the understanding that a disproportionate share of their clinical practice will be dedicated to organ procurement. In addition, depending on their skill set, they will be routinely involved in the care of patients with advanced cardiovascular and pulmonary disease. Furthermore, based on their skills, they will have an opportunity to perform general cardiothoracic surgery, transplant procedures, implant mechanical circulatory support systems, and participate in the initiation, maintenance, and discontinuation of ECMO/ECLS. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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